Noise sensitivity is a condition characterised by an excessive reaction to harmless levels of sound that would not normally affect typically functioning people. Previous research have found that reactions such as the reduction of attention and concentration as well as the presence of medically unexplained common symptoms such as headaches and fatigue appear in sufferers. The aim of the present study was to investigate whether such a class of sound sensitive individuals are affected by exposure to a potentially unpleasant sound source more than a relatively low sound sensitive group of individuals. Forty adults between 18-54 years of age were exposed to a white noise sound stimulus within a soundproof exposure chamber for 45 minutes. The sound pressure level of the sound varied over the course of the exposure session. The dependent variables of the study were perceived intensity, unpleasantness and effect on concentration, symptoms and cognitive strain. After the exposure session, participants were asked to fill in an online survey that included a 21 item Noise Sensitivity Scale. This was used to group the participants accordingly to a low or high NSS group. The high NSS group compared to the low NSS group had higher ratings for unpleasantness and negative effects on concentration after time point four, at which point the noise stimulus had been introduced. No differences were observed in ratings of Intensity of the noise stimulus between groups. The high NSS group also demonstrated higher ratings for symptoms after the noise stimulus had been introduced. In addition they also demonstrated a lower level of improvement for the cognitive task in comparison to the low NSS group. The findings from this study imply that individuals suffering from hyperacusis can be negatively affected by the presence of annoying sound stimuli. Hyperacusis can mean that sounds can become unpleasant to sufferers as well as potentially affecting their ability to concentrate. / Ljudkänslighet är ett tillstånd som karaktäriseras av en överreaktion på ofarliga ljudnivåer, som normalt inte skulle påverka majoriteten av befolkningen. Tidigare forskning har funnit symptom så som minskad uppmärksamhet och koncentration, samt medicinskt oförklarade symptom som huvudvärk och utmattning förekommer hos drabbade. Syftet med den nuvarande studien var att undersöka hur vida ljudkänsliga personer påverkas mer av en potentiellt obehaglig ljudkälla än en grupp av icke-ljudkänsliga. Fyrtio vuxna mellan 18-54 år exponerades för vitt brus under experimentet. Beroende variabler var upplevd intensitet, obehag, effekt på koncentration, symptom, och kognitiv belastning. Efter experimentet fyllde deltagarna i en online-enkät som inkluderade 21 item Noise Sensitivity Scale. Denna skala användes för att gruppera deltagarna i en hög och en låg NSS-grupp. Jämfört med den låga NSS-gruppen, hade den höga NSS-gruppen högre skattningar av obehag och negativa effekter på koncentrationen efter tidpunkt fyra, då ljud stimulit introducerades. Inga skillnader i intensitets-skattningar hittades mellan grupper. Den höga NSS-gruppen visade högre skattningar av symptom efter att ljud stimulit introducerats. De visade även lägre grad av förbättring på den kognitiva uppgiften jämfört med den låga NSS-gruppen. Denna studies resultat antyder att individer som lider av hyperakusis kan påverkas negativt av störande ljud. Drabbade kan uppfatta ljud som obehagliga, samt potentiellt påverka koncentrationsförmåga negativt.

The ability of neurons to regulate their activity (homeostatic plasticity) is thought to be responsible for changes in neural responsiveness/gain induced by sensory deprivation, or augmented stimulation. For example, following auditory deprivation, excitatory and inhibitory synaptic transmission is strengthened and weakened, respectively. Abnormally high neural gain results in an 'over amplification' of spontaneous and stimulus-evoked firing rates, and may result in aberrant auditory perceptions including tinnitus and/or hyperacusis, respectively. The first manuscript in the thesis 'Pump up the Volume' (Chapter Three) provides a summary of the neural gain mechanism in the adult auditory system. Aspects of neural gain, including temporal characteristics and frequency specificity, had not been systematically investigated. Therefore, the aim of this thesis was to investigate characteristics of the neural gain mechanism. The thesis comprises three related studies involving normal hearing adult listeners: two studies involved short term sensory deprivation and one study involved short term augmented stimulation. The main outcome measures were the acoustic reflex threshold (ART), auditory brainstem response (ABR) and loudness. In Study One, the time course, frequency specificity and anatomical location of changes in the ART, following 6 days of unilateral earplug use (ca 30 dB attenuation at 2-4 kHz), were investigated. The reduction in ART in the treatment ear was greatest at day 4 and at frequencies most attenuated by the earplug. Ipsilateral and contralateral ARTs were similar when stimuli were presented to the treatment ear. ARTs were not statistically significant from baseline when measured 4 and 24 hours after earplug removal. In Study Two, the ART and ABR were measured at baseline and after 7 days of unilateral and bilateral hearing aid use (13-17 dB real ear insertion gain), to compare the effect of symmetrical and asymmetrical inputs. There was no change in ART and ABR after treatment, suggesting that the augmented stimulation was insufficient to modify neural gain. In Study Three, ARTs, ABRs and loudness were investigated after 4 days of unilateral earplug use (30 dB attenuation at 2-4 kHz). There was a significant reduction in ART (ca 6 dB) in the treatment ear, which returned to baseline within 1-2 hours of earplug removal. There was an unexpected but significant 35 nV decrease in the ABR wave V peak-to-trough amplitude in the treatment ear, and a 12 nV increase in the control ear. The change in ABR was opposite in direction to the change in ART. There was no change in loudness. The thesis has provided information on the threshold of deprivation/stimulation required to elicit a change in neural gain, along with the frequency specificity and temporal characteristics of the gain control mechanism. The anatomical location for changes in neural gain is around the level of the cochlear nucleus. The change in ABR was in the opposite direction to those predicted, but could be due a difference in the compensatory changes of contralateral and ipsilateral inputs at the level of the inferior colliculus.

Hyperacusis is a type of decreased sound tolerance where the individual has decreased loudness discomfort levels (LDL), normal hearing thresholds and is sensitive to ordinary environmental sounds. Persons with hyperacusis frequently seek help at audiological departments as they are often affected by other audiological problems. Regrettably, there is neither a consensus-based diagnostic procedure nor an evidence-based treatment for hyperacusis. The principal aim of this thesis was to gain knowledge about the clinical condition hyperacusis. The specific aim of Paper I was to compare hyperacusis measurement tools in order to determine the most valid measures for assessing hyperacusis. Items from a constructed clinical interview were compared with the LDL test, the Hyperacusis Questionnaire (HQ) and the Hospital Anxiety and Depression Scale (HADS). LDLs were significantly correlated with the anxiety subscale of the HADS. A third of the 62 investigated patients scored below the previously recommended cut-off for the HQ. The results suggest that HQ and HADS in combination with a clinical interview are useful as part of the assessment procedure in patients with hyperacusis. The aim of Paper II was to further investigate the patient group with respect to individual characteristics, psychiatric morbidity and personality traits. It was shown that anxiety disorders and anxiety-related personality traits were over-represented, which suggests common or cooperating mechanisms. Avoidance behaviour proved to be very common in the patient group, as was being unable to work due to hyperacusis. In Paper III it was investigated in a randomized controlled trial whether Cognitive Behaviour Therapy (CBT) could be helpful for patients with hyperacusis. The effect of CBT for hyperacusis was assessed with measures of LDLs, symptoms of hyperacusis and of anxiety and depression, fear of (re)injury due to exposure to sounds, and quality of life, compared to a waiting list control group. There were significant group effects for a majority of the measures with moderate and strong effect sizes within- and between groups. After assessment the waiting list group was also given CBT, and was then reassessed with similar effects. The results were maintained for 12 months, concluding CBT to be potentially helpful for these patients.

Hyperacusis is a condition in which sufferers experience everyday sounds in their surroundings as unmanageable and disturbing. The condition is often associated with symptoms such fatigue, headaches, sleep disturbances and difficulties concentrating. Present study aimed to investigate how people are affected when exposed to noise over time. This was operationalized by collecting data from essentially three domains; subjective, physiological and cognitive. Since hyperacusis is largely defined by the individuals’ subjective experience, participants were divided into three groups based on their own subjective reports of discomfort during an exposure to white noise (60db). Cognitive performance was assessed using two well established measurements in the beginning and the end of the exposure session. Contrary to expectations, the groups did not differ significantly in cognitive performance. Heart rate variability was measured during the exposure session and was hypothesized to be lower in participants experiencing higher discomfort. As expected, the groups differed in their expressed variability in the direction of the hypothesis.

Sound intolerance affects a large part of the population and thus contributes to increased ill health in society. However, the extent to which and in what way sound intolerant is affected is unclear. The ​purpose​ was to contribute to a more qualitative understanding of the impact that sound intolerance can have by mapping and analyzing literature on sound intolerance in a perspective of Empowerment. The ​method​ used was a scoping study. In total, n = 24 studies were reviewed and n = 10 were included for an in-depth qualitative analysis. The results​ show that there are studies that describe that sound intolerance has an impact on Empowerment, but that none of the studies examined have such a pronounced focus. Sound intolerance seems in many respects to be a hidden or unconscious phenomenon and there is reason to work for higher knowledge and awareness to strengthen the sound intolerant's Empowerment. / Ljudintolerans drabbar en stor del av befolkning och bidrar således till ökad ohälsa isamhället. I vilken utsträckning och på vilket sätt ljudintoleranta påverkas är dock oklart.Syftet var att bidra till en mer kvalitativ förståelse för den påverkan ljudintolerans kan hagenom att kartlägga- och analysera litteratur om ljudintolerans i ett perspektiv avEmpowerment. Metoden som användes var en kartläggande litteraturöversikt. Totaltgranskades n=24 studier och n=10 inkluderades för en fördjupad kvalitativ analys.Resultatet visar att det finns studier som beskriver att ljudintolerans har en påverkan påljudintolerantas Empowerment men att inga av de granskade studierna har ett sådant uttalatfokus. Ljudintolerans förefaller i många avseende vara ett dolt eller omedvetet fenomenoch det finns anledning att arbeta för högre kunskap och medvetenhet för att stärkaljudintolerantas Empowerment.

Decreased sound tolerance (DST) conditions, including misophonia and hyperacusis, are emerging clinical conditions in behavioral medicine. Misophonia involves an extreme emotional response (often anger, disgust, or annoyance) to specific sounds (such as people chewing, swallowing, tapping their foot on the floor, etc.), while hyperacusis is defined by high sensitivity to sounds below normal sound sensitivity thresholds. Although research on these DST conditions is increasing, clearly defined prevalence rates, associations with other mental health conditions, and development of assessment tools that can identify and differentiate DST symptoms are needed. Research and clinical reports also suggest that DST problems are more likely to occur in individuals affected by tinnitus, and that drawing upon a bio-psychosocial conceptualization of tinnitus and other behavioral medicine conditions may be useful in understanding and treating DST conditions. This cross-sectional survey study was administered to college student (N=451) and community adult (N=375) samples and investigated DST prevalence rates, clinical correlates, and risk factors and mechanisms of action for misophonia and hyperacusis. In addition, the study developed and validated a new scale to identify misophonia and hyperacusis type sound sensitivity. Nearly 35% of individuals surveyed reported some degree of general auditory sensitivity, with 15-63% endorsing misophonia symptoms, and 17-26% endorsing hyperacusis symptoms, with rates depending on assessment method. Moderate to strong correlations were found between DST conditions and other mental and physical health conditions, including obsessive compulsive disorder, autism-spectrum traits, anxiety, depression, social phobia, medical conditions, and somatic and neurobehavioral symptoms. Mediation models revealed that the process by which misophonia symptoms become clinically significant and functionally impairing is partially mediated by amplification of bodily sensations and anxiety sensitivity. Risk factors for functional impairment related to misophonia symptoms were identified in moderation analyses and included neuroticism, synesthesia, and sensory sensitivity. An assessment instrument, the DST-10, and its subscales the Loudness Sensitivity Scale and Human Sounds Scale, was subjected to exploratory and confirmatory factor analysis and initial evidence for construct validity was demonstrated. This study was the first to assess hyperacusis, misophonia, and tinnitus rates in large general population samples and provides initial support for conceptualizing DST problems as behavioral medicine conditions.

Annotation: Master thesis "Psychosocial effects of tinnitus" is based on a general approach to this phenomenon as a disease of civilization. The symptom that tinnitus represents is underestimated in Czech Republic as well as treatment possibilities and the impact of tinnitus itself on person's life and his/hers surroundings. It can have devastating consequences. Coping with tinnitus can be very difficult if not impossible and in the end it can lead to suicidal attempt. Similar negative effects as on affected person can tinnitus have on his/hers closest surroundings which could not understand him/her.

INTRODUÇÃO: A misofonia é caracterizada pela aversão a sons bem seletivos, que provocam uma forte reação emocional. Foi proposto que a misofonia, assim como o zumbido, esteja associada à hiperconectividade entre os sistemas auditivo e límbico. Indivíduos com zumbido de incômodo significativo podem apresentar comprometimento da atenção seletiva, o que ainda não foi demonstrado no caso da misofonia. OBJETIVO: caracterizar uma amostra de indivíduos com misofonia e compará-la com dois grupos controle, um com zumbido (sem misofonia) e outro assintomático (sem zumbido e sem misofonia). METODOLOGIA: Foram avaliados 40 sujeitos normo-ouvintes, sendo 10 com misofonia (grupo misofonia - GM), 10 com zumbido (sem misofonia) (grupo controle zumbido - GCZ) e 20 sem zumbido e sem misofonia (grupo controle assintomático - GCA). Foi realizada anamnese geral em todos os grupos e anamnese específica apenas para o GM. Nos três grupos, foi aplicado o Teste de Identificação de Sentenças Dicóticas em três situações. Na primeira, foi realizado o exame padrão. Em seguida, foi aplicado incluindo mensagem competitiva, uma com som de mastigação (exame mastigação), e outra com white noise (exame white noise). RESULTADOS: A amostra do GM apontou que os primeiros sintomas da misofonia foram percebidos ainda na infância ou adolescência (média 11,5 anos). O grau de incômodo variou de 6 a 10 na escala visual analógica e, dentre os 10 participantes do GM, nove (90%) responderam que a misofonia atrapalha, sempre ou às vezes, a vida social e profissional. No teste de Identificação de Sentenças Dicóticas, foi observado que no exame mastigação, as médias da porcentagem de acertos diferem entre os grupos GM e GCA (valor-p = 0,027) e entre os grupos GM e GCZ (valor-p = 0,002), sendo menor em ambos os casos no GM. Para os exames padrão e white noise, não há diferença entre as médias da porcentagem de acertos nos três grupos (valores-p >= 0,452). CONCLUSÃO: os participantes do GM apresentaram menor porcentagem de acertos no Teste de Identificação de Sentenças Dicóticas na situação de apresentação de um ruído distraidor (exame mastigação) em relação ao mesmo teste aplicado em situação padrão ou white noise, sugerindo que indivíduos com misofonia podem apresentar alteração da atenção seletiva quando expostos a sons que desencadeiam esta condição / INTRODUCTION: Misophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been proposed that misophonia, as well as tinnitus, is associated with hyperconnectivity between the auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet. OBJECTIVE: to characterize a sample of misophonic subjects and compare it to two control groups, one with tinnitus individuals (without misophonia) and the other one with asymptomatic individuals (without misophonia and without tinnitus), regarding self-perception of the condition and selective attention. METHODOLOGY: we had evaluated 40 normal hearing participants: 10 with misophonia (GM), 10 with tinnitus (without misophonia) (GCZ) and 20 without tinnitus and without misophonia (GCA). General questionnare was applied in all of three groups and specific misophonia questionnaire was applied only in GM. In order to evaluate the selective attention, it was applied the Dichotic Sentence Identification (DSI) Test in three situations: In the first one, it was applied the original test. Then, the test was applied in two other situations including two competitive sounds, one with chewing sound (chewing test), and the other one with white noise sound (white noise test). RESULTS: The GM sample indicated that the onset of misophonia occurred in childhood or adolescence (mean 11.5 years). According to the visual analog scale, the discomfort with misophonia ranged from 5 to 10, and nine (90%) participants answered that misophonia always or sometimes limits their social and professional interactions. In the chewing test, it was observed that the average of correct responses differed between GM and GCA groups (pvalue = 0.027) and between GM and GCZ groups (p-value = 0.002), in both cases it was lower in GM. In the original and white noise tests, no difference was observed between the averages of correct responses in the three groups (p-values >= 0.452). CONCLUSION: The GM participants had a lower percentage of correct responses in the chewing test, suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger the condition

Hyperacusis and Disorders of Sound Intolerance: Clinical and Research Perspectives is a professional resource for audiology practitioners involved in the clinical management of patients who suffer from sound tolerance concerns. The text covers emerging assessment and intervention strategies associated with hyperacusis, disorders of pitch perception, and other unusual processing deficits of the auditory system. In order to illustrate the patients perspectives and experiences with disorders of auditory processing, cases are included throughout. This collection of diagnostic strategies and tools, evidence-based clinical research, and case reports provides practitioners with avenues for supporting patient management and coping. It combines new developments in the understanding of auditory mechanisms with the clinical tools developed to manage the effects such disorders exert in daily life. Topics addressed include unusual clinical findings and features that influence a patient s auditory processing such as their perceptual accuracy, recognition abilities, and satisfaction with the perception of sound. Hyperacusis is covered with respect to its effects, its relation to psychological disorders, and its management. Hyperacusis is often linked to trauma or closed head injury and the text also considers the management of patients with traumatic brain injury as an opportunity to illustrate the effectiveness of interprofessional care in such cases. Interventions such as cognitive behavioral therapy, self-efficacy training, and hearing aid use are reported in a way that enhances clinicians' ability to weave such strategies into their own work, or into their referral system. Hyperacusis and Disorders of Sound Intolerance illuminates increasingly observed auditory-related disorders that challenge students, clinicians, physicians, and patients. The text elucidates and reinforces audiologists contributions to polytrauma and interprofessional care teams and provides clear definitions, delineation of mechanisms, and intervention options for auditory disorders. / https://dc.etsu.edu/etsu_books/1210/thumbnail.jpg

A hiperacusia e o zumbido representam alterações na percepção dos sons, estando freqüentemente associados. Ambos refletem um estado de hiperatividade da via auditiva, gerado por alterações na plasticidade neuronal geralmente associadas à super estimulação ou deprivação sensorial. A hiperacusia refere-se a uma disfunção na percepção da intensidade de sons externos, o zumbido refere-se à percepção de um som interno que não tem uma fonte geradora externa. Afetam adultos e crianças e podem ocasionar limitações na qualidade de vida. Ainda são muito negligenciados por otorrinolaringologistas e pediatras, apesar da sua presença não ser incomum na infância. Delineamos um estudo populacional transversal randomizado entre crianças de 5 a 12 anos cujo objetivo principal foi estimar a prevalência da hiperacusia e do zumbido. O objetivo secundário foi avaliar a associação a possíveis fatores de risco e a causalidade entre os sintomas. Foram avaliadas 506 crianças em ambiente escolar. Os dados foram coletados por meio de questionário aos pais ou responsáveis, entrevista com as crianças, otoscopia e testes auditivos. A classificação dos resultados seguiu critérios previamente estabelecidos. Participaram 240 meninas (47,4%) e 266 meninos (52,6%), idade média 9.46 anos (DP= 2.09). Os limiares auditivos foram classificados como normais em 81%, disacusia de grau mínimo/leve em 14% e disacusia de grau moderado/ profundo em 4% das crianças. A prevalência da sensação de zumbido foi 37,5%, incômodo com zumbido 19,6% e hiperacusia 3,2%. Os fatores de risco foram analisados por um modelo de regressão multivariado. Em relação ao zumbido, os fatores associados foram: idade, gênero, perda auditiva, história de exposição aos sons e cinetose. Para a hiperacusia, o único fator de risco encontrado foi a perda auditiva leve na orelha esquerda. A presença de hiperacusia demonstrou ser o maior fator de risco associado ao incomodo com o zumbido / Hyperacusis and tinnitus are altered states of sound perception and are frequently associated. Both reflect a hyperactivity of the auditory pathway as an expression of neural plasticity which is often triggered by over stimulation or deprivation of sensorial stimuli. Hyperacusis is a dysfunction on loudness perception of external sounds and tinnitus a perception of an internal sound without an external source. They might affect adults and children causing interference on quality of life. They are still neglected by otolaryngologysts and pediatricians. A prospective cross sectional study was designed to estimate tinnitus and hyperacusis prevalence and evaluate association to possible risk factors and causality among them. Children from 5 to 12 years of age were evaluated in the school environment. Data was collected searching parental information, children\'s interview, otoscopy and audiometric tests. The symptoms were classified according to previous established criteria. The final sample counted on 240 girls and 266 boys, mean age 9.46 (SD= 2.09). Hearing thresholds were classified as normal in 81%, minimum to mild hearing loss in 14% and moderate to profound hearing loss in 4% of the children. Prevalence of tinnitus sensation was found to be 37.5%, tinnitus suffering 19.6% and hyperacusis 3.2%. Age, gender, hearing loss, history of noise exposure and motion sickness were risk factors to tinnitus. Left ear hearing loss was a risk factor for hyperacusis. The presence of hyperacusis demonstrated to be the highest risk factor to tinnitus suffering