PP1404 - Barriers to Effective Audiological Management of Hyperacusis in the United States

Abstract:
Hyperacusis (decreased sound tolerance) often leads to devastating psychosocial consequences, but there is no standard protocol for its diagnosis or management. In this study, we surveyed clinical audiologists across the United States (US) to understand their current clinical practices surrounding the evaluation and treatment of hyperacusis. Participants reported several barriers to working with hyperacusis patients, including a lack of education, poor reimbursement, and few effective treatments. Moreover, we found that US audiologists do not receive uniform education on hyperacusis. This information will facilitate the development of systematic, evidence-based training programs and clinical protocols for working with hyperacusis patients.

Summary:
Rationale: One of the most debilitating hearing problems is defined not by what is inaudible, but instead by the perception that ordinary sounds are uncomfortably loud, distressing, and/or painful. Hyperacusis (decreased sound tolerance) occurs in 9-15% of the general population and often leads to devastating psychosocial consequences including loss of employment and social isolation. Despite the prevalence and heterogeneity of hyperacusis symptoms, audiologists lack objective, evidence-based tools and protocols for its diagnosis and management. Absent an evidence-based consensus on the diagnosis and management of hyperacusis, audiologists must rely primarily on their clinical intuition and experience when working with these patients. In this study, we sought to understand the current clinical practices surrounding audiological testing and intervention for hyperacusis in the United States (US). This information will inform the development of systematic clinical protocols to improve outcomes for individuals with sound sensitivity disorders.

Design: We developed and distributed a web-based REDCap survey to US clinical audiologists via email, local and national professional organizations, social media, and our laboratory’s website. The survey sought to address several questions regarding audiological diagnosis and management in the US, including:

1. Which professionals do audiologists believe are responsible for recommending and implementing hyperacusis interventions?

2. What formal training do audiologists receive related to hyperacusis diagnosis and management? Where do they receive this training?

3. Do audiologists employ a hyperacusis test battery in their clinics? If so, what tests do they routinely administer as part of that battery?

4. Do audiologists routinely recommend interventions for hyperacusis? If so, what types of interventions do they routinely recommend?

Survey responses were quantified using descriptive statistics.

Results: To date, we have received 99 responses from clinical audiologists (80 female; age range 25 – 70 years) who practice in 25 different states and a variety of employment settings. Most participants (88%) agreed that audiologists are the primary professionals who are responsible for recommending and implementing hyperacusis interventions. However, despite overwhelming agreement that audiologists are responsible for diagnosing and treating hyperacusis, 62% of participants reported that their clinic does not have a hyperacusis management protocol. Participants indicated that the primary barrier to proper hyperacusis diagnosis and management is a lack of education and training. In fact, 65% of participants reported that they have received 5 hours or less of formal education on hyperacusis, and many of them had to seek this education on their own (i.e., professional development coursework outside of formal AuD training). Additionally, participants often cited time constraints, poor reimbursement, poor sensitivity and specificity of available diagnostic tools, and poor efficacy of available treatments and management strategies as key barriers to effective audiological management of hyperacusis.

Conclusions: Clinical audiologists in the US do not receive uniform education on hyperacusis, and they report multiple barriers to evidence-based diagnosis and management of sound sensitivity disorders. The information obtained via this survey will pave the way toward the refinement of educational programs and the development of systematic, evidence-based clinical protocols for working with patients who have decreased sound tolerance.