Improvement in Hyperacusis with Tinnitus Retraining Therapy

Abstract

Objective: Decreased sound tolerance and hyperacusis are frequently found in patients who complain of tinnitus. This study aims to investigate the efficacy of Tinnitus Retraining Therapy (TRT) in patients with hyperacusis. Method: Prospective study of patients with hyperacusis presenting to the tinnitus clinic in a tertiary referral otorhinolaryngology unit. Hyperacusis was confirmed with loudness discomfort level (LDL) measurements. Audiometry was performed in all patients. Improvement of hyperacusis following TRT was measured by structured interview with aid of questionnaires and visual analogue scores. Results: A total of 197 patients were studied. Improvement was achieved in 39%. Environmental sound (70%), Viennatone broadband noise generator (18%) and Marsona sound generator (5%) were used. 18% had hearing aids (HA) fitted even though 73% had hearing loss. Patients who opted for HA complained of worse effects of hyperacusis on life. Age, gender, and presence of hearing loss were similar in patients who did and did not improve. Duration of treatment was longer in patients that improved ( P < .01). Improvement with Viennatone was significantly higher than with environmental sounds alone (49% vs 35%, P < .05), especially when used in presence of hearing loss (61%). Conclusion: Modest proportion of patients with hyperacusis improved with TRT. Use of broadband noise generators and longer duration of therapy appear to give better success rates. Overall success of TRT in patients with hyperacusis may also be related to underlying medical problems such as thyroid conditions and multiple sclerosis.