Review Article Clinical Interventions for Hyperacusis in Adults: a Scoping Review to Assess the Current Position and Determine Priorities for Research
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Hindawi BioMed Research International Volume 2017, Article ID 2723715, 22 pages https://doi.org/10.1155/2017/2723715 Review Article Clinical Interventions for Hyperacusis in Adults: A Scoping Review to Assess the Current Position and Determine Priorities for Research Kathryn Fackrell,1,2 Iskra Potgieter,1 Giriraj S. Shekhawat,3,4 David M. Baguley,1,2 Magdalena Sereda,1,2 and Derek J. Hoare1,2 1 NIHR Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, UK 2Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK 3Health Systems and Audiology, The University of Auckland, Auckland, New Zealand 4Tinnitus Research Initiative, Regensburg, Germany Correspondence should be addressed to Kathryn Fackrell; [email protected] Received 31 May 2017; Accepted 16 August 2017; Published 9 October 2017 Academic Editor: Alberto Raggi Copyright © 2017 Kathryn Fackrell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. There is no universally accepted definition for hyperacusis, but in general it is characterised by decreased sound tolerance to ordinary environmental sounds. Despite hyperacusis being prevalent and having significant clinical implications, much remains unknown about current management strategies. Purpose. To establish the current position of research on hyperacusis and identify research gaps to direct future research. Design and Sample. Using an established methodological framework, electronic and manual searches of databases and journals identified 43 records that met our inclusion criteria. Incorporating content and thematic analysis approaches, the definitions of hyperacusis, management strategies, and outcome measures were catalogued. Results. Only 67% of the studies provided a definition of hyperacusis, such as “reduced tolerance” or “oversensitivity to sound.” Assessments and outcome measures included Loudness Discomfort Levels, the Hyperacusis Questionnaire, and Tinnitus Retraining Therapy (TRT) interview. Management strategies reported were Cognitive Behavioural Therapy, TRT, devices, pharmacological therapy, and surgery. Conclusions. Management strategies were typically evaluated in patients reporting hyperacusis as a secondary complaint or as part of a symptom set. As such the outcomes reported only provided an indication of their effectiveness for hyperacusis. Randomised Controlled Trials are needed to evaluate the effectiveness of management strategies for patients experiencing hyperacusis. 1. Introduction As with other subjective symptoms, data on the preva- lenceofhyperacusisisstronglyinfluencedbyhowtheenquiry Hyperacusis is the perception of everyday environmental about the symptom was worded. In children and adolescents, sound as being overwhelmingly loud or intense. Other the variability in wording of the enquiry in prevalence studies terminology in use includes reduced, decreased, or collapsed has been found to be so great as to render comparison across sound tolerance. It differs from phonophobia which is an studies to be meaningless [4]. In a study of 7096 11-year- episodic sound intolerance experienced by some people oldchildrenintheUK,3.7%answeredaffirmativelytothe during migraine attacks, sometimes associated with other question “do you ever experience oversensitivity or distress sensory sensitivities, and which abates as the attack recedes to particular sounds?” [5]. In adults, variability of the ques- [1]. It can also be differentiated from misophonia which is tions asked across studies of hyperacusis also significantly an acquired aversive reaction to specific human generated impacts on the ability to identify prevalence figures. Using sounds such as eating sound or breathing, the response being the question “Do you consider yourself sensitive to everyday characterised by anger and sometimes rage [2, 3]. sounds?,” Andersson and colleagues [6] found that of 1,174 2 BioMed Research International adults that answered the question via either the Internet questions were defined, (2) relevant studies were identified, or post, 8.6% (95% CI = 7.0–10.0) responded affirmatively. (3) studies were selected using an iterative approach through Another Swedish study [7] in adults asked 3406 participants, title, abstract, and full-text screening by three members “Do you have a hard time tolerating everyday sounds that of team (KF, IP, and GSS), (4) data were extracted and you believe most other people can tolerate?” and found 9.2% charted by two members of the team (KF, IP), (5) the responded affirmatively, with 1.9% reporting that they had results were collated, summarised, and reported, and (6) two been diagnosed with hyperacusis by a physician. clinical experts, who were not involved in the data extraction There is an apparent association between hyperacusis and or collating and summarising results, were consulted and tinnitus, with 86% of adult patients with a primary complaint reviewed the findings. of hyperacusis experience tinnitus [8] and 40% of patients with a primary complaint of tinnitus experience hyperacusis 2.1. Eligibility Criteria. To be included, records were required as well [9]. Many people with troublesome hyperacusis to report studies in which adults (≥18 years old) reported have normal or age appropriate hearing thresholds, but hyperacusis as a primary complaint or secondary complaint cochlear hearing loss has also been reported [10]. Medical or as part of a symptom set. Records were included where conditions associated with hyperacusis include closed head management strategies (i.e., interventions) were tested to injury, depression, posttraumatic stress syndrome, Williams address hyperacusis. Records were eligible from Randomised syndrome, and pain syndromes such as fibromyalgia [1]. The Controlled Trials (RCTs), nonrandomised control trials, physiological mechanisms that underpin hyperacusis are not cohort studies, case series, and case studies. Review articles well understood, and there is no compelling animal model. A including systematic reviews, epidemiology articles, and any consensus is emerging in the auditory neuroscience literature sources reporting personal/expert opinions were excluded. that hyperacusis may be associated with a sustained and No records were excluded based on controls used, outcomes persistent increase in central auditory gain [11]. reached, timing, setting, or study design. Records were A framework with which to categorise patients with excluded for studies reporting misophonia, phonophobia, hyperacusis has been proposed [12]. The subtypes consisted and loudness recruitment. ofhyperacusisthatischaracterisedbyloudness,annoyance, All included records were published in the English lan- fear, or pain. This schema was not based upon empirical data guage.Wheremultipleeligibleuniquerecordspertainingto and may serve to illustrate the various characteristics that a single trial were identified, the record that was published can define the lived experience of hyperacusis, rather than first was included and any secondary analyses of the data were to support diagnosis or treatment. Regardless, hyperacusis excluded. is a complex symptom which can have negative effects on daily functioning such as hearing, sleep, concentration, 2.2. Search Strategy. The search strategy followed a rec- and emotional well-being that can vary daily and between ommended three-step approach [16, 17]. In Step 1,totest individuals. Management, therefore, can be complex with keywords and search terms, a limited search in PsycINFO approaches taken including cognitive behaviour therapy, and Embase was conducted, checking the availability of Tinnitus Retraining Therapy, or sound therapy [13]. Com- relevant titles and abstracts. This allowed us to develop search plex interventions such as these need to be developed and term combinations to use across a wider search in step evaluated in a systematic way to have confidence in the two. The search strategy included hyperacusis and terms for effectiveness of the intervention for the given population [14]. identifying research studies, such as intervention, therapy, The purpose of this scoping review is to identify research treatment, management, assessment, outcome, and diagnoses gaps in existing literature and elements that should underpin (diagnostic) with narrow terms such as measure and test the design of any new studies. The aim of this scoping review (Table 1). In Step 2, to identify relevant research studies, is to consider the current position of research on hyperacusis electronic databases of peer reviewed journals were searched in adults. Specifically, the objective here is to identify in the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled (i) how hyperacusis is currently defined in research Trials (CENTRAL); PubMed; Embase; PsycINFO; Scopus; studies, Cumulative Index to Nursing and Allied Health Literature (ii) How it is currently measured (i.e., what measures (CINAHL); Web of Science; the International Standard are used for diagnosis and outcome and are they Randomised Controlled Trial Number (ISRCTN) registry; adequate?), ClinicalTrials.gov; the International Clinical Trials Registry Platform (ICTRP); and Google Scholar. Specific search term (iii) What the level of evidence is for current management strategies were