Intervention for restricted dynamic range and reduced sound tolerance: Clinical trial using a Tinnitus Retraining Therapy protocol for hyperacusis

Abstract

Hyperacusis is the intolerance to sound levels that normally are judged acceptable to others. The presence of hyperacusis (diagnosed or undiagnosed) can be an important reason that some persons reject their hearing aids. Tinnitus Retraining Therapy (TRT), a treatment approach for debilitating tinnitus and hyperacusis, routinely gives rise to increased Loudness Discomfort Levels (LDLs) and improved sound tolerance. TRT involves both counseling and the daily exposure to soft sound from bilateral noise generator devices (NGs). We implemented a randomized, double-blind, placebo-controlled clinical trial to assess the efficacy of TRT as an intervention for reduced sound tolerance in hearing-aid eligible persons with hyperacusis and/or restricted dynamic ranges. Subjects were assigned to one of four treatment groups (2x2): Devices: NGs or placebo NGs and Counseling: Yes or No. They were evaluated at least monthly on a variety of audiometric tests, including LDLs, the Contour Test for Loudness for tones and speech, and word recognition measured at each session's comfortable and loud levels. Eighty percent of the participants who received full treatment benefited significantly; whereas the other treatment groups demonstrated ≤ 45% treatment efficacy. Treatment dynamics and examples of improved word recognition post-treatment will be described. Supported by NIH R01 DC04678.