(PP1408) Loudness Discomfort Levels Are Not Sensitive at Detecting Hyperacusis in Tinnitus Patients

Abstract: Approximately 80% of patients who have hyperacusis, an intolerance to moderately-loud sounds, also report chronic tinnitus. Clinically, audiologists rely on testing loudness discomfort levels (LDLs) to detect hyperacusis; on average LDLs are significantly lower in patients reporting hyperacusis. However, self-reported oversensitivity to sound in everyday life does not correlate to clinical LDLs measured in a sound treated booth. The results of our retrospective chart review suggest that frequency-specific LDLs are not a sensitive metric to detect hyperacusis in patients with tinnitus.

Summary: 

Rationale/

Purpose: Hyperacusis, an intolerance to moderately-loud sounds, affects approximately 9% of the adult population (Anderson G., 2002). In most instances, clinicians rely on self-report or standardized questionnaires to inform them on the presence and severity of the patients’ symptoms. Loudness discomfort levels (LDLs) are often measured in an attempt to gauge the upper boundary of sound intensity that can be tolerated. However, previous literature has suggested that LDLs do not strongly correlate with self-reported sound sensitivity (Baguley D., Fagelson M., 2018). LDLs are noted to be subjective and inconsistent, as elicited response relies on the instruction of the test itself as well as relative sound tolerance of each patient (Zaugg TL., 2016). Since approximately 80% of patients with hyperacusis also report chronic tinnitus, it is important to determine if LDLs are different in patients who have tinnitus and hyperacusis versus tinnitus alone. Hyperacusis patients typically display reduced LDLs (Goldstein B, Shulman A., 1996). However, previous reports suggest that LDLs only weakly correlate with self-reported sensitivity to sounds in patients reporting tinnitus (Zaugg TL., 2016). The aim of this project was to determine if LDLs were different among patients who reported tinnitus alone, tinnitus and loudness hyperacusis or tinnitus and pain hyperacusis.

Methods:  A retrospective chart review was conducted of 100 patients previously seen for a tinnitus evaluation at the University at Buffalo Speech-Language and Hearing Clinic. Patients were categorized into three groups based on their report of loudness sensitivity and sound-related pain sensations. Importantly, this was done by history self-report as well as an interview with the audiologist. Audiometric thresholds and LDLs were compared across the three different groups.

Results: There was no significant difference in audiometric thresholds for any group. The average audiometric morphology displayed a sloping, predominantly high-frequency hearing loss between 250-8000 Hz for each group. Patients that were grouped as having tinnitus and loudness hyperacusis or tinnitus and pain hyperacusis both showed significantly lower LDLs than the tinnitus alone group. This was consistent for all four tonal LDL frequencies recorded (500, 1000, 2000 and 4000 Hz). However, while on average patients with tinnitus and loudness hyperacusis or pain hyperacusis had lower LDLs, using LDLs to identify patients who reported loudness or pain hyperacusis had very poor sensitivity.

 

Conclusions:  LDLs are frequently used by audiologist when evaluating sound tolerance. While, on average patients with tinnitus and hyperacusis appear to have significantly lower LDLs, they also have very poor sensitivity rendering poor utility at detecting hyperacusis in tinnitus patients (~80% of all hyperacusis patients). The use of LDLs is also controversial since some patients have reported the test can cause a ‘setback’, worsening their loudness tolerance or tinnitus. Further studies are needed to develop a reliable and safe test to predict loudness tolerance levels in patients with hyperacusis and tinnitus.