Association Between Hyperacusis and Tinnitus: Analysis of Prevalence and Impact on Daily Functioning

Background: Hyperacusis is a common, but often underrecognized comorbidity in patients with chronic subjective tinnitus. Reduced sound tolerance is associated with a greater tinnitus-related burden, impaired communication, reduced social participation, and poorer daily functioning. However, published data regarding its prevalence and clinical impact remain limited and inconsistent. Objectives: To determine the prevalence of hyperacusis in patients with chronic subjective tinnitus and to assess its association with tinnitus-related handicap, uncomfortable loudness levels, and degree of hearing loss and daily functioning. Methods: This cross-sectional study included 194 patients aged 21-85 years with chronic subjective tinnitus. Hyperacusis was assessed using a structured clinical interview that included questions on decreased sound tolerance and sound-induced ear pain and uncomfortable loudness level measurements (ULLs). Patients were categorized into two groups: tinnitus with hyperacusis (T + H; n = 32) and tinnitus without hyperacusis (T; n = 162). The impact of tinnitus on daily functioning was evaluated using a standardized and clinically validated questionnaire-the Tinnitus Handicap Inventory (THI). Data were analyzed using appropriate parametric and nonparametric statistical tests. Results: Hyperacusis was identified in 32 of 194 patients with chronic tinnitus (16.5%). Patients with tinnitus and hyperacusis (T + H) had significantly higher THI scores than those with isolated tinnitus, indicating greater tinnitus-related handicap (76.3 vs. 41.9; p < 0.001). Patients with hyperacusis also demonstrated significantly lower ULL values than those without hyperacusis (p < 0.001). Conclusions: Although the reported prevalence of hyperacusis among patients with tinnitus varies across the literature, our findings indicate that hyperacusis is a common comorbidity associated with significantly greater tinnitus-related handicap. Routine assessment of hyperacusis, including ULL measurements, should be incorporated into the clinical evaluation of patients with tinnitus to facilitate comprehensive diagnosis and optimize management. These findings highlight the importance of systematic assessment of hyperacusis in patients with tinnitus in routine audiological practice.