Noise sensitivity or hyperacusis? Comparing the Weinstein and Khalfa questionnaires in a community and a clinical samples.

Noise sensitivity and hyperacusis are decreased sound tolerance conditions that are not well delineated or defined. This paper presents the correlations and distributions of the Noise Sensitivity Scale (NSS) and the Hyperacusis Questionnaire (HQ) scores in two distinct large samples. In Study 1, a community-based sample of young healthy adults (n = 103) exhibited a strong correlation (r = 0.74) between the two questionnaires. The mean NSS and HQ scores were 54.4 ± 16.9 and 12.5 ± 7.5, respectively. NSS scores displayed a normal distribution, whereas HQ scores showed a slight positive skew. In Study 2, a clinical sample of Veterans with or without clinical comorbidities (n = 95) showed a moderate correlation (r = 0.58) between the two questionnaires. The mean scores were 66.6 ± 15.6 and 15.3 ± 7.3 on the NSS and HQ, respectively. Both questionnaires' scores followed a normal distribution. In both samples, participants who self-identified as having decreased sound tolerance scored higher on both questionnaires. These findings provide reference data from two diverse sample groups. The moderate to strong correlations observed in both studies suggest a significant overlap between noise sensitivity and hyperacusis. The results underscore that NSS and HQ should not be used interchangeably, as they aim to measure distinct constructs, however to what extent they actually do remains to be determined. Further investigation should distinguish between these conditions through a comprehensive psychometric analysis of the questionnaires and a thorough exploration of psychoacoustic, neurological, and physiological differences that set them apart.

Investigation of the relationship between hyperacusis and auditory processing difficulties in individuals with normal hearing.

PURPOSE: This study aimed to investigate the prevalence of hyperacusis and auditory processing (listening) difficulties (APDiff) in normal-hearing young adults and to explore the relationship between these two conditions. METHODS: A total of 333 participants aged 18-24 underwent pure-tone audiometry tests and completed the Khalfa Hyperacusis Questionnaire (KHQ) and the University of Cincinnati Auditory Processing Inventory (UCAPI) online. RESULTS: Hyperacusis was identified in 26.43% of participants, and APDiff in 36.04%. A strong, positive correlation was found between KHQ and UCAPI scores (r = 0.603, p < 0.001). Logistic regression models indicated that hyperacusis significantly increased the likelihood of having APDiff (OR 7.688, p < 0.001). CONCLUSION: Despite the high prevalence of hyperacusis and APDiff in young adults, few seek help from audiology clinics. Our findings highlight a significant link between hyperacusis and APDiff, emphasizing the need for screening protocols for auditory processing skills in young adults due to these conditions' potential social and academic impacts.

Turkish Adaptation of Khalfa Hyperacusis Questionnaire.

OBJECTIVE: The aim of this study is to adapt Khalfa Hyperacusis Questionnaire (HQ) into Turkish for the use in the diagnosis and treatment of patients with hyperacusis. METHOD: HQ and Beck Anxiety Inventory (BAI) were administered to a total of 529 participants (320 female, 209 male), aged 18 to 73 (mean age: 29.76±10.59) years who were randomly selected from the general population. For the evaluation of the data, confirmatory and exploratory factor analysis, correlation analysis, descriptive statistics, t-test, analysis of variance, and Sidak correction test were used. RESULTS: In the reliability analysis, the Cronbach's alpha (aC) internal consistency coefficient was found to be 0.81. Factor analysis revealed three subdimensions (attentional, social, and emotional). The total variance of these three subdimensions were 63%, and the internal consistency of the subdimensions was also high (αC >0.70). Confirmatory factor analysis and structural equation modeling results indicated that three-factor solutions with 14 items met the criteria for the adequacy of fit among the Turkish patients. The mean score for hyperacusis was estimated as 15.69±6.63 points.There was a positive, weak, but significant association between hyperacusis and anxiety (r=0.357, p=0.01, p<0.05). The patients who were exposed to noise were found to have higher levels of hyperacusis, compared to those who were not (t=6.78, p=0.01, p<0.05). The patients who had decreased noise tolerance over time were found to be higher hyperacusis levels than those without (t=4.83, p=0.01, p<0.05). CONCLUSION: Based on these measurements, 14 questions and three-factor solutions were found to be a valid and reliable tool.

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

OBJECTIVES: To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Validity of the Italian version of Khalfa's questionnaire on hyperacusis.

The present study aims to evaluate and validate the Italian version of Khalfa's questionnaire on hyperacusis (HQ). We recruited 117 patients (64 men, 53 women, mean age 53 years, range 14-88) with tinnitus for at least 3 months as a primary disorder. All patients completed the THI and the Italian version of the HQ and underwent audiometry, pitch and loudness tinnitus matching, otoacoustic emissions with distortion products (DPOAE) and uncomfortable loudness level (ULL). The overall performance of the tests was evaluated and compared using the area under the RO C curve (AUC) relative to the tests. The cut-off of the HQ was calculated. We also assessed the Cronbach's alpha (αC) for the HQ and its three major dimensions (attentional - αC1, emotional - αC2 and social - αC3). Statistical analysis showed no correlation between DPOAE, audiometry, ULL and gender. We observed a high correlation (p < 0.05) between hyperacusis and ULL described by the Spearman's ρ index (rs = 0.72). We found a cut-off of 16 indicative of hyperacusis comparing the area under the RO C curve (AUC) of HQ and audiometry, taken as a diagnostic reference, (sensitivity = 67.9% and specificity = 72.2%). The reliability of HQ was confirmed by a high αC = 0.89. The αC for the single dimensional scales were, respectively, αC1 = 0.73, αC2 = 0.72 and αC3 = 0.81. The Italian version of the HQ is recommended for proper and complete classification of patients with tinnitus and hyperacusis. From our study, we found a cut-off of 16 instead of the cut-off of 28 described as very high by other authors. Moreover, ULL was an important variable and can be discriminating in the evaluation of hyperacusis.