Clinical Interventions for Hyperacusis in Adults: A Scoping Review to Assess the Current Position and Determine Priorities for Research

Abstract

Background There is no universally accepted definition for hyperacusis, but in general it is characterised by decreased sound tolerance to ordinary environmental sounds. Despite hyperacusis being prevalent and having significant clinical implications, much remains unknown about current management strategies. Purpose To establish the current position of research on hyperacusis and identify research gaps to direct future research. Design and SampleUsing an established methodological framework, electronic and manual searches of databases and journals identified 43 records that met our inclusion criteria. Incorporating content and thematic analysis approaches, the definitions of hyperacusis, management strategies, and outcome measures were catalogued. Results Only 67% of the studies provided a definition of hyperacusis, such as “reduced tolerance” or “oversensitivity to sound.” Assessments and outcome measures included Loudness Discomfort Levels, the Hyperacusis Questionnaire, and Tinnitus Retraining Therapy (TRT) interview. Management strategies reported were Cognitive Behavioural Therapy, TRT, devices, pharmacological therapy, and surgery. Conclusions Management strategies were typically evaluated in patients reporting hyperacusis as a secondary complaint or as part of a symptom set. As such the outcomes reported only provided an indication of their effectiveness for hyperacusis. Randomised Controlled Trials are needed to evaluate the effectiveness of management strategies for patients experiencing hyperacusis.

Identifying and prioritising unanswered research questions for people with hyperacusis: James Lind Alliance Hyperacusis Priority Setting Partnership

“…For example, in 2014, a two-part review of hyperacusis research17 18 highlighted key areas in hyperacusis that were seen as important to progress, including but not limited to, properly defining and subtyping hyperacusis, identifying and understanding mechanisms and the role of the brain, and evaluating current treatments (particularly sound therapy and drugs). These topics also appeared in reviews published in 201716 and 2018 19. These more recent reviews also reported a need for up-to-date prevalence figures and valid measurement tools.…”

“…Patient representatives passionately felt that the definition needed to state that it was a hearing condition, and that a description of the experience had to be provided. Therefore, using evidence from a recent scoping review16 and the experience of steering group members, we defined hyperacusis as ‘ a hearing disorder involving an increased sensitivity or decreased tolerance to sound at levels that would not trouble most individuals. For the person experiencing hyperacusis, everyday sounds can be unpleasant, intense, frightening, painful and overwhelming and can cause anxiety and distress’ .…”

“…The structure and provision of services for hyperacusis vary across the UK, with a variety of different medical specialties (including ear, nose and throat, audiology, audiovestibular medicine, clinical psychology) involved in the management of people experiencing hyperacusis. Clinical management in general includes non-standardised assessment using sound-based tolerance tests, and questionnaires to determine and measure the specific effects hyperacusis has on an individual’s life 15. Approaches to treatment include sound therapy, counselling and cognitive–behavioural therapy16 but there is little or no evidence of their effectiveness.…”

“…Clinical management in general includes non-standardised assessment using sound-based tolerance tests, and questionnaires to determine and measure the specific effects hyperacusis has on an individual’s life 15. Approaches to treatment include sound therapy, counselling and cognitive–behavioural therapy16 but there is little or no evidence of their effectiveness. Indeed, despite its prevalence and clinical implications, hyperacusis research is in its infancy and there are many controversies in the field 17–19.…”

“…Indeed, despite its prevalence and clinical implications, hyperacusis research is in its infancy and there are many controversies in the field 17–19. For example, only two randomised controlled trials specifically testing hyperacusis treatments have been conducted,16 and the only systematic review on hyperacusis examines prevalence in children and adolescents 20. With such an open field, it is essential to identify and address research priorities that are immediately relevant and important to those affected by hyperacusis, and those who provide care for them.…”