Introduction: hearing loss is increasingly recognized as a complex phenotype characterized not only by elevated peripheral thresholds but also by decreased sound tolerance (DST) disorders, including tinnitus, hyperacusis, and misophonia. While audiometric configuration has been linked to tinnitus, misophonia and hyperacusis are reported to correlate more strongly with uncomfortable loudness levels (ULL) than with pure-tone thresholds. We hypothesized that audiogram configuration independently influences the prevalence and severity of DST symptoms in sensorineural hearing loss (SNHL), and aimed to evaluate misophonia, hyperacusis, and tinnitus across three configuration groups to inform individualized hearing-aid fitting strategies.

material & methods: in this cross-sectional study, adults (≥18 years) with audiometrically confirmed SNHL, candidates for hearing aids, were classified into three groups by audiogram configuration: low-frequency loss, high-frequency loss, and flat configuration. The misophonia scale, hyperacusis questionnaire, and tinnitus handicap inventory (THI) were administered. Groups were compared using one-way ANOVA or the kruskal-wallis test (bonferroni-corrected pairwise comparisons) depending on normality (shapiro-wilk), and categorical variables with chi-square testing (cramér's v). Significance was set at p<0.05.

results: this preliminary analysis included 50 patients (low-frequency n=9, high-frequency n=25, flat n=16) of a target sample of 108. Hyperacusis scores differed significantly across groups (kruskal-wallis h=8.12, p=0.017), being lower in the low-frequency group than in the high-frequency (p=0.009) and flat groups (p=0.013), with no difference between the latter two (p=0.678). Misophonia and THI scores did not differ significantly between groups (p=0.944 and p=0.771, respectively). Uncomfortable loudness levels also differed significantly across groups (p<0.001), consistent with the hyperacusis findings. Sex distribution differed between groups (p=0.031); age, ULL, and speech-discrimination correlations with symptom scores were not significant.

conclusions: preliminary findings suggest that audiogram configuration is independently associated with hyperacusis severity, but not with misophonia or tinnitus handicap, in patients with SNHL. Steeply configured (low-frequency) losses were associated with lower hyperacusis burden, potentially reflecting reduced high-frequency trigger exposure. These findings, once confirmed in the full target cohort, may help tailor hearing-aid output and compression strategies to individual sound-tolerance profiles.

Small signs, big impact: hearing loss in children