Loudness Discomfort Level Research Articles

Audiological Characteristics of a Sample of Adults With Misophonia.

The aim of this study was to describe the audiological test results from a sample of 60 adults with self-reported misophonia. Audiological testing was completed prior to participant randomization in a controlled trial for misophonia treatment. Participants completed the Inventory of Hyperacusis Symptoms Survey (IHS), the Tinnitus and Hearing Survey (THS), the Misophonia Questionnaire (MQ), and behavioral and objective audiometric measures. Hearing thresholds were less than 25 dBHL for 97% of the participants. Loudness discomfort levels for tonal stimuli suggested hyperacusis in 25% of the sample. Total scores on the IHS indicated that 12% met the clinical cutoff for hyperacusis, and, on the THS, 27% experienced problems with tinnitus, 77% experienced problems with hearing, and 53% experienced problems with sound tolerance. On the MQ, 37% indicated mild levels of misophonia and 58% indicated moderate levels. For speech-in-noise testing, a mild signal-to-noise ratio loss was present for 15% of participants. Most of the participants had present distortion product otoacoustic emissions (DPOAEs). Audiological data on individuals with misophonia are lacking. In this article, we present results from audiological testing on 60 adults with self-reported misophonia. Most had normal peripheral hearing sensitivity based on pure-tone audiometry and DPOAE measures; some had difficulties with sound sensitivities and understanding speech-in-noise, self-report indicated problems with hyperacusis, tinnitus, and hearing difficulty.

Electrocochleography in Chronic Tinnitus: Correlations with Audiological Profiles and Psychological Distress

ObjectivesThis study aimed to explore the electrophysiological characteristics of patients with chronic tinnitus through electrocochleography (ECochG) findings and determine if these findings correlate with specific audiological patterns that could differentiate tinnitus patients from those without this condition. Materials and methodsA retrospective analysis of medical records from patients who visited a tinnitus clinic at a tertiary university hospital between March 2020 and December 2023 was conducted. Inclusion criteria were non-pulsatile subjective tinnitus lasting over three months, and ECochG performed at initial evaluation. Audiological assessments and ECochG results were analyzed, with the SP/AP ratio being a focal point. ResultsAmong 256 patients, an elevated SP/AP ratio was observed in 37.5 % of patients. No significant difference in ECochG outcomes was noted based on tinnitus laterality. Patients with an elevated SP/AP ratio reported more sleep disturbances, higher depression scores, attention problems, and aural fullness. These patients also exhibited lower loudness discomfort levels and low-frequency hearing losses. Significant correlations were found between elevated SP/AP ratios and DPOAE responses. ConclusionsThe findings highlight the SP/AP ratio in ECochG as a valuable biomarker for assessing clinical and psychological aspects of tinnitus, indicating its potential utility in tailoring treatment strategies. Elevated SP/AP ratios were associated with sleep disturbances, depression, attention problems, aural fullness, hyperacusis, and low-frequency hearing loss, suggesting a complex interplay between cochlear pathology and tinnitus perception. This study underscores the need for a nuanced understanding of ECochG results in the clinical evaluation of tinnitus, potentially guiding more personalized management approaches.

Results of a 6-Month Field Trial of a Transitional Intervention for Debilitating Hyperacusis.

We present results from a 6-month field trial of a transitional intervention for debilitating primary hyperacusis, including a combination of structured counseling; promotion of safe, comfortable, and healthy sound exposure; and therapeutic broadband sound from sound generators. This intervention is designed to overcome barriers to successful delivery of therapeutic sound as a tool to downregulate neural hyperactivity in the central auditory pathways (i.e., the maladaptive mechanism believed to account for primary hyperacusis) and, together with the counseling, reduce the associated negative emotional and physiological reactions to debilitating hyperacusis. Twelve adults with normal or near-normal audiometric thresholds, complaints consistent with their pretreatment loudness discomfort levels ≤ 75 dB HL at multiple frequencies, and hearing questionnaire scores ≥ 24 completed the sound therapy-based intervention. The low-level broadband therapeutic sound was delivered by ear-level devices fitted bilaterally with either occluding earpieces and output-limiting loudness suppression (LS; to limit exposure to offensive sound levels) or open domes to maximize comfort and exposure to sound therapy. Thresholds for LS (primary outcome) were incrementally adjusted across six monthly visits based on treatment-driven change in loudness judgments for running speech in sound field. Secondary outcomes included categorical loudness judgments, speech understanding, and questionnaires to assess the hyperacusis problem, quality of life, and depression. An exit survey assessed satisfaction with and benefit from the intervention and the counseling, therapeutic sound, and LS components. The mean change in LS (34.8 dB) was highly significant (effect size = 2.045). Eleven of 12 participants achieved ≥ 16-dB change in LS, consistent with highly significant change in sound-based questionnaire scores. Exit surveys indicated satisfaction with and benefit from the intervention. The transitional intervention was successful in improving the hyperacusis conditions of 11 of 12 study participants while reducing their sound avoidance behaviors and reliance on sound protection.

Oval and round window reinforcement surgery leads to improvements in sound tolerance and quality of life for hyperacusis patients

PurposeHyperacusis is an audiological disorder in which patients become persistently sensitive and intolerant to everyday environmental sounds. For those patients that fail conservative options, a minimally invasive surgical procedure has been developed. Materials & methodsRetrospective case series of 73 adult patients with hyperacusis who underwent oval and round window reinforcement surgery between 1/2017–6/2023. Small pieces of temporalis fascia were used to reinforce the round and oval windows. Patients were separated into two groups based on their preoperative speech Loudness Discomfort Level (LDL). Patients with a preoperative speech LDL ≤ 70 dB were placed in the “low LDL group” whereas patients with a preoperative speech LDL >70 dB were placed in the “high LDL group.” Preoperative and one-week postoperative audiogram and speech LDLs were compared. Quality of life was assessed using the Glasgow Benefit Inventory (GBI) survey. Results73 patients met inclusion criteria - 21 patients in the low LDL group and 52 in the high LDL group. Patients in the high LDL group significantly improved their LDLs by an average of 3.5 dB (P < 0.0001). 42 patients (80.8 %) in the high LDL group had improvement and would recommend the surgery for hyperacusis. Patients in the low LDL group significantly improved their LDL by an average of 12.9 dB (P = 0.032). Ten patients (47.6 %) from the low LDL group experienced improvement and would recommend hyperacusis surgery. ConclusionMany patients with hyperacusis who undergo oval and round window reinforcement can receive significant improvement in sound tolerance and quality of life. Patients with a pre-op speech LDL > 70 dB have the greatest potential for improvement with surgery (80.8 %), probably because their hyperacusis was less severe. In the high LDL group(>70dB) the improvement in 1-10 scale went from 8.6 pre-op to 2.4 post op. In the low LDL group(<70dB) went from 9.2 pre-op to 6.8 post-op. These findings were consistent with the GBI results.

Analysis of Loudness Discomfort Level Tests in Tinnitus Patients

Introduction: We aimed to investigate the clinical significance of the loudness discomfort level (LDL) test in tinnitus patients and its relationship with pure-tone audiometry, tinnitogram, and questionnaires. Methods: We retrospectively reviewed the medical records of 320 tinnitus patients who visited a tertiary university hospital’s tinnitus clinic and completed LDL tests between March 2020 and December 2022. Epidemiological data and psychoacoustic test results were collected. Results: The LDL showed no significant differences between frequencies for both ears. The mean LDL did not correlate with mean pure-tone average or hearing thresholds at each frequency. The hearing loss group had a higher LDL at 8 kHz compared to the normal hearing group (p < 0.01). Objective sound intolerance was found in a quarter, correlating with subjective hyperacusis, anxiety, and depression. Weak negative correlations were found between most of questionnaire’s scores and LDL on the left side. Tinnitus loudness weak negatively correlated with LDL at most frequencies, except 8 kHz. Discussion/Conclusion: Our findings suggest a notable association between LDL levels and emotional factors in tinnitus patients, rather than with auditory thresholds. While lateralized differences in LDL responses were observed, specifically on the left side, these preliminary results do not confirm a causal link and thus do not warrant changes to current clinical testing protocols without further research.

Exploring the origins of decreased sound tolerance in tinnitus patients.

This study aimed to confirm the characteristics of auditory function alterations in tinnitus patients with concomitant decreased sound tolerance (ST) and provide insights for developing tailored therapeutic approaches. A retrospective analysis was conducted on patient records from a tertiary university hospital's tinnitus clinic between March 2020 and June 2023. Demographic attributes and audiological profiles were reviewed. Patients were categorized into Group 1 if loudness discomfort level test outcomes were 77 dB or below, measured using an average of frequencies from 250 Hz to 8 kHz. The remaining patients were allocated to Group 2. Among the 434 tinnitus patients, 115 (26.5%) demonstrated decreased ST and were classified as Group 1. This group exhibited higher DPOAE amplitudes (p < 0.001), shortened latency, and decreased threshold of ABR wave V bilaterally (p < 0.05). No significant disparities were observed in gender, age, tinnitus handicap inventory, visual analog scale, and pure-tone audiometry results except subjective hyperacusis. Binary logistic regression analysis utilizing the forward conditional method revealed that the difference between groups was independently linked to DPOAE response at 7,277 Hz on the left side [B = 0.093, p < 0.001, EXP(B) = 1.07, 95% CI = 1.044-1.153]. Increased DPOAE amplitude and shorter and decreased ABR wave V in tinnitus patients with decreased ST might suggest a possible association with lesions in or around the superior olivary complex or higher central auditory pathway, potentially linked to the inhibition of medial olivocochlear efferents.

Initial Response to Combination Therapies for Tinnitus: Lessons Learned From a Retrospective Analysis.

To investigate the initial reduction of tinnitus effects by combining common therapies applicable in general otology clinics and establishing optimal treatment strategies. Retrospective cohort study. A tertiary university hospital. Patients with nonpulsatile subjective tinnitus who visited the hospital between January and December 2022. Combination therapies consisting of at least one of the directive counseling based on the neurophysiological model, hearing aids, medication, and/or neuromodulation were performed. Tinnitus Handicap Inventory (THI) questionnaire at both their initial visit and 1-month follow-up. A total of 151 patients were enrolled. THI improvement of 20 points or more was observed in 31.8% of participants. One-way analysis of variance revealed that counseling had a significant reduction in THI, whereas neuromodulation, medication, and hearing aids did not. THI improvement was significantly associated with received counseling, severity of initial THI, and mean loudness discomfort level. Hearing aids and neuromodulation were not significant prognostic factors for improvement. Counseling alone is the best treatment for most patients with tinnitus. There will be other patients with tinnitus that, in addition to counseling, would benefit from hearing aids, medications, and/or certain forms of neuromodulation.

Comparison of Loudness Discomfort Level by the Testing Method in Adults With Normal Hearing and in Patients With Sensorineural Hearing Loss

Background and Objectives There are several variations in the technique for measuring loudness discomfort levels (LDL). The aim of this study was to evaluate LDL by measuring pure tone and narrow-band noise (NBN) in adults with normal hearing and in patients with sensorineural hearing loss, and to analyze the correlation of LDL at different frequencies.Subjects and Method Normal listeners (n=41) with the pure tone average of 12 dB HL and patients with hearing loss (n=42) with the pure tone average of 52 dB HL were studied from 2021 to 2022. Pure tone audiometry and LDL test by pure tone and NBN were performed twice in all participants at 250, 500, 1 k, 2 k, 3 k, 4 k, and 8 kHz.Results The LDL test showed some inter-subject variability with the mean being 107.0±9.4 dB, 106.0±11.6 dB by pure tone, and 100.1±6.8 dB, 100.4±6.7 dB by NBN (right and left ear, respectively) in the normal hearing group. There were no significant differences between LDL average by pure tone or NBN between two groups. Two serial tests showed high test-retest reliability. There was no difference in LDL between the two groups at each frequency, except for LDL by pure tone at 8 kHz in the left ear. High correlation of LDL was observed between different frequencies, except between 8 kHz and the other frequencies.Conclusion LDL by pure tone and NBN were consistent with or without hearing loss. High correlation of LDL between different frequencies were shown except at 8 kHz. It might be sufficient to measure LDL once by pure tone only, including 8 kHz.

Persian Version of the Hyperacusis Questionnaire: Psychometric Evaluation and Prevalence Determination.

Hyperacusis is an uncommon hearing disorder, known as increased sensitivity to daily surrounding sounds. This disorder can profoundly affect people's daily activities. The studies conducted about hyperacusis are very limited in Iran. The purposes of this study are the psychometric evaluation of the Persian version of the Hyperacusis Questionnaire (PHQ) and the investigation of its prevalence. This cross-sectional study was accomplished on 203 young university students with normal hearing sensitivity. After translating the questionnaire, the psychometric properties of the PHQ were evaluated by content validity ratio (CVR) and index (CVI) and exploratory factor analysis (EFA). Students were evaluated by clinical audiology tests, the loudness discomfort level (LDL) measurement, and answering the PHQ. The research data collection was done from April to November 2022. Otoscopy, clinical and speech audiometry, and LDL were all executed, respectively. The participants directly answered the PHQ. All statistical analyses were performed using SPSS software Version 26. The PHQ demonstrated acceptable validity and reliability, Cronbach's alpha (.81), CVI (> 0.88), and CVR (> 0.98). EFA revealed four dimensions of the questionnaire. Of the participants, four (2%) were identified as suffering from hyperacusis. The PHQ showed the possibility of differences between genders. The psychometric evaluations of the PHQ were found to be acceptable and can be used in future studies. The prevalence of hyperacusis in our sample was 2%, and estimated to be higher in females. These findings suggest the need for further research on hyperacusis in Iranian population and specified studies to compare the two genders.

Investigation of Frequency-Specific Loudness Discomfort Levels in Listeners With Migraine: A Case-Control Study.

Hypersensitivity to auditory stimuli is a commonly reported symptom in listeners with migraine, yet it remains relatively unexplored in research. This study aims to investigate loudness discomfort levels in listeners with migraine, while identifying the frequencies most affected by the phenomenon. To achieve this, the study compared just audible level and loudness discomfort level ranges between participants with and without migraine from the United Kingdom, Greece as well as the participant recruitment platform Prolific, across 13 frequencies from 100 to 12,000 Hz, through an online listening test. Fifty-five participants with migraine and 49 participants without migraine from both countries and Prolific were included in the analysis, where threshold ranges between just audible and mildly uncomfortable levels were compared in 13 frequencies. Migraineur group participants presented significantly smaller ranges between just audible and mildly uncomfortable level, due to lower thresholds of mild discomfort in 12 of the 13 frequencies when compared with the nonmigraineur group participants. Participants taking the test during their migraine attack or aura presented a tendency for smaller ranges. In addition, participants with self-reported higher severity migraine exhibited bigger ranges compared with participants with low severity migraine within the migraineur group. No relationship between ranges and medication or migraine attack frequency within the migraineur group was observed. Results from the study demonstrate a tendency for the migraineur group to present lower thresholds of mild discomfort compared with the nonmigraineur group, aligning with previous studies while extending the phenomenon to more frequencies than those previously examined. Though the present study presented no relationship between ranges and medication or attack frequency, further research is required to investigate a potential link between these factors.

Combined evaluation of audiology examination and self-reported symptoms in patients with hyperacusis

To investigate the application of combined audiological examination and a self-reported symptoms survey in the evaluation of hyperacusis. Patients who visited the outpatient department of Otolaryngology Head and Neck Surgery and Otological medicine, Affiliated Hospital of Southwest Medical University, from January 2019 to March 2021 were divided into a hyperacusis group and a normal control group. We measured the loudness discomfort level (LDL) and hearing threshold (HT) of the subjects and investigated their self-reported symptoms. We compared the demographic characteristics, loudness discomfort level, and hearing threshold of the two groups and analyzed the self-reported symptoms and audiological characteristics of hyperacusis. We considered 87 subjects, comprising 40 patients with hyperacusis and 47 healthy individuals. Among the hyperacusis patients, bilateral disease was predominant. Among them, 33 were females, 23 had hearing loss, and 20 had tinnitus. Patients are mainly in the 21–60 age group. Patients with hyperacusis had low discomfort thresholds at all frequencies except 500 Hz (P ≤ 0.05, mean LDL decreased by 6.14–1.37 dB HL for all frequencies). The incidences of feeling upset, pain, and anxiety or fear were 95%, 65%, and 82.5%, respectively, in patients with hyperacusis. The severity of symptoms varies between patients with hyperacusis and healthy individuals. A combination of LDL measurements and self-reported symptom surveys allows for an accurate and comprehensive assessment of hyperacusis.Trial registration: This study was retrospectively registered (TRN: ChiCTR2100047391) on June 13, 2021.

Audiological and psychological assessment of tinnitus patients with normal hearing.

This study was performed to assess identifiable abnormalities in tinnitus patients with normal hearing. The medical records of subjective non-pulsatile tinnitus patients with normal hearing confirmed by conventional pure-tone audiometry who visited our tinnitus clinic between March 2020 and May 2022 were reviewed. The loudness discomfort level (LDL), extended high-frequency hearing loss (EHFHL), summating potential (SP)/action potential (AP) ratio, distortion product otoacoustic emission (DPOAE), thresholds of auditory brainstem response (ABR) wave V, somatic modulation, and psychiatric symptoms, such as anxiety, depression, and stress were evaluated by questionnaires. Decreased LDL (n = 48, 59.8%) was the most frequent finding, followed by EHFHL (n = 29, 35.4%), increased SP/AP ratio (n = 27, 32.9%), psychiatric symptoms (n = 24, 29.3%), decreased DPOAE (n = 17, 20.7%), somatic modulation (n = 8, 9.8%), and increased ABR threshold (n = 3, 3.7%); 75.6% of patients had one or more of these findings. The presence of psychiatric symptoms was independently associated with the Tinnitus Handicap Inventory (THI) score. Tinnitus in patients with normal hearing may be accompanied by a combination of various subclinical abnormal audiological findings. However, the presence of psychiatric symptoms alone was independently associated with tinnitus distress.

Behavioural and Electrophysiological Evaluation of Loudness Growth in Clinically Normal Hearing Tinnitus Patients with and without Hyperacusis

Introduction: The common mechanism of tinnitus, hyperacusis, and loudness perception is hypothesized to be related to central gain. Although central gain increases with attempts to compensate hearing loss, reduced input can also be observed in those with clinically normal hearing. This study aimed to evaluate the loudness growth function of tinnitus patients with and without hyperacusis using behavioural and electrophysiological methods. Methods: The study consists of three groups with a total of 60 clinically normal hearing subjects, including the control group (10 men and 10 women; mean age 39.8, SD 11.8 years), tinnitus group (10 men and 10 women; mean age 40.9, SD 12.2 years), and hyperacusis group (also have tinnitus) (7 men and 13 women; mean age 38.7, SD 14.6 years). Loudness discomfort levels (LDLs), categorical loudness scaling (CLS), and cortical auditory evoked potentials were used for the evaluation of loudness growth. N1-P2 component amplitudes and latencies were measured. Results: LDL results of 500, 1,000, 2,000, 4,000, and 8,000 Hz showed a significant difference between the hyperacusis group and the other two groups (p < 0.001). In the loudness scale test performed with 500 Hz and 2,000 Hz narrow-band noise (NBN) stimulus, a significant difference was observed between the hyperacusis group and the other two groups in the “medium,” “loud,” and “very loud” categories (p < 0.001). In the cortical examination performed with 500 Hz and 2,000 Hz NBN stimulus at 40, 60, and 80 dB nHL intensities, no significant difference was observed between the groups in the N1, P2 latency, and N1-P2 peak-to-peak amplitude. Conclusion: Although the hyperacusis group is significantly different between groups in behavioural tests, the same cannot be said for electrophysiological tests. In our attempt to differentiate tinnitus and hyperacusis with electrophysiological tests over the loudness growth function, N1 and P2 responses were not seen as suitable methods. However, it appears to be beneficial to use CLS in addition to LDLs in behavioural tests.

What is Noise Sensitivity?

Noise sensitivity moderates the association between environmental noise exposure and annoyance and health outcomes. In normally hearing adults, we measured noise sensitivity in three ways: using the noise sensitivity questionnaire, a 3-point self-rating, and the loudness discomfort level (LDL; mean reported discomfort level for tone bursts). We then presented recordings of a 15-second 80 dBLAeq aeroplane overflight and participants rated the annoyance and loudness they experienced. The three measures of noise sensitivity were not well correlated with each other, and only the overall LDL was associated with the ratings of loudness and annoyance in response to the aeroplane sounds. This implies that our current measures of noise sensitivity may only capture parts of the underlying construct, and therefore underestimate effects due to it on the association between environmental noise and annoyance and health outcomes. We developed a theoretical model to describe the set of factors that may influence a person's sensitivity to noise and propose that interaction between the systems described is the basis for noise sensitivity. This paradigm alters the focus of noise research from the annoyance caused by the sound, to the sensitization to noise that may occur as a result of the interplay of many factors. We hope that our model will allow research to explore the sensitizing factors for noise more easily and systematically.

Audiologic Assessment.

Prior to the fitting of hearing aids, clinicians and patients must discuss the best treatment options for the physical and audiologic needs of the patients. To be able to confidently make these decisions, the clinician should complete a medical and audiological case history. Additionally, clinicians need accurate results from a comprehensive audiologic evaluation. The evaluation should include the following: pure-tone testing, word recognition testing, speech-in-noise testing, and loudness discomfort level measures. This article will outline the process and procedures for acquiring this information in line with the Audiology Practice Standards Organization (APSO) Guidelines for Adult Hearing Aid Fittings Standards 1 and 4. This article will also discuss how results can affect decision-making during the hearing aid selection and fitting process.

Psychiatric and audiologic features of misophonia: Use of a clinical control group with auditory over-responsivity

ObjectiveThis cross-sectional study was designed to add to the emerging empirical literature characterizing the psychiatric and audiologic features of misophonia. Because most research to date has not compared misophonia to clinical control groups, the present study used both participants who did not report any sound intolerance problems and a clinical control group of participants with auditory over-responsivity not formally meeting criteria for a diagnosis of misophonia using proposed diagnostic criteria by Schroeder et al. (2013). Severity of misophonia symptoms, frequency of current or lifetime psychiatric disorders, loudness discomfort, and hearing loss were compared across groups. MethodsStructured interviews, questionnaires, and objective measures of audiologic functioning were administered to a sample of adult participants (N = 156). Measures included an interviewer-rated diagnostic assessment of misophonia, the MisoQuest, (Siepsiak et al., 2020), M.I.N·I (Sheehan et al., 1998), loudness discomfort level (LDL), and hearing loss (PTA). ResultsGroup differences in misophonia symptom severity among all three groups were observed: FWelch (2,50.57) = 149.92, p < .001, n2 = 0.64, validating group assignment. Psychiatric disorders were significantly more frequent in the misophonia group (71%) than in the auditory over-responsivity group (40%) and control group (40%): X2 (2, N = 142) = 14.3; p = .001; V = 0.317. A wide range of psychiatric disorders were observed in the misophonia group, (e.g., major depressive episode, suicidality and panic disorder were the most common). There were no significant differences between groups with regards to audiologic functioning. ConclusionMisophonia co-occurs with a variety of psychiatric disorders but does not appear to be associated with loudness discomfort or hearing impairments.

Clinical Practice Patterns With Pediatric Loudness Perception Measures.

Obtaining a patient's loudness discomfort level (LDL) can assist the audiologist in defining their dynamic range so that the hearing device fitting can ensure that low-level sounds are audible, average-level sounds are comfortable, and more intense sounds are loud but not too loud. A 2016 survey showed that 67.5% of 350 pediatric audiologist reported to never or rarely measure LDLs with pediatric patients. The purpose of this study was to identify factors influencing this previously reported limited use of LDL measures. Sixty-two pediatric audiologists in the United States were surveyed using a questionnaire that sought to improve our understanding of the (non)use of loudness perception measures with pediatric patients and to assess familiarity with various loudness perception measurements. In addition, the questionnaire gathered information about the needs of pediatric audiologists in relation to LDL measures. Audiologist report being largely unfamiliar with methods of assessing loudness perception in children, with categorical loudness scaling being the method with which they are most familiar. In addition, audiologists reported being more willing and able to measure LDLs in older compared to younger pediatric patients. Limited use of pediatric loudness perception measures appears to be driven by a lack of familiarity with measurement methods and the belief that loudness perception measures may not be useful for clinical practice. Findings highlight audiologists' need for further information regarding the relevance of loudness perception measurements with pediatric patients and the need for easy-to-implement LDL measurement procedures for pediatric patients of all ages.

The Relation of Sound Level Tolerance to Tinnitus Ears in Human.

Background The aim of this study was to evaluate the relationship between sound level tolerance and tinnitus in humans.Methods: We compared the loudness discomfort levels at 500 and 3000 Hz pure tones in 33 subjects with bilateral tinnitus and 33 subjects with unilateral tinnitus with normal and symmetric hearing thresholds and those of age- and sex-matched control subjects.Results: Both the tinnitus ears (108.18 ± 10.22 dB HL and 103.03 ± 11.04 dB HL) and non-tinnitus ears (108.94 ± 12.61 dB HL and 104.24 ± 11.60 dB HL) in the unilateral tinnitus subjects showed significantly lower loudness discomfort levels at 500 and 3000 Hz than the control ears (115.91 ± 6.78 dB HL and 111.52 ± 8.88 dB HL, P < .008; α = 0.05/6 = 0.008), whereas there was no difference in the loudness discomfort levels of the tinnitus ears of the bilateral tinnitus subjects (111.52 ± 10.42 dB HL or 106.36 ± 11.34 dB HL) and the control ears.Conclusion: These results support the hypothesis that the reduced loudness discomfort levels in tinnitus subjects with normal and symmetric hearing thresholds are associated with a hidden injury to the cochlea that induces the development of tinnitus, especially on one side. Whether tinnitus is perceived unilaterally or bilaterally depends on the status of the auditory system, which may be reflected in the sound level tolerance and loudness discomfort levels.

Measurement of Loudness Discomfort Levels as a Test for Hyperacusis: Test-Retest Reliability and Its Clinical Value.

ObjectivesThe aims of this study were to investigate the test-retest reliability of measurements of loudness discomfort levels (LDLs), to suggest cut-off values for diagnosing patients with hyperacusis, and to evaluate the clinical value of-LDL measurements as a test for monitoring hyperacusis.MethodsFor the test-retest reliability of LDL measurements (study 1), a total of 68 patients who sought consultations at our clinic were subcategorized into four groups: patients with tinnitus (group 1), tinnitus and hearing loss (group 2), hyperacusis (group 3), and normal controls (group 4). Inter-hour and inter-day test-retest reliability values using different stimuli were investigated. For study 2, the clinical value of LDL measurements using pure tone stimuli was analyzed by comparing changes after sound generator use in patients with hyperacusis.ResultsIn study 1, the group 3 patients showed significantly lower LDLs than the other groups. High test-retest reliability of LDL tests was demonstrated, regardless of the type of stimulus used. The cut-off values for screening patients with hyperacusis were 90 dB HL using pure tone stimuli and 62 dB HL using white-band noise stimuli. In study 2, significantly increased LDLs were correlated with improved symptoms and improved scores on tinnitus questionnaires after sound generator use, indicating that LDL measurement is a reliable test for monitoring hyperacusis during an intervention.ConclusionLDL measurement is a reliable diagnostic tool to reflect the condition of hyperacusis, especially during the course of treatment.

Tinnitus Assessment and Management: A Survey of Practicing Audiologists in the United States and Canada.

Tinnitus is a prevalent auditory disorder that can become severely debilitating. Despite decades of investigation, there remains no conclusive cure for tinnitus. Clinical practice guidelines (CPGs) are available for assessing and managing tinnitus. Even though such guidelines have been available for several years, the degree that audiologists adhere to them has remained unexplored. To determine what clinical practices are commonly used by audiologists in the assessment and management of the patient population with tinnitus, we administered an online survey to audiologists practicing in the United States and Canada. Among the audiologists that completed the survey and were included in the final analysis (n = 61), 70% were from the United States and 30% were from Canada. The audiologists represented a wide range of clinical experience (1-35 years). On average, those who completed the survey were relatively confident in their ability to assess and manage tinnitus patients indicated by a 0 to 100 Likert scale, with 0 representing no confidence (mean 72.5, ± 21.5 standard deviation). The most commonly reported tinnitus assessment tools were pure tone audiogram (0.25-8 kHz), administration of standardized questionnaires, and tinnitus pitch and loudness matching. Approximately half (55%) of audiologists indicated they include otoacoustic emissions, while less audiologists (<40%) reported measuring high-frequency thresholds, minimum masking levels, or loudness discomfort levels. The most common recommendation for tinnitus patients was amplification (87%), followed by counseling (80%) and sound therapy (79%). Few audiologists administer a truly comprehensive tinnitus assessment and ∼20% indicated not recommending counseling or sound therapy to manage tinnitus. The results are discussed in the context of what is explicitly indicated in published CPGs, professional organization recommendations, and recent findings of peer-reviewed literature.