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Background: Hyperacusis can be defined as an intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. It is important to assess symptoms of sound intolerance and their impact on the patient's life, so as to evaluate the need for treatment and to assess the effectiveness of treatments., Purpose: The aim was to evaluate the psychometric properties of the Hyperacusis Impact Questionnaire (HIQ), and the Sound Sensitivity Symptoms Questionnaire (SSSQ). The 8-item HIQ focuses on assessing the impact of hyperacusis on the patient, while the 5-item SSSQ is designed to assess the type and severity of sound intolerance symptoms., Research Design: This was a retrospective cross-sectional study., Study Sample: In total, 266 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Clinic in the United Kingdom within a 6-month period. Fifty-five percent were female. The average age was 54 years (standard deviation = 16 years)., Data Collection and Analysis: Data were collected retrospectively from the records of patients held at the audiology department. Audiological measures were pure-tone audiometry and Uncomfortable Loudness Levels (ULLs). Questionnaires administered in addition to the HIQ and SSSQ were: Tinnitus Handicap Inventory, Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus., Results: Exploratory factor analysis suggested one-factor solutions for both the HIQ and SSSQ. Multiple-causes multiple-indicators (MIMIC) models showed some small influences of gender but negligible effects of age for both the HIQ and SSSQ. Receiver Operating Characteristic (ROC) analysis showed no significant effects of covariates on the ROC curves. Cronbach's α was 0.93 for the HIQ, and 0.87 for the SSSQ, indicating high internal consistency. Convergent validity was supported by moderate correlations between HQ and HIQ scores and between SSSQ scores and ULLs., Conclusion: The HIQ and SSSQ are internally consistent questionnaires that can be used in clinical and research settings., Competing Interests: None declared., (American Academy of Audiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Purpose: The purpose was to assess the proportion of patients seeking help for tinnitus and/or hyperacusis who have severe hyperacusis and to examine factors associated with severe hyperacusis., Research Design: This was a retrospective cross-sectional study based on 362 consecutive patients who attended a National Health Service audiology clinic for tinnitus and/or hyperacusis rehabilitation and for whom uncomfortable loudness levels (ULLs) had been measured. The criterion for severe hyperacusis was taken as a ULL of 30 dB HL or less for at least one of the measured frequencies for at least one ear., Results: Thirteen patients had severe hyperacusis, and eight of those had normal hearing. The lowest average ULL across frequencies was 28 dB HL. The difference in average ULLs between ears was 5 dB or less for nine patients. The range of ULLs across frequencies was between 5 and 60 dB, ULLs often being lowest at 8 kHz. Eleven patients had tinnitus, eight had otological abnormalities, twelve had mental health problems, and six were taking antidepressants., Conclusions: Severe hyperacusis is characterized by low ULLs for specific frequencies and no or mild hearing loss. Given the high incidence of tinnitus, otological abnormalities, and mental health problems, the management of patients with severe hyperacusis should involve otologists and psychiatrists in addition to audiologists., (American Academy of Audiology.)

Background: There are not many population-based epidemiological studies on the association between self-reported hearing problems and measured hearing thresholds in older adults. Previous studies have shown that the relationship between self-reported hearing difficulties and measured hearing thresholds is unclear and, according to our knowledge, there are no previous population-based studies reporting hearing thresholds among subjects with hyperacusis., Purpose: The aim was to investigate the prevalence of self-reported hearing problems, that is, hearing difficulties, difficulties in following a conversation in noise, tinnitus, and hyperacusis, and to compare the results with measured hearing thresholds in older adults., Research Design: Cross-sectional, population-based, and unscreened., Study Sample: Random sample of subjects (n=850) aged 54-66 yr living in the city of Oulu (Finland) and the surrounding areas., Data Collection and Analysis: Otological examination, pure tone audiometry, questionnaire survey, Results: The prevalence of self-reported hearing problems was 37.1% for hearing difficulties, 43.3% for difficulties in following a conversation in noise, 29.2% for tinnitus, and 17.2% for hyperacusis. More than half of the subjects had no hearing impairment, or HI (BEHL[better ear hearing level]0.5-4 kHz<20 dB HL) even though they reported hearing problems. Subjects with self-reported hearing problems, including tinnitus and hyperacusis, had significantly poorer hearing thresholds than those who did not report hearing problems. Self-reported hearing difficulties predicted hearing impairment in the pure-tone average at 4, 6, and 8 kHz, and at the single frequency of 4 kHz., Conclusions: The results indicate that self-reported hearing difficulties are more frequent than hearing impairment defined by audiometric measurement. Furthermore, self-reported hearing difficulties seem to predict hearing impairment at high frequencies (4-8 kHz) rather than at the frequencies of 0.5-4 kHz, which are commonly used to define the degree of hearing impairment in medical and legal issues., (American Academy of Audiology.)

Background: Self-efficacy refers to the beliefs (i.e., confidence) individuals have in their capabilities to perform skills needed to accomplish a specific goal or behavior. Research in the treatment of various health conditions such as chronic pain, balance disorders, and diabetes shows that self-efficacy beliefs play an important role in treatment outcomes and management of the condition. This article focuses on the application of self-efficacy to the management of tinnitus. The first step in formally incorporating self-efficacy in existing treatment regimens or developing a self-efficacy approach for tinnitus treatment is to have a valid and reliable measure available to assess the level of tinnitus self-efficacy., Purpose: The objective of this study was to develop the Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) and to obtain the psychometric properties of the questionnaire in a group of patients with tinnitus., Research Design: Observational study., Study Sample: A total of 199 patients who were enrolled in the Tinnitus Clinic at the James H. Quillen Veterans Affairs Medical Center participated in the current study., Data Collection and Analysis: The SETMQ was mailed to patients enrolled in the Tinnitus Clinic. The participants who completed one copy of the SETMQ were mailed a second copy to complete approximately 2 weeks later. An exploratory factor analysis was conducted to identify the most coherent subscale structure of the SETMQ. The internal consistency and test-retest reliability for each of the subscales and the questionnaire as a whole were assessed. The validity of the SETMQ also was evaluated by investigating the relations between the SETMQ and other clinical measures related to tinnitus., Results: Five components emerged from the factor analysis that explained 75.8% of the variance related to the following areas: (1) routine tinnitus management, (2) emotional response to tinnitus, (3) internal thoughts and interaction with others, (4) tinnitus concepts, and (5) use of assistive devices. Four items failed to load on any factor and were discarded, resulting in 40 items on the final SETMQ. The internal consistency reliability of the overall questionnaire and for each subscale was good (Chronbach's α ranged from .74 to .98). Item-total correlations ranged from .47 to .86, indicating that each item on the SETMQ correlated at a moderate or marked level with the SETMQ aggregate score. Intraclass correlation coefficients were computed to determine the test-retest reliability of the SETMQ total scale and separately for each subscale, which were all above .80, indicating good test-retest reliability. Correlations among the SETMQ subscales and various tinnitus-related measures (e.g., Tinnitus Handicap Inventory, tinnitus loudness rating, tinnitus distress rating, etc.) were significant, albeit indicative of fair to good relations overall (range r = -.18 to -.53)., Conclusions: The results of the current study suggest that the SETMQ is a valid and reliable measure that may be an insightful instrument for clinicians and investigators who are interested in assessing tinnitus self-efficacy. Incorporating self-efficacy principles into tinnitus management would provide clinicians with another formalized treatment option. A self-efficacy approach to treating tinnitus may result in better outcomes compared with approaches not focusing on self-efficacy principles., (American Academy of Audiology.)

The purpose of this series of experiments was to establish normative reference values for absolute and relative judgements of loudness discomfort and for the auditory dynamic range (DR), and to evaluate intersubject variability and intra-subject test-retest reliability for the respective measures of loudness discomfort. To establish the normal auditory DR, audiometric thresholds and loudness discomfort levels (LDLs) were measured from a group of 59 normal-hearing adults without sound tolerance problems. The resulting estimates of the LDL and DR were on the order of 100 dB HL and 95 dB, respectively. A subset (n = 18) of this larger group participated in further studies in which loudness growth functions and the upper limit of the auditory DR were measured by categorical scaling judgments. The findings revealed no significant differences between the test methods for absolute (LDL) and relative (categorical scaling) judgements of loudness discomfort, intersubject variability, or intrasubject test-retest reliability, and suggest that the simple LDL estimate of loudness discomfort is an efficient and valid clinical measure for characterizing the "threshold of discomfort."

Background: The pathogenesis of hearing loss caused by cerebellopontine angle tumors such as acoustic neuromas is unknown. The lack of loudness recruitment is thought to be one of the features of retrocochlear hearing impairment. In contrast to conventional suprathreshold tests, the categorial loudness scaling using the "Würzburger Hörfeld" is a valuable tool to describe the individual perception of sound. The aim of the present study was to analyze the loudness growth rate in patients with acoustic neuroma., Patients and Method: Pure tone and speech audiometry as well as auditory brainstem response and bilateral categorial loudness scaling were performed preoperatively in 54 patients with acoustic neuroma. Loudness scaling was done in free field switching off the contralateral ear by using an ear-plug., Results: An abnormal rapid loudness growth function was found in 38 of the 54 patients (70.4%) at least at one frequency on the tumor side. The contralateral side was effected only in 57.4% of the patients. The incidence of a recruitment depended on the frequency with a maximum at 4 kHz. The slope of the loudness function showed a tendency to increase with increasing hearing loss., Conclusions: Loudness recruitment is not a rare phenomenon in patients with acoustic neuroma. The underlying cause (a preexisting hair cell damage, hair cell changes resulting from an obstruction of the cochlear blood supply or a disruption of the cochlear efferents) still remains unclear.

A 52-year-old male was evaluated by the authors after initially reporting fullness in his left ear while traveling on an airplane. A unique feature of the patient's complaint was the development of severe bilateral hyperacusis (loudness discomfort levels of between 20-34 dB HL) in spite of the fact that the hearing loss was initially reported in the left ear. To achieve loudness comfort, the patient was initially fit with ER-25 musician earplugs that proved to be unsuccessful. The patient next purchased earplugs and earmuffs from a gun shop in order to obtain relief from the pain and discomfort caused by his exposure to everyday environmental sounds. This paper describes the use of hearing devices that proved to be effective in providing attenuation sufficient that the patient rarely needs to rely on earplugs and earmuffs for relief from his hyperacusis.

The aim of this paper is to provide information about the neurophysiologic model of tinnitus and Tinnitus Retraining Therapy (TRT). With this overview of the model and therapy, professionals may discern with this basic foundation of knowledge whether they wish to pursue learning and subsequently implement TRT in their practice. This paper provides an overview only and is insufficient for the implementation of TRT.

Background: Middle ear surgery sometimes leads to unpleasant auditory impressions such as distortion or hyperacusis that cannot be detected by conventional audiometric testing., Method: Sixty-one patients with conductive hearing loss caused by otosclerosis underwent audiological evaluation, which included a questionnaire followed by testing of the audiometric threshold, speech audiometry, and assessment and quantification of loudness perception with a commercial system (WESTRA). This investigation includes the postoperative measurement of hearing improvement and the patients' subjective impressions regarding hearing increase, distortion of speech, and hyperacusis., Results: Hearing improved in 88% of the patients. A quantification of this hearing increase was possible with pure tone audiometry and the Freiburg speech discrimination test. Reduced hearing threshold and lack of improvement in speech discrimination was confirmed by conventional hearing measurements. However, the presence of hyperacusis and distortion of speech could be determined by conventional audiometry in only 50% of cases. It was interesting to note that the subjects who reported speech distortion and hyperacusis in the questionnaire were identified by their increased loudness perception using the categorical loudness scaling., Conclusion: Category loudness scaling appears to be a valuable additional clinical test to characterize postoperative phenomena as distortion of speech and hyperacusis in patients undergoing stapes surgery.

This article reviews information on some auditory disorders that have in common a disturbance in loudness perception. The perceptual disturbances in these disorders have interchangeably been labeled "hyperacusis," "dysacusis," or "phonophobia." Our question concerns whether the loudness disturbances associated with these auditory disorders are sufficiently different as not to justify the equivalence implied by the labelling. Emphasis is placed on those articles that have given clear accounts of the phenomenology of the disturbed perceptual experience and have offered testable hypotheses about the mechanisms underlying it. Hypotheses about the origins of disturbed loudness perception are compared with independent experimental and clinical evidence on those mechanisms. The disturbances of loudness perception that occur in cochlear hearing loss, facial nerve paralysis and stapedectomy, and in more "central" disorders are phenomenologically different, have different underlying mechanisms, and merit different labels that most of them do not currently receive.