Validating and refining a psychoacoustic test to diagnose hyperacusis

Decreased sound tolerance refers to conditions like hyperacusis and misophonia, in which everyday sounds may provoke discomfort or distress. Hyperacusis is characterized by exaggerated loudness perception and aversive reactions to moderate to loud sounds, often leading to significant impairment. Despite its estimated prevalence of 10-15 %, no objective clinical test exists. Current assessment relies on interviews, questionnaires, and loudness discomfort levels (LDLs), which lack reliability and ecological validity. Recent work has shown that pleasantness ratings of natural sounds can differentiate individuals with hyperacusis from controls. A subset of seven natural sounds, termed Core Discriminant Sounds (CDS_hyper), was identified post-hoc as particularly effective, yielding 81 % sensitivity and 88 % specificity in prior lab-based testing. A similar approach for misophonia identified ten distinct trigger sounds (CDS_miso). This study aimed to validate a tablet-based version of the CDS test to diagnose hyperacusis prospectively. Forty-nine participants (20 with hyperacusis, 29 controls) completed the test that presented randomly CDS_hyper and CDS_miso sounds at 60, 70, and 80 dBA. Participants rated each sound presentation on visual analog scales for pleasantness and loudness. Hyperacusis was defined by clinical complaints, Hyperacusis Questionnaire scores (≥22), and LDLs (≤77 dB HL). Results showed that individuals with hyperacusis rated CDS_hyper sounds as significantly less pleasant (means score of 39 vs 25 for hyperacusis vs controls, p = .002, η² = 0.185) and louder (means score of 71 vs 63 for hyperacusis vs controls, p = .024, η² = 0.104) than controls. No group differences emerged for misophonia trigger sounds (CDS_miso sounds). The sensitivity and specificity for the combined CDS_hyper scores of pleasantness and loudness at detecting hyperacusis were 90 % and 69 %, respectively. These findings validate the tablet-based test as an efficient, ecologically valid tool for diagnosing hyperacusis.