Analysis of Clinical Tools Used for Hyperacusis Assessment: A Systematic Review and Meta-Analysis

Hyperacusis remains a misunderstood and often confusing hearing disorder that is complicated by a lack of consensus about how best to diagnose it and characterize its severity. This study reviews the clinical tools currently available for loudness hyperacusis by applying a systematic search and meta-analysis technique to identify a more reliable testing method. From the systematic review of electronic journal databases, nine studies and 14 studies met our inclusion criteria for hyperacusis questionnaires and for behavioral loudness measurement, respectively. Meta-analysis was also conducted to determine the most critical testing frequency that evaluates the loudness discomfort levels (LDL) by using data extracted from 1,783 subjects (1,548 for hyperacusis and 235 for normal hearing function). The effect size for LDL values was estimated using the mean and standard deviation for the hyperacusis group and the control group. The 10 questionnaires selected from nine studies varied in the number of questions in four typical subcategories (physical, attentional/ perceptual, emotional, and behavioral/social). In the meta-analysis, individuals with hyperacusis had significantly lower LDL levels compared to the controls. Although there were no significant differences between two groups as a function of testing frequencies, we found a notable trend at LDL of 2 kHz with standardized mean difference and descriptive analysis. Due to the heterogeneity of the questionnaires, we suggest that the clinician should choose the appropriate questionnaire based on the functional impact of hyperacusis. In addition, when measuring LDL in hyperacusis, it is clinically efficient to first measure at 2 kHz.