Loudness Discomfort Level Research Articles

Clinical Findings That Differentiate Co-Occurrence of Hyperacusis and Tinnitus from Tinnitus Alone.

We aimed to assess the characteristics of patients with concurrent tinnitus and hyperacusis, determine the best audiological criteria for predicting hyperacusis, and confirm whether objective evidence of changes in the brain exists. The medical records of patients with tinnitus who visited the hospital between March 2020 and December 2021 were reviewed. Data on accompanying hyperacusis, audiological profiles, and questionnaires including the Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and numerical rating scale were analyzed. Resting-state quantitative electroencephalography (qEEG) using power spectral density (PSD) and event-related spectral perturbation (ERSP) were performed to objectively quantify changes in the brain. A total of 194 patients were analyzed. Among them, 51 (26.3%) reported combined subjective hyperacusis with tinnitus. However, the proportions widely varied from 7.4% to 68.4% based on three audiological criteria for assessment. A higher score on the THI questionnaire was independently associated with the co-occurrence of tinnitus and hyperacusis. Fair agreement was observed between subjective hyperacusis and the audiological criterion based on a loudness discomfort level (LDL) of ≤90 dB at two or more frequencies for the diagnosis of hyperacusis. An increased beta-PSD and decreased levels of gamma-PSD, all-ERSP, and delta-ERSP were observed in patients with hyperacusis (p<0.05). Patients with co-occurring tinnitus and hyperacusis had more severe tinnitus distress. An LDL of ≤90 dB at two or more frequencies may be applicable to predict accompanying hyperacusis in subjects with tinnitus, and qEEG also provides more objective information.

AudioChip: A Deep Phenotyping Approach for Deconstructing and Quantifying Audiological Phenotypes of Self-Reported Speech Perception Difficulties.

About 15% of U.S. adults report speech perception difficulties despite showing normal audiograms. Recent research suggests that genetic factors might influence the phenotypic spectrum of speech perception difficulties. The primary objective of the present study was to describe a conceptual framework of a deep phenotyping method, referred to as AudioChipping, for deconstructing and quantifying complex audiometric phenotypes. In a sample of 70 females 18 to 35 years of age with normal audiograms (from 250 to 8000 Hz), the study measured behavioral hearing thresholds (250 to 16,000 Hz), distortion product otoacoustic emissions (1000 to 16,000 Hz), click-evoked auditory brainstem responses (ABR), complex ABR (cABR), QuickSIN, dichotic digit test score, loudness discomfort level, and noise exposure background. The speech perception difficulties were evaluated using the Speech, Spatial, and Quality of Hearing Scale-12-item version (SSQ). A multiple linear regression model was used to determine the relationship between SSQ scores and audiometric measures. Participants were categorized into three groups (i.e., high, mid, and low) using the SSQ scores before performing the clustering analysis. Audiometric measures were normalized and standardized before performing unsupervised k-means clustering to generate AudioChip. The results showed that SSQ and noise exposure background exhibited a significant negative correlation. ABR wave I amplitude, cABR offset latency, cABR response morphology, and loudness discomfort level were significant predictors for SSQ scores. These predictors explained about 18% of the variance in the SSQ score. The k-means clustering was used to split the participants into three major groups; one of these clusters revealed 53% of participants with low SSQ. Our study highlighted the relationship between SSQ and auditory coding precision in the auditory brainstem in normal-hearing young females. AudioChip was useful in delineating and quantifying internal homogeneity and heterogeneity in audiometric measures among individuals with a range of SSQ scores. AudioChip could help identify the genotype-phenotype relationship, document longitudinal changes in auditory phenotypes, and pair individuals in case-control groups for the genetic association analysis.

Auditory hypersensitivity in Williams syndrome

ObjectivesThe objective of this study was to investigate auditory hypersensitivity in WS and to evaluate hyperacusis through standardized protocols, checking if it can be associated with the absence of acoustic reflexes in people with WS. MethodThe study was performed in 17 individuals with WS, aged between seven and 17 years old (10 males and seven females), and 17 individuals with typical development age- and gender-matched to individuals with WS. Statistical tests were used to analyze the responses collected with the Loudness Discomfort Level (LDL) test as well as ipsilateral and contralateral reflex responses. ResultsAuditory hypersensitivity was commonly found. Individuals with WS had phonophobia and were less tolerant to high sound intensity, presenting a reduced discomfort threshold compared to those with typical development. However, hyperacusis was found in 35.29% of individuals with WS and was mild in 50% of cases. There was an association between hyperacusis and acoustic reflex responses, and individuals with absence of the contralateral acoustic reflex were more likely to have hyperacusis. ConclusionsIndividuals with WS have a high prevalence of auditory hypersensitivity, with the presence of phonophobia; however, hyperacusis was not as prevalent and may be associated with the absence of contralateral acoustic reflexes.

Relationship between psychological and physiological measurements of auditory sensitivity in adolescents with attention-deficit/hyperactivity disorder

Abnormal auditory sensitivity is common in patients with ADHD, however, auditory sensitivity issues have not been well-studied in ADHD. This study investigated auditory sensitivity in ADHD using psychological and physiological measures. A group of 13 adolescents aged 13 to 19 with a current ADHD diagnosis (ADHD group) and a group of 24 adolescents with normal development (control group) participated in this study. Acoustic reflex thresholds (ART) were obtained using pure-tone stimuli (500 Hz and 1 kHz) and wideband noise. Each stimuli was presented to each ear from 56dB to 104 dB in a 2-dB step. Loudness discomfort levels (LDL) were also obtained using two stimuli (500 Hz and wideband noise) in each ear. ART and LDL were collected without daily stimulant medication in the ADHD group. Questions related to auditory sensitivity were obtained using the Adolescent/Adult Sensory Profile. Preliminary results indicated no significant correlation between ARTs and LDLs and between ARTs and sensory profile scores in both groups. We found a weak correlation between ARTs and some sensory profile scores in the ADHD group. The results suggested a mismatch between ARTs and behavioral measures on auditory sensitivity. [Work supported by the ACCEL grant (NIH U54GM104941), the State of Delaware, and Nemours Foundation.]

Abnormal auditory event-related potentials in Williams syndrome

Individuals with Williams Syndrome (WS) have specific auditory characteristics, including hypoacusis and hyperacusis, and music appreciation skills. Little is known about the functionality of the central auditory nervous system (CANS) for sound processing in WS. Thus, the objective of the present study was to evaluate the functionality of the CANS in individuals with WS, based on auditory event-related potentials, as far as cognitive and behavioral aspects are concerned. The study was carried out with 17 individuals, seven females and ten males, between seven and 17 years old, with WS, and 17 individuals with typical development matched by sex and chronological age to individuals with WS. None of these individuals had middle ear impairment or hearing loss. The subjects were evaluated for intelligence quotient, loudness discomfort level, and auditory event-related potentials with Tone Burst stimuli, on the oddball paradigm; the parents also answered the MTA-SNAP-IV questionnaire. Hyperacusis was found in six WS individuals and two individuals with typical development. In the present study, WS individuals present longer latency and reduced amplitude for P1, N1, N2 and P3 components. These results, suggesting a delay and hypoactive responses of the CANS in this syndrome, that cannot be related to the cognitive or behavioral aspects of these individuals, but it indicates a cortical immaturity to process acoustic stimuli.

A comparative study of results of stapedotomy and neo-stapedotomy as a surgical treatment for otosclerosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to establish the usefulness of preservation of the stapedius tendon and the incudo-stapedial joint during the surgical procedure for the treatment of otosclerosis, to find out the advantages of neo-stapedotomy over standard stapedotomy and to compare the hearing improvement in neo-stapedotomy and stapedotomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective, randomised, controlled study with a sample size of 150 patients (ears) presented with pure conductive deafness, paracusis willisii and tinnitus was done. The patients were divided in to group A (n=60) &amp;amp;and group B (n=90), where neo-stapedotomy and standard stapedotomy procedure were performed respectively. Pure tone audiometry and tympanometry were done both pre and postoperatively. Speech discrimination score (SDS) and loudness discomfort levels (LDL) were measured at 3 months postoperatively. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Postoperative hearing improvement in both groups was almost identical. Improvement in middle ear compliance was marginally more in group A patients. Stapedial reflex could be elicited in 72 % of the patients in group A, but remained absent in group B, at 3 month post-operatively. The SDS became worse with more than 20 dB suprathreshold sounds in group B patients whereas it was maintained even with 80 dB in most patients of group A. Post-operative mean LDL for both pure tone and speech frequency in group A patients were higher than those in group B. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The difference of SDS and LDL between two groups were statistically significant. Hence, neo-stapedotomy is a better procedure, as no postoperative pseudo-recruitment ‘rollover’ observed and also dynamic range of hearing increased.&lt;/p&gt;

A psychoacoustic test for diagnosing hyperacusis based on ratings of natural sounds

Hyperacusis is defined as an increased sensitivity to sounds, i.e. sounds presented at moderate levels can produce discomfort or even pain. Existing diagnostic methods, like the Hyperacusis Questionnaire (HQ) and Loudness Discomfort Levels (LDLs), have been challenged because of their variability and lack of agreement on appropriate cut-off values. We propose a novel approach by using psychoacoustic ratings of natural sounds as an assessment tool for hyperacusis. Subjects (n = 81) were presented with natural and artificial (tone pips, noises) sounds (n = 69) in a controlled environment at four sound levels (60, 70, 80 and 90 dB SPL). The task was to rate them on a pleasant to unpleasant visual analog scale. The inherent challenge of this study was to create a new diagnostic tool when no gold standard of hyperacusis diagnosis exists. We labeled our subjects as hyperacusic (n = 26) when they were diagnosed as such by at least two of three methods (HQ, LDLs and self-report). There was a significant difference between controls (n = 23) and hyperacusics in the median global rating of pleasant sounds. Median global ratings of unpleasant sounds and artificial sounds did not differ significantly. Then we selected the subset of sounds that could best discriminate the controls from the hyperacusics, the Core Discriminant Sounds (CDS), and we used them to develop a new metric: The CDS score. A normalized global score and a score for each sound level can be computed with respect to a control population without hyperacusis. A receiver operating characteristic analysis showed that the accuracy of our method in distinguishing subjects with and without complaints of hyperacusis (86%, 95% Confidence Interval (CI): 76–93%) is comparable to that of existing methods such as the LDL (77%, CI: 67–86%) and the HQ (80%, CI: 69–88%). We believe that the CDS score is more relevant to subject's complaints than LDLs and that it could be applied in a clinical environment in a fast and effective way, while minimizing discomfort and biases.

Uni- and bilateral spectral loudness summation and binaural loudness summation with loudness matching and categorical loudness scaling

Objective Current hearing aid prescription rules assume that spectral loudness summation decreases with hearing impairment and that binaural loudness summation is independent of hearing loss and signal bandwidth. Previous studies have shown that these assumptions might be incorrect. Spectral loudness summation was measured and compared for loudness scaling and loudness matching. Design In this study, the effect of bandwidth on binaural summation was investigated by comparing loudness perception of low-pass filtered, high-pass filtered, and broadband pink noise at 35 Categorical Units for both unilateral and bilateral presentation. Study sample Sixteen hearing-impaired listeners. Results The results show that loudness differences between the three signals are different for bilateral presentation than for unilateral presentation. In specific, binaural loudness summation is larger for the low-pass filtered pink noise than for the high-pass filtered pink noise. Finally, individual variability in loudness perception near loudness discomfort level was found to be very large. Conclusions Loudness matching is offered as a fast and reliable method to measure individual loudness perception. As discomfort with loud sounds is one of the major problems encountered by hearing aid users, measurement of individual loudness perception could improve hearing aid fitting substantially.

Enhanced loudness perception in ears with reduced peripheral function: A remote psychoacoustic investigation

Central gain models of hyperacusis propose that a loss of afferent input drives over-amplification of sound-evoked activity in the central auditory system, leading to enhanced loudness perception. We conducted a remote study aimed at quantifying variation in loudness perception as a function of peripheral auditory status [i.e., summating potential (SP)/action potential (AP) ratio]. To control for the contributions of age and other individual differences, twelve adults with normal hearing and strongly asymmetric SP/AP ratios between ears were recruited from a prior study. Participants completed a battery of self-directed psychoacoustic tests at home using calibrated headphones and tablet computers running custom software. Loudness perception was assessed at a variety of frequencies in each ear using standard clinical assessments [e.g., loudness discomfort levels (LDLs), dynamic range] and more fine-grained assessments of loudness growth as a function of stimulus intensity. While traditional measures of LDL and dynamic range varied widely both within and between subjects, ears with evidence of possible cochlear synaptopathy (high SP/AP ratios) demonstrated elevated loudness perception for intensities in-between threshold and LDL. Detailed assessments of loudness growth across sensation levels may be more sensitive to variation in underlying peripheral neural status than traditional, single-point clinical measures of loudness discomfort.

Fluctuations in Subjective Tinnitus Ratings Over Time: Implications for Clinical Research.

Patients with chronic, subjective tinnitus are often administered a battery of audiometric tests to characterize their tinnitus percept. Even a comprehensive battery, if applied just once, cannot capture fluctuations in tinnitus strength or quality over time. Moreover, subjects experience a learning curve when reporting the detailed characteristics of their tinnitus percept, such that a single assessment will reflect a lack of familiarity with test requirements. We addressed these challenges by programming an automated software platform for at-home tinnitus characterization over a 2-week period. Prospective case series. Tertiary referral center, patients' homes. Following an initial clinic visit, 25 subjects with chronic subjective tinnitus returned home with a tablet computer and calibrated headphones to complete questionnaires, hearing tests, and tinnitus psychoacoustic testing. We repeatedly characterized loudness discomfort levels and tinnitus matching over a 2-week period. Primary outcomes included intrasubject variability in loudness discomfort levels, tinnitus intensity, and tinnitus acoustic matching over the course of testing. Within-subject variability for all outcome measures could be reduced by approximately 25 to 50% by excluding initial measurements and by focusing only on tinnitus matching attempts where subjects report high confidence in the accuracy of their ratings. Tinnitus self-report is inherently variable but can converge on reliable values with extended testing. Repeated, self-directed tinnitus assessments may have implications for identifying malingerers. Further, these findings suggest that extending the baseline phase of tinnitus characterizations will increase the statistical power for future studies focused on tinnitus interventions.

Total remission or persistence of tinnitus and decreased sound level tolerance in adolescents with normal audiograms: A follow-up study.

Tinnitus may reflect hidden cochlear synaptic injury that does not express in the audiogram, but leads to neuroplastic changes in auditory pathways that, in turn, reduce tolerance to sounds. Such injury may follow the exposure to loud sounds. The aim of this study was to follow-up adolescents enrolled in a private school to evaluate the prevalence of tinnitus and reduced sound level tolerance (SLT) with 1-year interval, as well as to observe rates of tinnitus persistence, remission and incidence of new cases by repeat measurements. In Study 1 (Sanchez et al., 2016), we evaluated 170 adolescents by a questionnaire about tinnitus and reduced tolerance to ordinary sounds and by measurements in a sound booth: audiometry (0.25-16kHz), Loudness Discomfort Levels (LDL, 0.5-4kHz) and tinnitus pitch/loudness matching (if present). Tinnitus measured in the booth was then called "confirmed tinnitus." In Study 2, we revaluated 54 adolescents who returned voluntarily 1 year later to repeat all measurements. From Study 1 to 2, the prevalence of confirmed tinnitus reduced from 28.8% (49/170) to 14.9% (8/54) in retested subjects, which includes the cases of persisting tinnitus (confirmed tinnitus in both studies, n=6/54=11.2%) and the new cases of tinnitus (confirmed tinnitus just at Study 2, n=2/54=3.7%). Among the 15 adolescents with confirmed tinnitus at Study 1 who returned for Study 2, 40% had persistent tinnitus (n=6) and 60% did not (remitted tinnitus, n=9). SLT was reduced by 17.3dB in cases with persistent tinnitus (P<0.0002), similar to the findings of Study 1, and returned to normal levels in subjects with remitted tinnitus. Hearing thresholds averaged 4.37dBHL and were <20dBHL in 97% of ears and all frequencies. At 14 and 16kHz thresholds were bilaterally elevated at Study 1 (5.07dB) and 2 (5.56dB) in adolescents with confirmed tinnitus. Tinnitus and reduced sound tolerance could feature early signals of hidden synaptic injury that is prevalent among adolescents and hidden from the audiogram. The strong relationship between both symptoms, in addition to low-level increases in hearing thresholds at high frequencies in the extended audiogram, poses a challenge for future hearing health and should be further evaluated as a possible intrinsic vulnerability for lesions following exposure to loud sounds. Moreover, the relationship between their spontaneous remissions may signal a possible synaptic repair, which has been reported in animal models.

Typewriter tinnitus: An investigative comparison with middle ear myoclonic tinnitus and its long-term therapeutic response to carbamazepine

ObjectivesDue to its rarity and similar sound, typewriter tinnitus (TT) can be misdiagnosed as middle ear myoclonic tinnitus (MEMT). We aim to clarify the characteristics of TT compared to MEMT, and the long-term therapeutic response to carbamazepine. MethodsFourteen patients with TT and 28 patients with MEMT were enrolled. ResultsTT patients were older than MEMT patients, and their tinnitus symptoms were mostly unilateral. Tinnitus symptoms, which is associated with dizziness, facial spasm, and head motion, were more common in TT, whereas MEMT were more related to noise. Acoustic reflex decay perturbation and low loudness discomfort level were diagnostic signs in MEMT patients, while decreased level of wave II in ABR was the most reliable sign in TT patients. All TT patients exhibited partial or complete response to carbamazepine, but there was a relapse rate after withdrawal of the drug was 60%. Increase in age and longer duration of symptoms were the risk factors of relapse of TT. ConclusionThe different characteristics observed in this study will be helpful to diagnose TT and MENT. Duration of tinnitus was the most important long-term prognostic factor of the carbamazepine trial, which indicates the importance of its earlier diagnosis.

Efficacy of Multi-Modal Migraine Prophylaxis Therapy on Hyperacusis Patients.

To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis. In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared. Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB (P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment (P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, P < .001). The majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.

Noninvasive Bimodal Neuromodulation for the Treatment of Tinnitus: Protocol for a Second Large-Scale Double-Blind Randomized Clinical Trial to Optimize Stimulation Parameters.

BackgroundThere is increasing evidence from animal and human studies that bimodal neuromodulation combining sound and electrical somatosensory stimulation of the tongue can induce extensive brain changes and treat tinnitus.ObjectiveThe main objectives of the proposed clinical study are to confirm the efficacy, safety, and tolerability of treatment demonstrated in a previous large-scale study of bimodal auditory and trigeminal nerve (tongue) stimulation (Treatment Evaluation of Neuromodulation for Tinnitus - Stage A1); evaluate the therapeutic effects of adjusting stimulation parameters over time; and determine the contribution of different features of bimodal stimulation in improving tinnitus outcomes.MethodsThis study will be a prospective, randomized, double-blind, parallel-arm, comparative clinical trial of a 12-week treatment for tinnitus using a Conformité Européenne (CE)–marked device with a pre-post and 12-month follow-up design. Four treatment arms will be investigated, in which each arm consists of two different stimulation settings, with the first setting presented during the first 6 weeks and the second setting presented during the next 6 weeks of treatment. The study will enroll 192 participants, split in a ratio of 80:80:16:16 across the four arms. Participants will be randomized to one of four arms and stratified to minimize baseline variability in four categories: two separate strata for sound level tolerance (using loudness discomfort level as indicators for hyperacusis severity), high tinnitus symptom severity based on the Tinnitus Handicap Inventory (THI), and tinnitus laterality. The primary efficacy endpoints are within-arm changes in THI and Tinnitus Functional Index as well as between-arm changes in THI after 6 weeks of treatment for the full cohort and two subgroups of tinnitus participants (ie, one hyperacusis subgroup and a high tinnitus symptom severity subgroup). Additional efficacy endpoints include within-arm or between-arm changes in THI after 6 or 12 weeks of treatment and in different subgroups of tinnitus participants as well as at posttreatment assessments at 6 weeks, 6 months, and 12 months. Treatment safety, attrition rates, and compliance rates will also be assessed and reported.ResultsThis study protocol was approved by the Tallaght University Hospital/St. James’s Hospital Joint Research Ethics Committee in Dublin, Ireland. The first participant was enrolled on March 20, 2018. The data collection and database lock are expected to be completed by February 2020, and the data analysis and manuscript submission are expected to be conducted in autumn of 2020.ConclusionsThe findings of this study will be disseminated to relevant research, clinical, and health services and patient communities through publications in peer-reviewed journals and presentations at scientific and clinical conferences.Trial RegistrationClinicalTrials.gov NCT03530306; https://clinicaltrials.gov/ct2/show/NCT03530306International Registered Report Identifier (IRRID)DERR1-10.2196/13176

Auditory brainstem function in women with vestibular migraine: a controlled study

BackgroundVestibular migraine (VM) has been recognized as a diagnostic entity over the past three decades. It affects up to 1% of the general population and 7% of patients seen in dizziness clinics. It is still underdiagnosed; consequently, it is important to conduct clinical studies that address diagnostic indicators of VM. The aim of this study was to assess auditory brainstem function in women with vestibular migraine using electrophysiological testing, contralateral acoustic reflex and loudness discomfort level.MethodsThe study group consisted of 29 women with vestibular migraine in the interictal period, and the control group comprised 25 healthy women. Auditory brainstem response, frequency following response, binaural interaction component and assessment of contralateral efferent suppression were performed. The threshold of loudness discomfort and the contralateral acoustic reflex were also investigated. The results were compared between the groups.ResultsThere was a statistically significant difference between the groups in the frequency following response and the loudness discomfort level.ConclusionsThe current study suggested that temporal auditory processing and loudness discomfort levels are altered in VM patients during the interictal period, indicating that these measures may be useful as diagnostic criteria.

Clinical profile and implications of tinnitus in individuals with and without hearing loss.

To compare clinical characteristics of tinnitus and interference in quality of life in individuals with and without associated hearing loss, as well as to discuss the association of quantitative measurements and qualitative instruments. A quantitative, cross-sectional and comparative study approved by the Research Ethics Committee (No. 973.314/CAEE: 41634815.3.0000.0106) was carried out. The responses of the psychoacoustic assessment of tinnitus (intensity, frequency, minimum masking level and loudness discomfort level for pure tone and speech), as well as the Tinnitus Handicap Inventory (THI) questionnaire, and the visual analogue scale (VAS) were compared between 15 patients with tinnitus and peripheral hearing loss (group I) and 16 adults with normal hearing (group II). The mean VAS and THI scores obtained in GI were 5.1 (+1.5) and 42.3 (+18), and in GII, 5.7 (+2.6) and 32.7 (+25), respectively. This result suggests moderate GI annoyance and moderate/mild GII annoyance (p>0.005). There was a positive and moderate correlation between THI and VAS only in GII. In the psychoacoustic evaluation, significant differences were observed between the groups regarding the measurement of loudness (*p=0.013) and the minimum masking level (*p=0.001). There was no direct influence of the presence of hearing loss in relation to the impact of tinnitus. The differences found between the groups regarding the psychoacoustics measures can be justified by the presence of cochlear damage. The objective measurement of tinnitus, regardless of the presence or absence of peripheral hearing loss, is an important instrument to be used along with self-evaluation measures.

Stapes hypermobility as a possible cause of hyperacusis.

Hyperacusis is a reduction of normal tolerances for everyday sounds. Although several publications have been produced demonstrating that minimally invasive surgical procedures may improve patient symptoms, the precise etiology of hyperacusis often remains elusive. This study describes 21 patients, 7 of whom stapes hypermobility is believed to be a mechanical genesis of their hyperacusis symptoms. A prospective, repeated-measure single-arm design was used for this study. All patients were evaluated and treated at a tertiary level otologic referral center. 21 patients (Cohort A) with severe hyperacusis underwent oval and round window reinforcement. Seven patients (Cohort B) intraoperatively appeared to have subjective hypermobility of the stapes. Additional reinforcement of the stapes superstructure was performed in these patients. In Cohort A, loudness discomfort level (LDL) values improved on average from 72.7 dB to 81.9 dB. Hyperacusis questionnaire (HQ) scores improved from 30.1 to 14.7. Numeric Rating Scale scores (0-10) decreased from 8.5 to 4.0. In Cohort B, values similarly improved from an average of 72.4 dB to 88.2 dB. HQ scores improved from 35.8 to 18.9. Numeric Rating Scale scores fell from 10.0 to 3.7. Postoperatively there were no complaints of hearing loss. Sixteen out of 21(76%) reported improved quality of life and diminished symptoms of hyperacusis. It is possible that patients suffering from hyperacusis may have a mechanical cause for their symptoms. Further research is necessary to clarify stapes mobility in patients with these symptoms. Excess temporalis tissue reinforcement of the stapes along with round window reinforcement shows promise as a minimally invasive surgical option for patients suffering from hyperacusis.

Tinnitus and Auditory Perception After a History of Noise Exposure: Relationship to Auditory Brainstem Response Measures.

To determine whether auditory brainstem response (ABR) wave I amplitude is associated with measures of auditory perception in young people with normal distortion product otoacoustic emissions (DPOAEs) and varying levels of noise exposure history. Tinnitus, loudness tolerance, and speech perception ability were measured in 31 young military Veterans and 43 non-Veterans (19 to 35 years of age) with normal pure-tone thresholds and DPOAEs. Speech perception was evaluated in quiet using Northwestern University Auditory Test (NU-6) word lists and in background noise using the words in noise (WIN) test. Loudness discomfort levels were measured using 1-, 3-, 4-, and 6-kHz pulsed pure tones. DPOAEs and ABRs were collected in each participant to assess outer hair cell and auditory nerve function. The probability of reporting tinnitus in this sample increased by a factor of 2.0 per 0.1 µV decrease in ABR wave I amplitude (95% Bayesian confidence interval, 1.1 to 5.0) for males and by a factor of 2.2 (95% confidence interval, 1.0 to 6.4) for females after adjusting for sex and DPOAE levels. Similar results were obtained in an alternate model adjusted for pure-tone thresholds in addition to sex and DPOAE levels. No apparent relationship was found between wave I amplitude and either loudness tolerance or speech perception in quiet or noise. Reduced ABR wave I amplitude was associated with an increased risk of tinnitus, even after adjusting for DPOAEs and sex. In contrast, wave III and V amplitudes had little effect on tinnitus risk. This suggests that changes in peripheral input at the level of the inner hair cell or auditory nerve may lead to increases in central gain that give rise to the perception of tinnitus. Although the extent of synaptopathy in the study participants cannot be measured directly, these findings are consistent with the prediction that tinnitus may be a perceptual consequence of cochlear synaptopathy.

CI Programming in Patients with Neurologic Impairment

CI Programming in Patients with Neurologic Impairment

Effect of sound generator on tinnitus and hyperacusis

Objective: Sound generator (SG) plays a role as effective sound therapy of tinnitus retaining therapy (TRT) in patients with severe tinnitus (Category 1) or hyperacusis (Category 3). This study was performed to evaluate the therapeutic effect of SGs.Methods: A total of 120 tinnitus patients who visited our tinnitus clinic and were treated with SG along with TRT from January 2008 to December 2016 were included. The patients were divided into two groups by tinnitus category; 78 patients of category 1 and 42 patients of category 3. Their medical records including questionnaires regarding tinnitus severity were retrospectively reviewed to evaluate the therapeutic effect of SGs on tinnitus and hyperacusis.Results: Category 3 patients included more female patients, were younger than category 1 patients (p = .001), and were prescribed SG earlier due to their severe symptom of hyperacusis. (p = .004) All patients showed significant improvements on all categories of tinnitus visual analogue scale (VAS) scores and tinnitus handicap inventory (THI) scores after six months use of SG (p < .05). Loudness discomfort levels measured by pure tone audiometry were significantly improved in category 3 group after six months use of SGs.Conclusion: SG with TRT seems to be an effective treatment modality for all tinnitus patients, especially those with comorbid hyperacusis.