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Hyperacusis: Clinical Studies and Effect of Cognitive Behaviour Therapy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Hyperacusis is a type of decreased sound tolerance where the individual has decreased loudness discomfort levels (LDL), normal hearing thresholds and is sensitive to ordinary environmental sounds. Persons with hyperacusis frequently seek help at audiological departments as they are often affected by other audiological problems. Regrettably, there is neither a consensus-based diagnostic procedure nor an evidence-based treatment for hyperacusis.

The principal aim of this thesis was to gain knowledge about the clinical condition hyperacusis. The specific aim of Paper I was to compare hyperacusis measurement tools in order to determine the most valid measures for assessing hyperacusis. Items from a constructed clinical interview were compared with the LDL test, the Hyperacusis Questionnaire (HQ) and the Hospital Anxiety and Depression Scale (HADS). LDLs were significantly correlated with the anxiety subscale of the HADS. A third of the 62 investigated patients scored below the previously recommended cut-off for the HQ. The results suggest that HQ and HADS in combination with a clinical interview are useful as part of the assessment procedure in patients with hyperacusis.

The aim of Paper II was to further investigate the patient group with respect to individual characteristics, psychiatric morbidity and personality traits. It was shown that anxiety disorders and anxiety-related personality traits were over-represented, which suggests common or cooperating mechanisms. Avoidance behaviour proved to be very common in the patient group, as was being unable to work due to hyperacusis.

In Paper III it was investigated in a randomized controlled trial whether Cognitive Behaviour Therapy (CBT) could be helpful for patients with hyperacusis. The effect of CBT for hyperacusis was assessed with measures of LDLs, symptoms of hyperacusis and of anxiety and depression, fear of (re)injury due to exposure to sounds, and quality of life, compared to a waiting list control group. There were significant group effects for a majority of the measures with moderate and strong effect sizes within- and between groups. After assessment the waiting list group was also given CBT, and was then reassessed with similar effects. The results were maintained for 12 months, concluding CBT to be potentially helpful for these patients.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 934
Keyword [en]
Hyperacusis, Cognitive Behaviour Therapy, Randomized Controlled Trial, Personality, Psychiatric Disorders
National Category
Psychiatry Otorhinolaryngology Applied Psychology
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-207577ISBN: 978-91-554-8756-0 (print)OAI: oai:DiVA.org:uu-207577DiVA: diva2:648834
Public defence
2013-10-31, Universitetshuset, room IX, Biskopsgatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council
Available from: 2013-10-08 Created: 2013-09-16 Last updated: 2014-01-23
List of papers
1. The Hyperacusis Questionnaire, loudness discomfort levels, and the Hospital Anxiety and Depression Scale: A cross-sectional study
Open this publication in new window or tab >>The Hyperacusis Questionnaire, loudness discomfort levels, and the Hospital Anxiety and Depression Scale: A cross-sectional study
2013 (English)In: Hearing, Balance and Communication, ISSN 2169-5717, Vol. 11, no 2, 72-79 p.Article in journal (Refereed) Published
Abstract [en]

Objective: 

The aim of this study was to compare hyperacusis measurement tools often used in audiological practice in order to determine the most valid measure for assessing hyperacusis. Another aim was to examine the mean value for the Hyperacusis Questionnaire (HQ) in this patient group. 

Design: 

This was a cross-sectional study to compare the HQ with loudness discomfort levels (LDL), the Hospital Anxiety and Depression Scale (HADS), and items from a clinical interview dealing with hyperacusis symptoms. Sixty-two patients between the ages of 18 and 61 years were evaluated. All patients were diagnosed with hyperacusis. 

Results: 

There were significant negative correlations between the HQ and nearly all LDL scores for the right ear, but no significant correlations could be found for the left ear. LDLs were significantly correlated with the anxiety subscale of the HADS while there were no significant correlations between the HQ and either of the HADS scales. Of the 62 patients, 41 scored above and 21 scored below the previously recommended cut-off for the HQ. 

Conclusion: 

We suggest that clinicians should use the HQ and HADS in combination with a clinical interview to diagnose hyperacusis, and propose that the cut-off for the Swedish version of the HQ should be lowered.

Keyword
Hyperacusis, assessment
National Category
Medical and Health Sciences
Research subject
Psychiatry; Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-206736 (URN)10.3109/21695717.2013.780409 (DOI)
Available from: 2013-09-03 Created: 2013-09-03 Last updated: 2014-01-23Bibliographically approved
2. Psychiatric Comorbidity and Personality Traits in Patients with Hyperacusis.
Open this publication in new window or tab >>Psychiatric Comorbidity and Personality Traits in Patients with Hyperacusis.
2013 (English)In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 52, no 4, 230-235 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Hyperacusis, defined as unusual intolerance of ordinary environmental sounds, is a common problem. In spite of this, there is limited understanding of the underlying mechanisms. We hypothesized that individuals withhyperacusis would be prone to suffer from psychiatric disorders, related in particular to anxiety. Therefore, psychiatric morbidity and personality traits were investigated, along with different sociodemographic and clinical characteristics. Design: Patientswere assessed with a clinical interview related to symptoms of hyperacusis, the Mini-international neuropsychiatric interview (MINI), and the Swedish Universities scales ofPersonality (SSP) to study psychiatric disorders and personality traits. Study sample: A group of 62 Swedish patients with hyperacusis between 18 and 61 years (mean 40.2, SD 12.2) was included. Results: Altogether 56% of the patients had at least onepsychiatric disorder, and 47% had an anxiety disorder. Also, personality traits related to neuroticism were over-represented. A majority, 79%, suffered from comorbid tinnitus, and a similar proportion used measures to avoid noisy environments. Conclusions: The over-representation of anxiety disorders and anxiety-relatedpersonality traits in patients with hyperacusis suggests common or cooperating mechanisms. Cognitive behavioural treatment strategies, proven efficient in treating anxiety, may be indicated and are suggested for further studies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-190576 (URN)10.3109/14992027.2012.743043 (DOI)000316810100003 ()
Available from: 2013-01-08 Created: 2013-01-08 Last updated: 2017-12-06Bibliographically approved
3. Cognitive Behaviour Therapy for Hyperacusis: A Randomized Controlled Trial
Open this publication in new window or tab >>Cognitive Behaviour Therapy for Hyperacusis: A Randomized Controlled Trial
2014 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, 30-37 p.Article in journal (Refereed) Published
Abstract [en]

Hyperacusis, defined as unusual intolerance to ordinary environmental sounds, is a common problem for which there are no controlled trials on psychological treatment. Given the avoidance strategies present in hyperacusis, and similarities with problems such as tinnitus and chronic pain, cognitive behaviour therapy (CBT) is hypothesized to be helpful for patients with hyperacusis. In this randomized controlled study of 60 patients with hyperacusis, CBT was compared with a waiting list control group using the Loudness Discomfort Level test (LDL), the Hyperacusis Questionnaire, the Hospital Anxiety and Depression Scales, the Quality of Life Inventory and an adapted version of the Tampa Scale of Kinesiophobia. There were significant between-group effects in favour of the CBT group on all measures except for the HADS anxiety scale. Between-group effect sizes were moderate to high, with Cohen's d = 0.67 and 0.69 per ear, respectively, for the primary measure LDL, and ranging from d = 0.32 to 1.36 for the secondary measures. The differences between groups ceased to exist when the waiting list group was treated later with CBT, and the treatment results were largely maintained after 12 months. In conclusion, CBT is a promising treatment for hyperacusis, although more research is necessary.

Keyword
Hyperacusis, RCT, CBT
National Category
Psychiatry Otorhinolaryngology
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-207210 (URN)10.1016/j.brat.2014.01.001 (DOI)000334009000005 ()
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2017-12-06Bibliographically approved

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