<br>响度和疼痛听觉过敏的表型比较：多国患者登记中的症状、合并症和相关特征。,American Journal of Audiology

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响度和疼痛听觉过敏的表型比较：多国患者登记中的症状、合并症和相关特征。
American Journal of Audiology ( IF 1.4 ) Pub Date : 2021-04-20 , DOI: 10.1044/2021_aja-20-00209
Zachary J Williams _{1,

2,

3,

4} , Evan Suzman ₅ , Tiffany G Woynaroski _{2,

3,

4,

6}

Affiliation

目的听觉过敏是一种复杂且知之甚少的听觉障碍，其特征是对声音的耐受性下降到不会困扰大多数人的水平。最近，有人提出，对日常声音做出反应而出现耳痛（称为痛觉过敏）的个体在临床上可能与那些主要症状是认为日常声音过大（称为响度听觉过敏）的人不同。尽管存在这种理论上的区别，但还没有实证研究直接比较这两组听觉过敏患者。方法使用来自多国患者登记处（桑福德登记处罕见病协调）的数据，我们检查了 243 名成人听觉过敏患者样本中自我报告的人口统计学、症状、合并症和对治疗的反应，其中 152 名根据报告的症状被归类为疼痛听觉过敏。贝叶斯统计检验用于调查响度和疼痛听觉过敏患者之间是否存在组差异。结果疼痛听觉过敏个体表现出更严重的临床表型，报告暂时性症状恶化的频率较高（即“挫折”），随着时间的推移感知到的症状改善较少，合并头痛疾病更严重，并且声音治疗的益处降低。然而，两种假设的听觉过敏亚型表现出的相似性多于差异性，大多数症状和合并症在各组之间同样普遍。通常观察到多种合并症，包括耳鸣、原发性头痛疾病、精神疾病和功能性躯体综合征。也经常报道对其他方式的感觉刺激不耐受。结论尽管这项研究几乎没有证据表明响度和疼痛听觉过敏是病理生理学上不同的情况，但我们的研究结果表明，以疼痛为主的表型可能是听觉过敏患者有意义的预后标志物。

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A Phenotypic Comparison of Loudness and Pain Hyperacusis: Symptoms, Comorbidity, and Associated Features in a Multinational Patient Registry.

Purpose Hyperacusis is a complex and poorly understood auditory disorder characterized by decreased tolerance to sound at levels that would not trouble most individuals. Recently, it has been suggested that individuals who experience otalgia in response to everyday sounds (termed pain hyperacusis) may differ clinically from those whose primary symptom is the perception of everyday sounds as excessively loud (termed loudness hyperacusis). Despite this theoretical distinction, there have been no empirical studies directly comparing these two populations of hyperacusis patients. Method Using data from a multinational patient registry (the Coordination of Rare Diseases at Sanford Registry), we examined self-reported demographics, symptoms, comorbidity, and response to treatment in a sample of 243 adults with hyperacusis, 152 of whom were classified as having pain hyperacusis based on reported symptoms. Bayesian statistical tests were used to investigate both the presence and absence of group differences between patients with loudness and pain hyperacusis. Results Individuals with pain hyperacusis presented with a more severe clinical phenotype, reporting a higher frequency of temporary symptom exacerbations (i.e., "setbacks"), less perceived symptom improvement over time, more severe comorbid headache disorders, and reduced benefit from sound therapy. However, the two hypothesized hyperacusis subtypes exhibited more similarities than differences, with the majority of symptoms and comorbidities being equally prevalent across groups. Multiple comorbidities were commonly observed, including tinnitus, primary headache disorders, psychiatric disorders, and functional somatic syndromes. Intolerance of sensory stimuli in other modalities was also frequently reported. Conclusion Although this study provides little evidence that loudness and pain hyperacusis are pathophysiologically distinct conditions, our findings indicate that a pain-predominant phenotype may be a meaningful prognostic marker in patients with hyperacusis.

更新日期：2021-04-22

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