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Raj-Koziak D, Gos E, Kutyba JJ, Skarzynski PH, Skarzynski H. Hyperacusis Assessment Questionnaire-A New Tool Assessing Hyperacusis in Subjects with Tinnitus. J Clin Med 2023; 12:6622. [PMID: 37892760 PMCID: PMC10607047 DOI: 10.3390/jcm12206622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023] Open
Abstract
Hyperacusis, a kind of decreased sound tolerance, is difficult to measure objectively. It often co-occurs with tinnitus. There is a need for valid and reliable patient-reported outcome measures to capture this subjective phenomenon. The aim of the study was to create a questionnaire capturing hyperacusis in terms of loudness, fear, and pain and to evaluate its psychometric properties. The study sample consisted of 106 adult patients with hyperacusis and tinnitus with a mean age of 45.2 years. A medical interview, an audiological examination, and several questionnaires (the Tinnitus Handicap Inventory, the Hyperacusis Questionnaire, the State-Trait Anxiety Inventory, and Visual Analog Scales) were applied. The final 14-item Hyperacusis Assessment Questionnaire showed an appropriate three-factor structure with 70.5% of the variance explained. Convergent and divergent validity were confirmed by correlations with other measures of hyperacusis, anxiety, tinnitus severity, misophonia, and hearing thresholds. The internal consistency assessed with Cronbach's alpha was excellent (α = 0.91), as was reproducibility (intraclass correlation, ICC = 0.96). The new Hyperacusis Assessment Questionnaire is a psychometrically sound and brief tool assessing the severity of hyperacusis in terms of loudness, fear, and pain. It can be used in clinical practice and scientific research for patients with hyperacusis and tinnitus.
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Affiliation(s)
- Danuta Raj-Koziak
- Tinnitus Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland;
| | - Elżbieta Gos
- Teleaudiology and Screening Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (J.J.K.); (P.H.S.)
| | - Justyna Jolanta Kutyba
- Teleaudiology and Screening Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (J.J.K.); (P.H.S.)
| | - Piotr H. Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (J.J.K.); (P.H.S.)
- Institute of Sensory Organs, 05-830 Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Henryk Skarzynski
- Otorhinolaryngology Clinic, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland;
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Adams Z, Bechlivanidis C, Osman M, O'Hagan J, Naldzhiev D. Self-reported Side-effects of Ultraviolet-C Disinfection Devices. Photochem Photobiol 2023; 99:1299-1309. [PMID: 36533869 DOI: 10.1111/php.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic increased sales of portable UV-C devices as a means of inactivating the SARS-CoV-2 virus. Research suggests that excessive UV-C exposure to the eyes and skin can lead to side-effects, primarily photokeratitis and erythema, but these findings are limited to case studies. This study explores self-reported side-effects of UV-C devices by collating five waves of UK consumer survey data from April 2020-December 2021 (N = 26 864). 30%-46% of owners report a side-effect after using a device claiming to emit UV-C. However, detailed analysis of Wave 4 data (N = 309) highlights inconsistencies between reported and plausible side-effect(s) associated with skin or eye exposure from UV-C devices. Alternative explanations are considered, namely that the reported side-effect(s) were psychosomatic or misattributed to direct exposure of UV-C radiation. Data regarding awareness of warnings about device side-effect(s) supports the misattribution explanation. For risk assessment purposes, limited reliable information about specific irritation or injury to the eye and skin was found from self-reporting surveys. To optimize future data collection, we recommend addressing recall errors by: reducing the period under investigation, supplementing responses with empirical measures, and incentivizing respondents to provide accurate information about the make and model of the UV-C device.
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Affiliation(s)
- Zoë Adams
- Queen Mary University of London, London, UK
| | | | | | | | - Dzhordzhio Naldzhiev
- Department for Business, Energy and Industrial Strategy, Office for Product Safety and Standards, London, UK
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What Should Be Considered When Assessing Hyperacusis? A Qualitative Analysis of Problems Reported by Hyperacusis Patients. Brain Sci 2022; 12:brainsci12121615. [PMID: 36552075 PMCID: PMC9775019 DOI: 10.3390/brainsci12121615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
Abstract
Hyperacusis (decreased sound tolerance) is a prevalent complaint. Yet, to date, no research has qualitatively evaluated the types of problems experienced by adults with hyperacusis. Our service evaluation aims to determine the hyperacusis-related problem domains reported by patients and the degree to which these domains were reported together. Retrospective analysis was conducted on an anonymised clinical dataset from 306 patients who attended a UK tinnitus and hyperacusis treatment centre between 1994 and 2017. Conventional content analysis was used to categorise responses to the question 'Why is hyperacusis a problem?' into domains which were then subjected to a cluster analysis. Twenty-five problem domains were identified, of which 12 were further classified into three overarching categories. 'Fear', 'Reduced quality of life' and 'Physical reaction to sound' were most frequently reported problems. Cluster analysis revealed that 'Sleep difficulties' and 'Despondency', were commonly reported together. Adults with hyperacusis face many challenges in their everyday lives. The nature of these problems indicates the need to develop complex interventions and assessments to aid management of hyperacusis. Current hyperacusis questionnaires may be useful in identifying some problem domains, but further assessment thorough patient interviews is required to fully explore all potential problems and make informed decisions about treatment.
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Hyperacusis: Loudness Intolerance, Fear, Annoyance and Pain. Hear Res 2022; 426:108648. [DOI: 10.1016/j.heares.2022.108648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
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Erinc M, Mutlu A, Celik S, Kalcioglu MT, Szczepek AJ. Long-Term Effects of COVID-19 and the Pandemic on Tinnitus Patients. Front Neurol 2022; 13:921173. [PMID: 35847215 PMCID: PMC9279732 DOI: 10.3389/fneur.2022.921173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to explore the effect of COVID-19 and the pandemic period on the tinnitus-related complaints of patients with chronic tinnitus. Ninety-six patients who were diagnosed with chronic tinnitus before the pandemic were enrolled in this study. Before the pandemic and in January 2022, all patients used the Visual Analog Scale (VAS) to assess tinnitus loudness, annoyance, and effect on everyday life, sleep, and concentration. Additionally, patients filled the Tinnitus Handicap Inventory (THI) and the Hyperacusis Questionnaire (HQ). In the entire cohort, tinnitus loudness, annoyance, and tinnitus-induced difficulties with concentration as well as THI and HQ scores increased significantly during the two pandemic years. Thirty-seven tinnitus patients contracted COVID-19 between March 2020 and January 2022. These patients were asked to list leading COVID-19 symptoms, changes in tinnitus complaints during and after the disease, and whether their hearing abilities were affected. Three patients in the COVID-19 group confirmed worsening their hearing abilities. There was no decrease in the tinnitus complaint during COVID-19, 24.3% of the infected patients reported exacerbation of tinnitus, and 75.7% said tinnitus remained the same. In the COVID-19-negative group, 13.5% reported tinnitus decrease during the pandemic, 57.6% said it remained the same, and 28.8% reported exacerbation of tinnitus. When split into infected and non-infected groups, a significant increase in tinnitus loudness, tinnitus effect on concentration, and THI scores were seen only in patients who contracted COVID-19, while hyperacusis worsened significantly (p < 0.05) only in COVID-19-negative tinnitus patients. Despite significant differences within the groups, there were no differences found between the groups. This study points to possible different effects of the infection with SARS-CoV-2 and the pandemic period on patients with chronic tinnitus. It also provides evidence for deterioration of preexisting tinnitus as a possible long-term effect of COVID-19.
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Affiliation(s)
- Murat Erinc
- Department of Audiology, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ahmet Mutlu
- Department of Otorhinolaryngology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
- Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Serdal Celik
- Department of Otorhinolaryngology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Tayyar Kalcioglu
- Department of Otorhinolaryngology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
- Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
- *Correspondence: Mahmut Tayyar Kalcioglu
| | - Agnieszka J. Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
- Agnieszka J. Szczepek
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Williams ZJ, Suzman E, Woynaroski TG. A Phenotypic Comparison of Loudness and Pain Hyperacusis: Symptoms, Comorbidity, and Associated Features in a Multinational Patient Registry. Am J Audiol 2021; 30:341-358. [PMID: 33877881 DOI: 10.1044/2021_aja-20-00209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Hyperacusis is a complex and poorly understood auditory disorder characterized by decreased tolerance to sound at levels that would not trouble most individuals. Recently, it has been suggested that individuals who experience otalgia in response to everyday sounds (termed pain hyperacusis) may differ clinically from those whose primary symptom is the perception of everyday sounds as excessively loud (termed loudness hyperacusis). Despite this theoretical distinction, there have been no empirical studies directly comparing these two populations of hyperacusis patients. Method Using data from a multinational patient registry (the Coordination of Rare Diseases at Sanford Registry), we examined self-reported demographics, symptoms, comorbidity, and response to treatment in a sample of 243 adults with hyperacusis, 152 of whom were classified as having pain hyperacusis based on reported symptoms. Bayesian statistical tests were used to investigate both the presence and absence of group differences between patients with loudness and pain hyperacusis. Results Individuals with pain hyperacusis presented with a more severe clinical phenotype, reporting a higher frequency of temporary symptom exacerbations (i.e., "setbacks"), less perceived symptom improvement over time, more severe comorbid headache disorders, and reduced benefit from sound therapy. However, the two hypothesized hyperacusis subtypes exhibited more similarities than differences, with the majority of symptoms and comorbidities being equally prevalent across groups. Multiple comorbidities were commonly observed, including tinnitus, primary headache disorders, psychiatric disorders, and functional somatic syndromes. Intolerance of sensory stimuli in other modalities was also frequently reported. Conclusion Although this study provides little evidence that loudness and pain hyperacusis are pathophysiologically distinct conditions, our findings indicate that a pain-predominant phenotype may be a meaningful prognostic marker in patients with hyperacusis.
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
| | - Evan Suzman
- Graduate Program in Biomedical Sciences, Vanderbilt University, Nashville, TN
| | - Tiffany G. Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
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Abstract
Tinnitus is a phantom auditory sensation in the absence of external sounds, while hyperacusis is an atypical sensitivity to external sounds that leads them to be perceived as abnormally loud or even painful. Both conditions may reflect the brain's over-compensation for reduced input from the ear. The present work differentiates between two compensation models: The additive central noise compensates for hearing loss and is likely to generate tinnitus, whereas the multiplicative central gain compensates for hidden hearing loss and is likely to generate hyperacusis. Importantly, both models predict increased variance in central representations of sounds, especially a nonlinear increase in variance by the central gain. The increased central variance limits the amount of central compensation and reduces temporal synchrony, which can explain the insufficient central gain reported in the literature. Future studies need to collect trial-by-trial firing variance data so that the present variance-based model can be falsified.
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Affiliation(s)
- Fan-Gang Zeng
- Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, and Otolaryngology - Head and Neck Surgery, Center for Hearing Research, University of California Irvine
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