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Berger JI, Gander PE, Kumar S. A social cognition perspective on misophonia. Philos Trans R Soc Lond B Biol Sci 2024; 379:20230257. [PMID: 39005025 DOI: 10.1098/rstb.2023.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/26/2024] [Indexed: 07/16/2024] Open
Abstract
Misophonia is commonly classified by intense emotional reactions to common everyday sounds. The condition has an impact both on the mental health of its sufferers and societally. As yet, formal models on the basis of misophonia are in their infancy. Based on developing behavioural and neuroscientific research we are gaining a growing understanding of the phenomenology and empirical findings in misophonia, such as the importance of context, types of coping strategies used and the activation of particular brain regions. In this article, we argue for a model of misophonia that includes not only the sound but also the context within which sound is perceived and the emotional reaction triggered. We review the current behavioural and neuroimaging literature, which lends support to this idea. Based on the current evidence, we propose that misophonia should be understood within the broader context of social perception and cognition, and not restricted within the narrow domain of being a disorder of auditory processing. We discuss the evidence in support of this hypothesis, as well as the implications for potential treatment approaches. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.
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Affiliation(s)
- Joel I Berger
- Department of Neurosurgery, University of Iowa, Iowa City, 52242 USA
| | - Phillip E Gander
- Department of Neurosurgery, University of Iowa, Iowa City, 52242 USA
- Department of Radiology, University of Iowa, Iowa City, 52242 USA
| | - Sukhbinder Kumar
- Department of Neurosurgery, University of Iowa, Iowa City, 52242 USA
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Formby C, Secor CA, Cherri D, Eddins DA. Background and Rationale for a Transitional Intervention for Debilitating Hyperacusis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1984-1993. [PMID: 38718264 PMCID: PMC11192566 DOI: 10.1044/2023_jslhr-23-00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 06/07/2024]
Abstract
PURPOSE This report provides the experimental, clinical, theoretical, and historical background that motivated a patented transitional intervention and its implementation and evaluation in a field trial for mitigation of debilitating loudness-based hyperacusis (LH). BACKGROUND AND RATIONALE Barriers for ameliorating LH, which is differentiated here from other forms of hyperacusis, are delineated, including counterproductive management and treatment strategies that may exacerbate the condition. Evidence for hyper-gain central auditory processes as the bases for LH and the associated LH-induced distress and stress responses are presented. This presentation is followed by an overview of prior efforts to use counseling and therapeutic sound as interventional tools for recalibrating the hyper-gain LH response. We also consider previous efforts to use output-limiting sound-protection devices in the management of LH. This historical background lays the foundation for our transitional intervention protocol and its implementation and evaluation in a field trial. CONCLUSIONS The successful implementation and evaluation of a transitional intervention, which we document in the outcomes of a companion proof-of-concept field trial in this issue, build on our prior efforts and those of others to understand, manage, and treat hyperacusis. These efforts to overcome significant barriers and vexing long-standing challenges in the management and treatment of LH, as reviewed here, are the pillars of the transitional intervention and its primary components, namely, counseling combined with protective sound management and therapeutic sound, which we detail in separate reports in this issue.
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Affiliation(s)
- Craig Formby
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
- Department of Communicative Disorders, University of Alabama, Tuscaloosa
| | - Carrie A. Secor
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
| | - Dana Cherri
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
| | - David A. Eddins
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
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Cherri D, Formby C, Secor CA, Eddins DA. Counseling Protocol for a Transitional Intervention for Debilitating Hyperacusis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1886-1902. [PMID: 38718266 PMCID: PMC11192559 DOI: 10.1044/2023_jslhr-23-00353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/31/2023] [Accepted: 12/18/2023] [Indexed: 06/07/2024]
Abstract
INTRODUCTION This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. DESCRIPTION OF COUNSELING COMPONENTS The counseling protocol includes five components. First, the patient's audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. RESULTS AND CONCLUSION The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention.
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Affiliation(s)
- Dana Cherri
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
| | - Craig Formby
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
- The University of Alabama, Tuscaloosa
| | - Carrie A. Secor
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
| | - David A. Eddins
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
- University of Central Florida, Orlando
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Aazh H, Najjari A, Moore BCJ. A Preliminary Analysis of the Clinical Effectiveness of Audiologist-Delivered Cognitive Behavioral Therapy Delivered via Video Calls for Rehabilitation of Misophonia, Hyperacusis, and Tinnitus. Am J Audiol 2024; 33:559-574. [PMID: 38651993 DOI: 10.1044/2024_aja-23-00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Cognitive behavioral therapy (CBT) is a key intervention for management of misophonia, hyperacusis, and tinnitus. The aim of this study was to perform a preliminary analysis comparing the scores for self-report questionnaires before and after audiologist-delivered CBT via video calls for adults with misophonia, hyperacusis, or tinnitus or a combination of these. METHOD This was a retrospective cross-sectional study. The data for 37 consecutive patients who received CBT for misophonia, hyperacusis, or tinnitus from a private institute in the United Kingdom were analyzed. Self-report questionnaires taken as part of routine care were as follows: 4C Questionnaires for tinnitus, hyperacusis, and misophonia (4C-T, 4C-H, and 4C-M, respectively), Tinnitus Impact Questionnaire (TIQ), Hyperacusis Impact Questionnaire (HIQ), Misophonia Impact Questionnaire (MIQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T). Responses were also obtained to other questionnaires related to tinnitus, hyperacusis, insomnia, and anxiety and mood disorders. A linear mixed-model method was used to assess the changes in response to the questionnaires pretreatment and posttreatment. RESULTS Pretreatment-posttreatment comparisons showed that scores for the 4C-T, 4C-H, 4C-M, TIQ, HIQ, MIQ, SSSQ, and SAD-T improved, with effect sizes of 1.4, 1.2, 1.3, 2.6, 0.9, 0.7, 0.9, and 1.4, respectively (all p < .05). CONCLUSIONS This preliminary analysis suggests that CBT via video calls may be effective in reducing the impact of misophonia, hyperacusis, and tinnitus. However, this study did not have a control group, so its results need to be interpreted with caution.
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Affiliation(s)
- Hashir Aazh
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis, London, United Kingdom
- Faculty of Engineering and Physical Sciences, University of Surrey, United Kingdom
| | - Anahita Najjari
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis, London, United Kingdom
| | - Brian C J Moore
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis, London, United Kingdom
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, United Kingdom
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Aazh H, Moore BCJ, Erfanian M. Confirmatory factor analysis of the Tinnitus Impact Questionnaire using data from patients seeking help for tinnitus alone or tinnitus combined with hyperacusis. PLoS One 2024; 19:e0302837. [PMID: 38718050 PMCID: PMC11078403 DOI: 10.1371/journal.pone.0302837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
A confirmatory factor analysis (CFA) of the Tinnitus Impact Questionnaire (TIQ) was performed. In contrast to commonly used tinnitus questionnaires, the TIQ is intended solely to assess the impact of tinnitus by not including items related to hearing loss or tinnitus loudness. This was a psychometric study based on a retrospective cross-sectional analysis of clinical data. Data were available for 155 new patients who had attended a tinnitus and hyperacusis clinic in the UK within a five-month period and had completed the TIQ. The mean age was 54 years (standard deviation = 14 years). The TIQ demonstrated good internal consistency, with Cronbach's α = 0.84 and McDonald's ω = 0.89. CFA showed that two items of the TIQ had low factor loadings for both one-factor and two-factor models and their scores showed low correlations with scores for other items. Bi-factor analysis gave a better fit, indicated by a relative chi-square (χ2) of 18.5, a Root-Mean Square Error of Approximation (RMSEA) of 0.103, a Comparative Fit Index (CFI) of 0.97, a Tucker Lewis Index (TLI) of 0.92, and a Standardized Root-Mean Residual (SPMR) of 0.038. Total TIQ scores were moderately correlated with scores for the Visual Analogue Scale of effect of tinnitus on life and the Screening for Anxiety and Depression-Tinnitus questionnaire, supporting the convergent validity of the TIQ. The TIQ score was not correlated with the pure-tone average hearing threshold, indicating discriminant validity. A multiple-causes multiple-indicator (MIMIC) model showed no influences of age, gender or hearing status on TIQ item scores. The TIQ is an internally consistent tool. CFA suggests a bi-factor model with sufficient unidimensionality to support the use of the overall TIQ score for assessing the impact of tinnitus. TIQ scores are distinct from the impact of hearing impairment among patients who have tinnitus combined with hearing loss.
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Affiliation(s)
- Hashir Aazh
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd, London, United Kingdom
- Audiology Department, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Brian C. J. Moore
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd, London, United Kingdom
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Mercede Erfanian
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd, London, United Kingdom
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London, United Kingdom
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Burke LA, El Refaie A. The Current State of Evidence Regarding Audiologist-Provided Cognitive Behavioural Therapy for the Management of Tinnitus: A Scoping Review. Audiol Res 2024; 14:412-431. [PMID: 38804459 PMCID: PMC11130867 DOI: 10.3390/audiolres14030035] [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: 03/25/2024] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) for tinnitus management is effective and widely recommended by national and international practice guidelines. However, all the evidence for CBT so far has come from Psychologist-led programs, and the potential role of Audiologists in providing CBT for tinnitus remains an important consideration. OBJECTIVES This study sets out to systematically map the body of literature relating to Audiologist-provided CBT for tinnitus, in order to summarise the current state of evidence and determine directions for future research. ELIGIBILITY CRITERIA Sources were eligible for inclusion if they addressed the concept of Audiologist-provided CBT. No restrictions were imposed on the date of publication. Only sources published in English were included. SOURCES OF EVIDENCE A wide range of primary and secondary literature sources were sought. CHARTING METHODS Data from included sources were charted systematically using a pre-designed data charting form. RESULTS Of the 267 identified sources, 30 were included in this review. This included both primary and secondary literature sources. Primary sources were compared and showed variation across Audiologist-provided CBT programs both in terms of procedural details and from a research standpoint. CONCLUSIONS A growing body of evidence has addressed the concept of Audiologist-provided CBT. Directions for future research include further primary research with an increased focus on face-to-face Audiologist-provided CBT, and a comparison of the outcomes of Audiologist-provided vs. Psychologist-provided CBT.
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Affiliation(s)
- Louise A. Burke
- Audiology, School of Clinical Therapies, College of Medicine and Health, University College Cork, T12 EK59 Cork, Ireland
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Wertz J, Rüttiger L, Bender B, Klose U, Stark RS, Dapper K, Saemisch J, Braun C, Singer W, Dalhoff E, Bader K, Wolpert SM, Knipper M, Munk MHJ. Differential cortical activation patterns: pioneering sub-classification of tinnitus with and without hyperacusis by combining audiometry, gamma oscillations, and hemodynamics. Front Neurosci 2024; 17:1232446. [PMID: 38239827 PMCID: PMC10794389 DOI: 10.3389/fnins.2023.1232446] [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: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 01/22/2024] Open
Abstract
The ongoing controversies about the neural basis of tinnitus, whether linked with central neural gain or not, may hamper efforts to develop therapies. We asked to what extent measurable audiometric characteristics of tinnitus without (T) or with co-occurrence of hyperacusis (TH) are distinguishable on the level of cortical responses. To accomplish this, electroencephalography (EEG) and concurrent functional near-infrared spectroscopy (fNIRS) were measured while patients performed an attentionally demanding auditory discrimination task using stimuli within the individual tinnitus frequency (fTin) and a reference frequency (fRef). Resting-state-fMRI-based functional connectivity (rs-fMRI-bfc) in ascending auditory nuclei (AAN), the primary auditory cortex (AC-I), and four other regions relevant for directing attention or regulating distress in temporal, parietal, and prefrontal cortex was compiled and compared to EEG and concurrent fNIRS activity in the same brain areas. We observed no group differences in pure-tone audiometry (PTA) between 10 and 16 kHz. However, the PTA threshold around the tinnitus pitch was positively correlated with the self-rated tinnitus loudness and also correlated with distress in T-groups, while TH experienced their tinnitus loudness at minimal loudness levels already with maximal suffering scores. The T-group exhibited prolonged auditory brain stem (ABR) wave I latency and reduced ABR wave V amplitudes (indicating reduced neural synchrony in the brainstem), which were associated with lower rs-fMRI-bfc between AAN and the AC-I, as observed in previous studies. In T-subjects, these features were linked with elevated spontaneous and reduced evoked gamma oscillations and with reduced deoxygenated hemoglobin (deoxy-Hb) concentrations in response to stimulation with lower frequencies in temporal cortex (Brodmann area (BA) 41, 42, 22), implying less synchronous auditory responses during active auditory discrimination of reference frequencies. In contrast, in the TH-group gamma oscillations and hemodynamic responses in temporoparietal regions were reversed during active discrimination of tinnitus frequencies. Our findings suggest that T and TH differ in auditory discrimination and memory-dependent directed attention during active discrimination at either tinnitus or reference frequencies, offering a test paradigm that may allow for more precise sub-classification of tinnitus and future improved treatment approaches.
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Affiliation(s)
- Jakob Wertz
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Robert S. Stark
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Konrad Dapper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
- Department of Biology, Technical University Darmstadt, Darmstadt, Germany
| | - Jörg Saemisch
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | | | - Wibke Singer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Katharina Bader
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Stephan M. Wolpert
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Matthias H. J. Munk
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Department of Biology, Technical University Darmstadt, Darmstadt, Germany
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Aazh H, Kartsonaki C, Moore BCJ. Psychometric evaluation of the 4C tinnitus management questionnaire for patients with tinnitus alone or tinnitus combined with hyperacusis. Int J Audiol 2024; 63:21-29. [PMID: 36426916 DOI: 10.1080/14992027.2022.2143430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the psychometric properties of a new questionnaire evaluating patients' confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. DESIGN Retrospective cross-sectional based on patient records. STUDY SAMPLES 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. RESULTS Cronbach's alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. CONCLUSIONS The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients' confidence in managing their tinnitus.
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Affiliation(s)
- Hashir Aazh
- Audiology Department, Royal Surrey NHS Foundation Trust, Guildford, UK
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, USA
- Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Christiana Kartsonaki
- MRC Population Health Research Unit, Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brian C J Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, UK
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Jahn KN, Koach CE. Hyperacusis Diagnosis and Management in the United States: Clinical Audiology Practice Patterns. Am J Audiol 2023; 32:950-961. [PMID: 37917915 PMCID: PMC11001428 DOI: 10.1044/2023_aja-23-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/27/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE Hyperacusis often leads to debilitating psychosocial consequences, but there is no standard protocol for its diagnosis and management in the United States. In this study, we surveyed U.S. clinical audiologists to understand their education and clinical practices surrounding the evaluation and treatment of hyperacusis. METHOD An online survey was distributed to clinical audiologists across the United States. Survey responses were quantified using descriptive statistics and inductive content analysis. RESULTS Hyperacusis definitions and clinical practice patterns varied widely across the 102 respondents. Respondents cited a lack of education and training as the primary barrier to effective audiological diagnosis and management of hyperacusis, with most respondents reporting ≤ 5 hr of hyperacusis education. Other primary barriers to effective audiological management of hyperacusis included time constraints, reimbursement, poor sensitivity and specificity of available diagnostic tools, and poor efficacy of available treatments and management strategies. Most respondents (82.5%) agreed that audiologists are the primary professionals who are responsible for implementing hyperacusis interventions. However, 63.3% of respondents reported that their clinic does not have a hyperacusis management protocol, and 80.0% routinely recommend treatment that is outside their scope of practice to implement (cognitive behavioral therapy). CONCLUSIONS Clinical audiologists in the United States do not receive uniform education on hyperacusis, and they report multiple barriers to its evidence-based diagnosis and management. Effective hyperacusis management necessitates a multidisciplinary approach. The information obtained via this survey will pave the way toward the refinement of interprofessional education programs and the development of systematic, evidence-based clinical protocols for hyperacusis. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24431188.
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Affiliation(s)
- Kelly N. Jahn
- Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson
- Callier Center for Communication Disorders, The University of Texas at Dallas
| | - Chelsea E. Koach
- Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson
- Callier Center for Communication Disorders, The University of Texas at Dallas
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Vasilkov V, Caswell-Midwinter B, Zhao Y, de Gruttola V, Jung DH, Liberman MC, Maison SF. Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus. Sci Rep 2023; 13:19870. [PMID: 38036538 PMCID: PMC10689483 DOI: 10.1038/s41598-023-46741-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Tinnitus, reduced sound-level tolerance, and difficulties hearing in noisy environments are the most common complaints associated with sensorineural hearing loss in adult populations. This study aims to clarify if cochlear neural degeneration estimated in a large pool of participants with normal audiograms is associated with self-report of tinnitus using a test battery probing the different stages of the auditory processing from hair cell responses to the auditory reflexes of the brainstem. Self-report of chronic tinnitus was significantly associated with (1) reduced cochlear nerve responses, (2) weaker middle-ear muscle reflexes, (3) stronger medial olivocochlear efferent reflexes and (4) hyperactivity in the central auditory pathways. These results support the model of tinnitus generation whereby decreased neural activity from a damaged cochlea can elicit hyperactivity from decreased inhibition in the central nervous system.
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Affiliation(s)
- Viacheslav Vasilkov
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Benjamin Caswell-Midwinter
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Yan Zhao
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02114, USA
| | - David H Jung
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - M Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Stéphane F Maison
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA.
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Monaco A, Cattaneo R, Di Nicolantonio S, Strada M, Altamura S, Ortu E. Central effects of trigeminal electrical stimulation. Cranio 2023:1-24. [PMID: 38032105 DOI: 10.1080/08869634.2023.2280153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This is a review of the literature on the main neuromodulation techniques, focusing on the possibility of introducing sensory threshold ULFTENS into them. Electro neuromodulation techniques have been in use for many years as promising methods of therapy for cognitive and emotional disorders. One of the most widely used forms of stimulation for orofacial pain is transcutaneous trigeminal stimulation on three levels: supraorbital area, dorsal surface of the tongue, and anterior skin area of the tragus. The purpose of this review is to trigger interest on using dental ULFTENS as an additional trigeminal neurostimulation and neuromodulation technique in the context of TMD. In particular, we point out the possibility of using ULFTENS at a lower activation level than that required to trigger a muscle contraction that is capable of triggering effects at the level of the autonomic nervous system, with extreme ease of execution and few side effects.
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Affiliation(s)
- Annalisa Monaco
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Ruggero Cattaneo
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | | | - Marco Strada
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Serena Altamura
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Ortu
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
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Dozier T, Mitchell N. Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder. F1000Res 2023; 12:808. [PMID: 37881332 PMCID: PMC10594049 DOI: 10.12688/f1000research.133506.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual's coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual's impairment. Results: Anticipatory anxiety and avoidance of phase one contributes to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. Phase four includes internal and external coping behaviors to the intense emotions and distress, and phase five includes the consequences of those behaviors. Internal consequences include beliefs fiveand new emotions based on environmental responses to anger and panic. For example, the development of emotions such as shame and guilt, and beliefs regarding how 'intolerable' the trigger is. Conclusions: We assert misophonia is a multi-sensory condition and includes anticipatory anxiety, conditioned physical reflexes, intense emotional and physical distress, subsequent internal and external responses, and environmental consequences.
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Miller L. Cognitive behavioral therapy for patients suffering with tinnitus distress. JAAPA 2023; 36:13-16. [PMID: 37561667 DOI: 10.1097/01.jaa.0000947036.33633.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT Of the 21% of the US population with tinnitus, between 3% and 6% develop tinnitus distress, a sudden, traumatic, and severe emotional response to tinnitus. Cognitive behavioral therapy (CBT) is the most effective therapy for reducing the initial and secondary emotional stresses caused by tinnitus distress. The skills taught in CBT lead to habituation and desensitization, providing relief for the patient. This article describes tinnitus distress, CBT, and resources that clinicians can use immediately in their practices.
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Affiliation(s)
- Leila Miller
- Leila Miller practices at Midwest Medical Specialists-Otolaryngology and Dermatology, in Merriam, Kan. The author has disclosed no potential conflicts of interest, financial or otherwise
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14
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Tang D, Wang J, Yu X, Yu H. The clinical effects of modified tinnitus relieving sound (MTRS) for chronic tinnitus: protocol for a randomized controlled trial. Trials 2023; 24:372. [PMID: 37268971 DOI: 10.1186/s13063-023-07389-8] [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: 12/16/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Chronic subjective tinnitus has become an increasingly serious hazard that affects the health-related quality of life for millions of people. Due to the lack of curative treatment strategies, this study aims to introduce a novel acoustic therapy named the modified tinnitus relieving sound (MTRS) for tinnitus and to evaluate the efficacy of MTRS in comparison with unmodified music (UM) which served as a control. METHODS AND ANALYSIS A randomized, double-blinded, controlled, clinical trial will be carried out. Sixty-eight patients with subjective tinnitus will be recruited and randomly allocated into two groups in 1:1 ratio. The primary outcome is Tinnitus Handicapped Inventory (THI); the secondary outcomes are the Hospital Anxiety and Distress Scale (HADS; HADS subscales for Anxiety (HADS-A) and Depression (HADS-D)), Athens Insomnia Scale (AIS), the visual analog scale (VAS) for tinnitus, and tinnitus loudness matched by sensation level (SL). Assessment will be performed at baseline and at 1, 3, 9, and 12 months post-randomization. The sound stimulus will be persistent until 9 months after randomization, and be interdictory in the last three months. Data collected during the intervention process will be analyzed and compared to baseline. ETHICS AND DISSEMINATION This trial received ethical approval from the Institutional Review Board (IRB) of Eye & ENT Hospital of Fudan University (No. 2017048). The study results will be disseminated via academic journals and conferences. FUNDING This study is supported by the Shanghai Shenkang Development Program (SHDC12019119), the Excellent Doctors-Excellent Clinical Researchers Program (SYB202008), the Shanghai Rising-Star Program (23QC1401200), the Shanghai Rising Stars of Medical Talent Youth Development Program (2021-99), the National Natural Science Foundation of China (81800912), and the National Natural Science Foundation of Shanghai (21ZR1411800). TRIAL REGISTRATION ClinicalTrials.gov NCT04026932. Registered on 18 July 2019.
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Affiliation(s)
- Dongmei Tang
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, People's Republic of China.
| | - Jinghan Wang
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, People's Republic of China
| | - Xiaopei Yu
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China
| | - Huiqian Yu
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, People's Republic of China.
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15
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Neacsiu AD, Szymkiewicz V, Galla JT, Li B, Kulkarni Y, Spector CW. The neurobiology of misophonia and implications for novel, neuroscience-driven interventions. Front Neurosci 2022; 16:893903. [PMID: 35958984 PMCID: PMC9359080 DOI: 10.3389/fnins.2022.893903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Decreased tolerance in response to specific every-day sounds (misophonia) is a serious, debilitating disorder that is gaining rapid recognition within the mental health community. Emerging research findings suggest that misophonia may have a unique neural signature. Specifically, when examining responses to misophonic trigger sounds, differences emerge at a physiological and neural level from potentially overlapping psychopathologies. While these findings are preliminary and in need of replication, they support the hypothesis that misophonia is a unique disorder. In this theoretical paper, we begin by reviewing the candidate networks that may be at play in this complex disorder (e.g., regulatory, sensory, and auditory). We then summarize current neuroimaging findings in misophonia and present areas of overlap and divergence from other mental health disorders that are hypothesized to co-occur with misophonia (e.g., obsessive compulsive disorder). Future studies needed to further our understanding of the neuroscience of misophonia will also be discussed. Next, we introduce the potential of neurostimulation as a tool to treat neural dysfunction in misophonia. We describe how neurostimulation research has led to novel interventions in psychiatric disorders, targeting regions that may also be relevant to misophonia. The paper is concluded by presenting several options for how neurostimulation interventions for misophonia could be crafted.
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Affiliation(s)
- Andrada D. Neacsiu
- Duke Center for Misophonia and Emotion Regulation, Duke Brain Stimulation Research Center, Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Duke University, Durham, NC, United States
| | - Victoria Szymkiewicz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Jeffrey T. Galla
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Brenden Li
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Yashaswini Kulkarni
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Cade W. Spector
- Department of Philosophy, Duke University, Durham, NC, United States
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Kula FB, Cropley M, Aazh H. Hyperacusis and Misophonia: A Systematic Review of Psychometric Measures. J Am Acad Audiol 2022; 33:417-428. [PMID: 35817311 DOI: 10.1055/a-1896-5032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Hyperacusis can be defined as an intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. Misophonia is defined as a high magnitude of emotional and behavioral reaction to certain sounds produced by human beings, such as eating sounds and breathing sounds. Several psychometric instruments have been developed to assess symptoms and the impact of hyperacusis and misophonia; however, to the authors' knowledge, no study has evaluated and compared the methodological quality of the studies on psychometric properties of the existing instruments. PURPOSE This article systematically reviews the research studies assessing the psychometric properties of the instruments used for hyperacusis and misophonia and assesses the quality and appropriateness of the methodologies used. RESEARCH DESIGN Systematic review. DATA COLLECTION AND ANALYSIS A systematic literature search was performed using five electronic literature databases (PubMed, Scopus, PsycINFO, Google Scholar, and Web of Science). Studies were included if they were written in English and reported information about the psychometric properties of instruments measuring hyperacusis or misophonia symptoms or their impact. The quality of the studies and that of the psychometric instruments were evaluated using the consensus-based standards for the selection of health-measurement instruments (COSMIN) tool. RESULTS The title and abstracts of 916 articles were screened and 39 articles were selected for full-text evaluation, with 14 articles meeting the inclusion criteria. From these 14 articles, 8 different instruments (5 for hyperacusis and 3 for misophonia) were identified and reviewed comprising: (1) Hyperacusis Questionnaire (HQ), (2) Inventory of Hyperacusis Symptoms, (3) questionnaire on hypersensitivity to sound, (4) Hyperacusis Handicap Questionnaire, (5) short HQ, (6) Amsterdam Misophonia Scale, (7) MisoQuest, and (8) the Misophonia Questionnaire. CONCLUSION None of the papers reviewed reported all the information required to meet the COSMIN standards. The studies' methodological quality varied between "very good" and "inadequate" depending on their grade on the COSMIN tool. There is a need for further research on the psychometric properties of the instruments included in this review.
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Affiliation(s)
- Fatma Betul Kula
- Department of Psychology, The University of Surrey, Guildford, United Kingdom
| | - Mark Cropley
- Department of Psychology, The University of Surrey, Guildford, United Kingdom
| | - Hashir Aazh
- Audiology Department, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
- Department of Physics, Faculty of Engineering and Physical Sciences, The University of Surrey, Guildford, United Kingdom
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17
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Aazh H, Taylor L, Danesh AA, Moore BCJ. The Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Tinnitus for Patients with Tinnitus Alone or Combined with Hyperacusis and/or Misophonia: A Preliminary Analysis. J Am Acad Audiol 2022; 33:405-416. [PMID: 37146649 PMCID: PMC11293900 DOI: 10.1055/a-2087-0262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/10/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND In the United Kingdom, audiologist-delivered cognitive behavioral therapy (CBT) is a key intervention to alleviate the distress caused by tinnitus and its comorbid hyperacusis. However, the availability of face-to-face CBT is limited, and such therapy involves significant costs. CBT provided via the internet provides a potential solution to improve access to CBT for tinnitus. PURPOSE The aim was to perform a preliminary assessment of the effect of a specific program of nonguided internet-based CBT for tinnitus, denoted iCBT(T), in alleviating the problems caused by tinnitus alone or tinnitus combined with hyperacusis. RESEARCH DESIGN This was a retrospective cross-sectional study. STUDY SAMPLE The data for 28 people with tinnitus who completed the iCBT(T) program and answered a series of questions about their tinnitus and hearing status were included in the study. Twelve patients also reported having hyperacusis (including five also with misophonia). DATA COLLECTION AND ANALYSIS The iCBT(T) program has seven self-help modules. Anonymous data were collected retrospectively from patients' answers to the questions in the iCBT(T) initial and final assessment modules. Questionnaires administered within the iCBT(T) program were: 4C Tinnitus Management Questionnaire (4C), Screening for Anxiety and Depression in Tinnitus (SAD-T), and the CBT Effectiveness Questionnaire (CBT-EQ). RESULTS Responses to the 4C showed a significant improvement from pre- to posttreatment, with a medium effect size. The mean improvement was similar for those with and without hyperacusis. Responses to the SAD-T questionnaire also showed a significant improvement from pre- to posttreatment with a medium effect size. The improvement was significantly greater for participants with tinnitus alone than for participants who also had hyperacusis. For both the 4C and the SAD-T, the improvements were not significantly related to age or gender. Participants' views of the effectiveness of the iCBT(T) program were assessed using the CBT-EQ. The mean score was 50 out of a maximum of 80, indicating moderately high effectiveness. CBT-EQ scores did not differ for those with and without hyperacusis. CONCLUSION Based on this preliminary analysis, the iCBT(T) program showed promising results in improving the ability to manage tinnitus and decreasing symptoms of anxiety and depression. Future studies with larger samples and control group(s) are required to further assess various aspects of this program.
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Affiliation(s)
- Hashir Aazh
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd., London, United Kingdom
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
- Faculty of Engineering and Physical Sciences, University of Surrey, United Kingdom
| | - Lauren Taylor
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd., London, United Kingdom
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Ali A. Danesh
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
| | - Brian C. J. Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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18
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Ferrer-Torres A, Giménez-Llort L. Misophonia: A Systematic Review of Current and Future Trends in This Emerging Clinical Field. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6790. [PMID: 35682372 PMCID: PMC9180704 DOI: 10.3390/ijerph19116790] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/01/2023]
Abstract
Misophonia is a scarcely known disorder. This systematic review (1) offers a quantitative and qualitative analysis of the literature since 2001, (2) identifies the most relevant aspects but also controversies, (3) identifies the theoretical and methodological approaches, and (4) highlights the outstanding advances until May 2022 as well as aspects that remain unknown and deserve future research efforts. Misophonia is characterized by strong physiological, emotional, and behavioral reactions to auditory, visual, and/or kinesthetic stimuli of different nature regardless of their physical characteristics. These misophonic responses include anger, general discomfort, disgust, anxiety, and avoidance and escape behaviors, and decrease the quality of life of the people with the disorder and their relatives. There is no consensus on the diagnostic criteria yet. High comorbidity between misophonia and other psychiatric and auditory disorders is reported. Importantly, the confusion with other disorders contributes to its underdiagnosis. In recent years, assessment systems with good psychometric properties have increased considerably, as have treatment proposals. Although misophonia is not yet included in international classification systems, it is an emerging field of growing scientific and clinical interest.
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Affiliation(s)
- Antonia Ferrer-Torres
- L’Alfatier-Centro Médico Psicológico, 08025 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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19
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Bendowska A, Malak R, Zok A, Baum E. The Ethics of Translational Audiology. Audiol Res 2022; 12:273-280. [PMID: 35645198 PMCID: PMC9149949 DOI: 10.3390/audiolres12030028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Translational research moves promising primary research results from the laboratory to practical application. The transition from basic science to clinical research and from clinical research to routine healthcare applications presents many challenges, including ethical. This paper addresses issues in the ethics of translational audiology and discusses the ethical principles that should guide research involving people with hearing loss. Four major ethical principles are defined and explained, which are as follows: beneficence, nonmaleficence, autonomy, and justice. In addition, the authors discuss issues of discrimination and equal access to medical services among people with hearing loss. Despite audiology’s broad field of interest, which includes evaluation and treatment of auditory disorders (e.g., deafness, tinnitus, misophonia, or hyperacusis) and balance disorders, this study focuses primarily on deafness and its therapies.
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Affiliation(s)
- Aleksandra Bendowska
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
- Correspondence:
| | - Roksana Malak
- Department and Clinic of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-545 Poznan, Poland;
| | - Agnieszka Zok
- Division of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
- Division of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
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20
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Swedo SE, Baguley DM, Denys D, Dixon LJ, Erfanian M, Fioretti A, Jastreboff PJ, Kumar S, Rosenthal MZ, Rouw R, Schiller D, Simner J, Storch EA, Taylor S, Werff KRV, Altimus CM, Raver SM. Consensus Definition of Misophonia: A Delphi Study. Front Neurosci 2022; 16:841816. [PMID: 35368272 PMCID: PMC8969743 DOI: 10.3389/fnins.2022.841816] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 01/24/2023] Open
Abstract
Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.
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Affiliation(s)
- Susan E. Swedo
- PANDAS Physicians Network, Mooresville, NC, United States,Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - David M. Baguley
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom,Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Laura J. Dixon
- Department of Psychology, University of Mississippi, Oxford, MS, United States
| | - Mercede Erfanian
- UCL Institute for Environmental Design and Engineering, University College London, London, United Kingdom
| | | | - Pawel J. Jastreboff
- Jastreboff Hearing Disorders Foundation, Columbia, MD, United States,Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sukhbinder Kumar
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - M. Zachary Rosenthal
- Center for Misophonia and Emotion Regulation, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Romke Rouw
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Daniela Schiller
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Julia Simner
- School of Psychology, Pevensey Building, University of Sussex, Brighton, United Kingdom,Department of Psychology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Steven Taylor
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Kathy R. Vander Werff
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, United States
| | - Cara M. Altimus
- Center for Strategic Philanthropy, Milken Institute, Washington, DC, United States
| | - Sylvina M. Raver
- Center for Strategic Philanthropy, Milken Institute, Washington, DC, United States,*Correspondence: Sylvina M. Raver,
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21
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Sheppard A, Ishida I, Holder T, Stocking C, Qian J, Sun W. Tinnitus Assessment and Management: A Survey of Practicing Audiologists in the United States and Canada. J Am Acad Audiol 2022; 33:75-81. [PMID: 36049753 DOI: 10.1055/s-0041-1736576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Tinnitus is a prevalent auditory disorder that can become severely debilitating. Despite decades of investigation, there remains no conclusive cure for tinnitus. Clinical practice guidelines (CPGs) are available for assessing and managing tinnitus. Even though such guidelines have been available for several years, the degree that audiologists adhere to them has remained unexplored. PURPOSE OF STUDY To determine what clinical practices are commonly used by audiologists in the assessment and management of the patient population with tinnitus, we administered an online survey to audiologists practicing in the United States and Canada. RESULTS Among the audiologists that completed the survey and were included in the final analysis (n = 61), 70% were from the United States and 30% were from Canada. The audiologists represented a wide range of clinical experience (1-35 years). On average, those who completed the survey were relatively confident in their ability to assess and manage tinnitus patients indicated by a 0 to 100 Likert scale, with 0 representing no confidence (mean 72.5, ± 21.5 standard deviation). The most commonly reported tinnitus assessment tools were pure tone audiogram (0.25-8 kHz), administration of standardized questionnaires, and tinnitus pitch and loudness matching. Approximately half (55%) of audiologists indicated they include otoacoustic emissions, while less audiologists (<40%) reported measuring high-frequency thresholds, minimum masking levels, or loudness discomfort levels. The most common recommendation for tinnitus patients was amplification (87%), followed by counseling (80%) and sound therapy (79%). CONCLUSION Few audiologists administer a truly comprehensive tinnitus assessment and ∼20% indicated not recommending counseling or sound therapy to manage tinnitus. The results are discussed in the context of what is explicitly indicated in published CPGs, professional organization recommendations, and recent findings of peer-reviewed literature.
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Affiliation(s)
- Adam Sheppard
- Department of Communicative Disorders and Sciences, Center for Hearing and Deafness, State University of New York at Buffalo, Buffalo, New York
| | - Ieda Ishida
- Innovation Centre Toronto, Sonova Canada, Mississauga, Ontario
| | - Thea Holder
- Department of Communicative Disorders and Sciences, UB Speech-Language and Hearing Clinic, State University of New York at Buffalo, Buffalo, New York
| | - Christina Stocking
- Department of Communicative Disorders and Sciences, UB Speech-Language and Hearing Clinic, State University of New York at Buffalo, Buffalo, New York
| | - Jinyu Qian
- Department of Communicative Disorders and Sciences, Center for Hearing and Deafness, State University of New York at Buffalo, Buffalo, New York.,Innovation Centre Toronto, Sonova Canada, Mississauga, Ontario
| | - Wei Sun
- Department of Communicative Disorders and Sciences, Center for Hearing and Deafness, State University of New York at Buffalo, Buffalo, New York
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22
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郝 娟, 夏 立, 杨 向. [The latest research progress of tinnitus related treatment]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1141-1144. [PMID: 34886634 PMCID: PMC10127643 DOI: 10.13201/j.issn.2096-7993.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 04/30/2023]
Abstract
Tinnitus is a kind of phantom hearing. The quality of life of millions of people around the world is affected by it. There is no data to prove that drugs can be cured. There is no final conclusion on the clinical treatment of tinnitus. This article focuses on the treatment of tinnitus: Drug Treatment, Traditional Chinese Medicine, Surgical Treatment, Hyperbaric Oxygen Therapy, Acoustic Resonance Therapy, Transcranial Magnetic Stimulation Therapy, Cognitive Behavioral Therapy(CBT), Tinnitus Retraining Therapy (TRT), Multiple Compound Sound Therapy, etc. Provide more personalized tinnitus treatment programs for clinical patients.
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23
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Cognitive Behavioral Therapy for Tinnitus: Addressing the Controversy of Its Clinical Delivery by Audiologists. Ear Hear 2021; 43:283-289. [PMID: 34711745 DOI: 10.1097/aud.0000000000001150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Audiologists' role in providing care for tinnitus typically includes conducting an audiologic evaluation, fitting hearing aids when appropriate, assessing the impact of tinnitus, and facilitating use of sound to improve quality of life with tinnitus when appropriate. Cognitive behavioral therapy (CBT) is consistently judged by systematic reviews as having the strongest evidence relative to other therapies for improving quality of life with tinnitus. Because audiologists are already playing an active role in providing care for tinnitus, and the relative paucity of behavioral health providers who are experienced in implementing CBT for tinnitus, a logical question is whether audiologists can provide CBT and whether it is within their scope of practice. In this article, we present both sides of the argument as to whether audiologists can provide CBT and we make recommendations for appropriate administration of CBT for tinnitus management.
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Knipper M, Mazurek B, van Dijk P, Schulze H. Too Blind to See the Elephant? Why Neuroscientists Ought to Be Interested in Tinnitus. J Assoc Res Otolaryngol 2021; 22:609-621. [PMID: 34686939 PMCID: PMC8599745 DOI: 10.1007/s10162-021-00815-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/30/2021] [Indexed: 01/13/2023] Open
Abstract
A curative therapy for tinnitus currently does not exist. One may actually exist but cannot currently be causally linked to tinnitus due to the lack of consistency of concepts about the neural correlate of tinnitus. Depending on predictions, these concepts would require either a suppression or enhancement of brain activity or an increase in inhibition or disinhibition. Although procedures with a potential to silence tinnitus may exist, the lack of rationale for their curative success hampers an optimization of therapeutic protocols. We discuss here six candidate contributors to tinnitus that have been suggested by a variety of scientific experts in the field and that were addressed in a virtual panel discussion at the ARO round table in February 2021. In this discussion, several potential tinnitus contributors were considered: (i) inhibitory circuits, (ii) attention, (iii) stress, (iv) unidentified sub-entities, (v) maladaptive information transmission, and (vi) minor cochlear deafferentation. Finally, (vii) some potential therapeutic approaches were discussed. The results of this discussion is reflected here in view of potential blind spots that may still remain and that have been ignored in most tinnitus literature. We strongly suggest to consider the high impact of connecting the controversial findings to unravel the whole complexity of the tinnitus phenomenon; an essential prerequisite for establishing suitable therapeutic approaches.
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Affiliation(s)
- Marlies Knipper
- Molecular Physiology of Hearing, Tübingen Hearing Research Centre (THRC), Department of Otolaryngology, Head & Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany.
| | - Birgit Mazurek
- Tinnitus Center Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Holger Schulze
- Experimental Otolaryngology, Friedrich-Alexander Universität Erlangen-Nürnberg, Waldstrasse 1, 91054, Erlangen, Germany
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Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms. Ear Hear 2021; 42:917-926. [PMID: 33259445 DOI: 10.1097/aud.0000000000000982] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population. DESIGN This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9. RESULTS Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with highest overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%. CONCLUSIONS The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis.
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Zitelli L. Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report. Semin Hear 2021; 42:123-135. [PMID: 34381296 DOI: 10.1055/s-0041-1731693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.
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Affiliation(s)
- Lori Zitelli
- Department of Audiology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
Die Misophonie ist eine Intoleranz auf bestimmte Alltagsgeräusche. Hierbei fungieren als „Trigger“ „menschliche Körpergeräusche“, z. B. Schlucken/Schmatzen/Atemgeräusche oder Geräusche, die von Menschen, aber nicht vom menschlichen Körper erzeugt werden (z. B. Klicken Kugelschreiberknopf), ferner Tier‑/Maschinengeräusche. Die Betroffenen verspüren sofort eine negativ-emotionale Reaktion wie Wut, Aggression, Ekel u.a. Objektivierbare Veränderungen sind Herzfrequenzerhöhung und Blutdruckveränderungen. Die emotionale Reaktion ist individuell und hängt z. B. von Geräuschart, persönlicher Vorerfahrung, sozialem Kontext oder psychologischem Profil ab. Die Misophonie ist bisher als Krankheit nicht definiert und keinem offiziellen Diagnosesystem zugeordnet, sie scheint eine eigenständige Störung zu sein: Assoziationen bestehen u. a. mit Aufmerksamkeits‑/Zwangsstörungen, Tinnitus, Hyperakusis, Autismus-Spektrum-Krankheiten. Definitionskriterien wurden 2013 veröffentlicht; verschiedene, validierte Fragebögen wurden bisher zur Misophonieausprägung entwickelt. Studien mit funktionellen MRT-Untersuchungen des Kopfes zeigten eine übermäßige Aktivierung des anterioren Inselkortex (AIC) und seiner benachbarten Regionen, die für Emotionsverarbeitung/-regulation verantwortlich sind. Bisher gibt es keine randomisierten kontrollierten Studien zur Therapie. Einzelne Publikationen beschreiben kognitive Verhaltensinterventionen, Retrainingtherapien und Schallmaskierungssysteme. Zur Triggerreduktion werden Ohrstöpsel/Musikkopfhörer verwendet. Auch HNO-Ärzte können mit Misophoniepatienten konfrontiert werden, z. B. zur Klärung des Hörvermögens oder Beratung von Therapiemöglichkeiten. Der Bericht stellt eine Übersicht des aktuellen Wissensstands zur Misophonie sowie ihrer Diagnostik und Therapie dar.
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Affiliation(s)
- C Schwemmle
- Arbeitsbereich Phoniatrie, Pädaudiologie, klinische Audiologie, Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
| | - C Arens
- Arbeitsbereich Phoniatrie, Pädaudiologie, klinische Audiologie, Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
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28
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Boecking B, Biehl R, Brueggemann P, Mazurek B. Health-Related Quality of Life, Depressive Symptoms, Anxiety, and Somatization Symptoms in Male and Female Patients with Chronic Tinnitus. J Clin Med 2021; 10:jcm10132798. [PMID: 34202097 PMCID: PMC8267833 DOI: 10.3390/jcm10132798] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: To investigate the joint impact of tinnitus-related distress (TRD), anxiety, depressive symptoms, and other somatization symptoms on health-related quality of life (HRQoL) in female vs. male patients with chronic tinnitus. Method: Three-hundred-and-fifty-two patients with chronic tinnitus completed audiological testing and a psychological assessment battery that comprised—among other measures—German versions of the Tinnitus Questionnaire, Hospital Anxiety and Depression Scale, Somatic Symptom Scale-8, and Health-Related Quality of Life scale. Descriptive analyses examined associations as well as within- and between-gender differences of the measured variables. Gender-specific serial indirect effects analyses aimed to explain the impact of TRD on HRQoL through psychological processes, notably anxiety, depressive symptoms, and somatization symptoms. Results: Both female and male patients yielded lower mental than physical HRQoL and negative associations between the measured psychological variables and HRQoL. Compared to male patients, female patients reported higher levels of tinnitus-related- and wider psychological distress, other somatization symptoms (e.g., headaches), and impairments in mental and physical HRQoL. For each gender, depressive symptoms, anxiety, and somatization symptoms fully mediated the effect of TRD on mental and physical HRQoL. A double-dissociation revealed an interaction of somatization symptoms and depression on the TRD-HRQoL association in women, and of somatization symptoms and anxiety in men. Conclusions: In patients with chronic tinnitus, psychological constructs account for reported impairments in both mental and physical HRQoL. To improve patients’ HRQoL, treatment conceptualizations should consider gender-specific psychological expressions of low mood or anxiety.
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Affiliation(s)
| | | | | | - Birgit Mazurek
- Correspondence: ; Tel.: +49-30-450-009; Fax: +49-30-450-555-907
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29
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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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30
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Williams ZJ, He JL, Cascio CJ, Woynaroski TG. A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms. Neurosci Biobehav Rev 2021; 121:1-17. [PMID: 33285160 PMCID: PMC7855558 DOI: 10.1016/j.neubiorev.2020.11.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50-70 % of this population exhibiting decreased sound tolerance (DST) at some point in their lives. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. However, relatively little is known about its phenomenology or neurocognitive underpinnings. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.
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Affiliation(s)
- Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 221 Eskind Biomedical Library and Learning Center, 2209 Garland Ave., Nashville, TN, 37240, United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States.
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Strand Building, Strand Campus, Strand, London, WC2R 2LS, London, United Kingdom.
| | - Carissa J Cascio
- Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 2254 Village at Vanderbilt, 1500 21st Ave South, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
| | - Tiffany G Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
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31
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Opperman E, le Roux T, Masenge A, Eikelboom RH. The effect of tinnitus on hearing-related quality of life outcomes in adult cochlear implant recipients. Int J Audiol 2020; 60:246-254. [PMID: 33100038 DOI: 10.1080/14992027.2020.1828633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the effect of tinnitus distress on the hearing-related quality of life (QoL) outcomes over time in adult cochlear implant (CI) recipients. DESIGN A retrospective, longitudinal study of adult CI recipients was conducted. Hearing-related QoL and tinnitus distress were assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Tinnitus Reaction Questionnaire (TRQ) preoperatively and at 6-months, 12-months and >24-month postoperatively. The association between tinnitus distress and hearing-related QoL outcomes over time was investigated. Furthermore, 13 potential predictive factors were identified from the retrospective dataset. Multiple regression analyses were performed to identify variables that influence hearing-related QoL outcomes over time. STUDY SAMPLE The study sample included 210 adult (≥18 years) CI recipients implanted between 2001 and 2017. RESULTS Lower tinnitus distress and younger age at implantation were significant predictors of better hearing-related QoL in adult CI recipients. A significant reduction in tinnitus distress up to two years post-implantation was found, as well as greater tinnitus distress correlating with poorer hearing-related QoL outcomes. CONCLUSION Tinnitus distress negatively affects the hearing-related QoL outcomes of adult CI recipients. Tinnitus distress and age at implantation were found to be significant predictors of hearing-related QoL when controlling for other predictive factors.
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Affiliation(s)
- Elmien Opperman
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield, South Africa
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield, South Africa
| | - Andries Masenge
- Department of Statistics, University of Pretoria, Hatfield, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield, South Africa.,Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, Medical School, The University of Western Australia, Nedlands, Australia
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Telehealth tinnitus therapy during the COVID-19 outbreak in the UK: uptake and related factors. Int J Audiol 2020; 60:322-327. [PMID: 33000663 DOI: 10.1080/14992027.2020.1822553] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The Audiology Department at the Royal Surrey County Hospital usually offers face-to-face audiologist-delivered cognitive behavioural therapy (CBT) for tinnitus rehabilitation. During COVID-19 lockdown, patients were offered telehealth CBT via video using a web-based platform. This study evaluated the proportion of patients who took up the offer of telehealth sessions and factors related to this. DESIGN Retrospective service evaluation. STUDY SAMPLE 113 consecutive patients whose care was interrupted by the lockdown. RESULTS 80% of patients accepted telehealth. The main reasons for declining were not having access to a suitable device and the belief that telehealth appointments would not be useful. Compared to having no hearing loss in the better ear, having a mild or moderate hearing loss increased the chance of declining telehealth by factors of 3.5 (p = 0.04) and 14.9 (p = 0.038), respectively. High tinnitus annoyance as measured via the visual analogue scale increased the chance of declining telehealth appointments by a factor of 1.4 (p = 0.019). CONCLUSIONS Although CBT via telehealth was acceptable to most patients, alternatives may be necessary for the 20% who declined. These tended to have worse hearing in their better ear and more annoying tinnitus.
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The potential interruptive effect of tinnitus-related distress on attention. Sci Rep 2020; 10:11911. [PMID: 32681139 PMCID: PMC7367824 DOI: 10.1038/s41598-020-68664-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/09/2020] [Indexed: 01/12/2023] Open
Abstract
The mechanism through which tinnitus affects attention is unclear. This study examines whether distress mediates the relationship(s) between tinnitus and sustained, selective and executive attentions as well as response inhibition. Eighteen participants with tinnitus and fifteen controls completed the Counting Stroop, Vigilance and Stop Signal tasks. Tinnitus distress was assessed using the Tinnitus Questionnaire (TQ), severity of depressive mood states examined using the Beck Depression Inventory-II, and general distress assessed using the Hospital Anxiety and Depression Scale. Tinnitus participants had significantly slower reactions during the Vigilance task (F = 4.86, p = .035), and incongruent trials of the Cognitive Counting task (F = 3.45, p = .045) compared to controls. Tinnitus-related distress significantly mediated the effect of tinnitus in incongruent trials (TQ: Sobel test t = 1.73, p = .042) of the Cognitive Counting Task. Complaints of distress and concentration difficulties are common amongst tinnitus patients in clinical settings and these afflictions have been shown to negatively impact an individual’s quality of life. If confirmed in future studies, results suggest that distress may be an important factor in the causal mechanism between tinnitus and attention.
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