Auditory and Speech Sciences Laboratory, University of South Florida, Tampa.
The University of Alabama, Tuscaloosa.
J Speech Lang Hear Res. 2024 Jun 6;67(6):1903-1931. doi: 10.1044/2024_JSLHR-23-00360. Epub 2024 May 8.
We present results from a 6-month field trial of a transitional intervention for debilitating primary hyperacusis, including a combination of structured counseling; promotion of safe, comfortable, and healthy sound exposure; and therapeutic broadband sound from sound generators. This intervention is designed to overcome barriers to successful delivery of therapeutic sound as a tool to downregulate neural hyperactivity in the central auditory pathways (i.e., the maladaptive mechanism believed to account for primary hyperacusis) and, together with the counseling, reduce the associated negative emotional and physiological reactions to debilitating hyperacusis.
Twelve adults with normal or near-normal audiometric thresholds, complaints consistent with their pretreatment loudness discomfort levels ≤ 75 dB HL at multiple frequencies, and hearing questionnaire scores ≥ 24 completed the sound therapy-based intervention. The low-level broadband therapeutic sound was delivered by ear-level devices fitted bilaterally with either occluding earpieces and output-limiting loudness suppression (LS; to limit exposure to offensive sound levels) or open domes to maximize comfort and exposure to sound therapy. Thresholds for LS (primary outcome) were incrementally adjusted across six monthly visits based on treatment-driven change in loudness judgments for running speech in sound field. Secondary outcomes included categorical loudness judgments, speech understanding, and questionnaires to assess the hyperacusis problem, quality of life, and depression. An exit survey assessed satisfaction with and benefit from the intervention and the counseling, therapeutic sound, and LS components.
The mean change in LS (34.8 dB) was highly significant (effect size = 2.045). Eleven of 12 participants achieved ≥ 16-dB change in LS, consistent with highly significant change in sound-based questionnaire scores. Exit surveys indicated satisfaction with and benefit from the intervention.
The transitional intervention was successful in improving the hyperacusis conditions of 11 of 12 study participants while reducing their sound avoidance behaviors and reliance on sound protection.
我们报告了一项为期 6 个月的针对严重原发性听觉过敏的过渡性干预的研究结果，该干预包括结构化咨询；促进安全、舒适和健康的声音暴露；以及来自声音发生器的治疗性宽带声音。该干预旨在克服成功提供治疗性声音的障碍，作为一种调节中枢听觉通路神经过度活跃的工具（即，被认为是导致原发性听觉过敏的适应不良机制），并与咨询一起，减少与严重听觉过敏相关的负面情绪和生理反应。
12 名成年人参加了该研究，他们的听力阈值正常或接近正常，听力问卷评分≥24，其听力阈值在多个频率下的听力不适响度水平≤75dBHL，且听力问卷评分≥24。基于低水平宽带治疗性声音的干预措施通过双侧耳级设备进行，这些设备配备有阻塞耳塞和输出限制响度抑制（LS；限制对刺耳声音水平的暴露）或开放式耳罩，以最大限度地提高舒适度和声音治疗暴露度。根据治疗驱动的响度判断在声场中进行言语的变化，在六次月度就诊中逐步调整 LS 阈值（主要结果）。次要结果包括分类响度判断、言语理解和问卷调查，以评估听觉过敏问题、生活质量和抑郁情况。一项退出调查评估了对干预措施以及咨询、治疗性声音和 LS 组件的满意度和受益情况。
LS（34.8dB）的平均变化具有高度显著性（效应量=2.045）。12 名参与者中有 11 名达到了 LS 变化≥16dB，这与基于声音的问卷评分的显著变化一致。退出调查表明，参与者对干预措施和咨询、治疗性声音和 LS 组件的满意度和受益情况。
过渡性干预成功地改善了 12 名研究参与者中的 11 名的听觉过敏状况，同时减少了他们的声音回避行为和对声音保护的依赖。
