General Traits
Audiometric Traits

General Traits

Below are rough estimates for general traits of hyperacusis. These are taken from surveys conducted during hyperacusis studies. Keep in mind sample sizes are small and definitions can be unclear. Prevalence estimates for general and musician populations will be larger than the population severe enough to seek treatment.

Trait Description Sample Size Reference
Hyperacusis Prevalence Unknown. One estimate is 1.75% of general population. NA Jastreboff 2014
Average Age 43.5 years (Compare with 57 years for tinnitus) 381 Sheldrake 2015
Age vs Severity Severe patients younger than moderate/mild patients 197 Dauman 2005
Laterality 80% in both ears (Not always symmetrical) 333 Anari 1999, Juris 2013, Westcott 2013
Onset 54% Sudden
31% Gradual
15% Don’t Know
157 Anari 1999, Juris 2013
Pain 71.5% seeking treatment reported pain from sound 162 Anari 1999, Juris 2013
Tinnitus 84% develop tinnitus 336 Anari 1999, Juris 2013, Westcott 2013
Normal Hearing 37% had <20dB hearing loss up to 8kHz 481 Anari 1999, Sheldrake 2015
Caused by sound exposure 51% Reported (small study) 100 Anari 1999
Musician Prevalence in Hyperacusis Population 31% surveyed were musicians (small study). See Musicians 100 Anari 1999
Hyperacusis Prevalence in Musician Population 39% self reported in Jazz/Rock Musicians (small study). See Musicians 139 Kaharit 2003
Most common sound types to trigger negative reaction 89% Rattling of dishes
86% Child crying
162 Anari 1999, Juris 2013

Audiometric Traits

Audiologists have several tools to help diagnose auditory disorders however they can involve sound levels above the loudness tolerance of someone with hyperacusis. Inexperienced audiologists may try to run the standard array of tests without knowledge of loudness discomfort levels. For example, while acoustic reflex threshold tests can identify a less common cause of hyperacusis, the test is very loud and should not be performed without consideration of loudness discomfort levels.

Typical Test Sound Levels

Below are some typical levels for common tests. Ask your audiologist to compare the specific sound level of tests performed with your LDLs beforehand.

Test Sound Level
Acoustic Reflex Thresholds 85dB-100dB
Tone Decay 85dB-100dB
Auditory Brainstem Response 70dB-90dB
TOAE 80dB-90dB
DPOAE 60dB-70dB

Below is a summary of average results for hyperacusis patients (Anari 1999, Sheldrake 2015):

Test Name Test Description Average Results
Loudness Discomfort Level (LDL) Maximum comfortable sound level 75dB – 85dB Avg
(90% show LDLs below 100dB).Similar level across full frequency range tested (up to 8 kHz).Similar level in both ears
Hearing Thresholds Minimum detectable sound level Normal
Acoustic Reflex Threshods (ART) Sound level that triggers middle ear muscle contraction Normal*
Distortion Product Otoacoustic Emissions (DPOAE) Outer Hair Cell Function Normal**
Transient Evoked Otoacoustic Emissions (TEOAE) Outer Hair Cell Function Normal
Speech Discrimination in Noise Hidden hearing loss/auditory processing measure Normal
Tone Decay Neural hearing loss measure Normal

*ART is high or absent for a less common case of hyperacusis that is caused by a loss of acoustic reflex function. This test is loud.
**DPOAE studies with hyperacusis patients are sparse. Abnormal average DPOAE were found in two studies but the results of the two were not consistent with each other (Bartnik 2009, Sztuka 2009). In either case, there was significant overlap with normal DPOAE levels. As a result, these measurements are not used for diagnosing hyperacusis.

Lowered loudness discomfort levels (LDLs) are the primary quantitative indicator for hyperacusis. This alone has not been found to be sufficient for clinical diagnosis. Hyperacusis questionnaires have been developed to help quantify several dimensions of decreased sound tolerance and hyperacusis that cannot be captured from an LDL test.

Next: Potential Mechanisms

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Anari M, Axelsson Alf, Eliasson A, Magnusson L. Hypersensitivity to Sound: Questionnaire data, audiometry and classification. Scand Audiol 1999:28:219-230

Bartnik G, Hawley M, Rogowski M, Raj-Koziak D, Fabijanska A, Formby C. Distortion Product Otoacoustic Emission Levels and input/output-growth functions in normal-hearing individuals with tinnitus and/or hyperacusis. Otolaryngolia Polska 2009:63:171-181.

Dauman R, Bouscau-Faur F. Assessment and amelioration of hyperacusis in tinnitus patients. Acta Oto-Laryngologia 2005:125:503-509.

Jastreboff P, Jastreboff M. Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia). Seminars in Hearing 2014:35(2):105-120.

Juris L. Hyperacusis: Clinical Studies and Effect of Cognitive Behavioral Therapy. Uppsala Dissertations from the Faculty of Medicine 2013:934:1-64.

Kähärit K, Zachau G, Eklöf M, Sandsjö L, Möller C. Assessment of hearing and hearing disorders in rock/jazz musicians. Int J Audiol. 2003:42(5):279-288.

Khalfa S, Veuillet E, Grima F, Bazin F, Collet L. Hyperacusis Assessment: Relationships with tinnitus Proceedings of the sixth international tinnitus seminar Cambridge UK 1999.

Sheldrake J, Diehl P, Schaette R. Audiometric characteristics of hyperacusis patients. Frontiers in Neurology 2015:6(105):1-7.

Sztuka A, Pospiech L, Gawron W. DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing. Auris Nasus Larynx 2009:37:55-60.

Westcott M et. al. Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: A multi-clinic prevalence study. Noise & Health 2013:15:117-128.