Hi,
I'm sure that Is a sickening thing for you to hear. I know it makes me cringe.
I don't have any good guesses for you.
Does it only do it in gear driving forward? Or do you hear it in neutral when you rev it up?
And what about reverse?
I'm usually not a big fan of using muffs to run an outboard but I think, in this case, running it on muffs to try and narrow down where the noise is coming from might be the preferred method to troubleshoot this.
If you do use muffs you should probably remove the prop for safety if you are going to test it in gear.
Good luck.