Visual analogue scale effectively screens for hyperacusis.

Hyperacusis is associated with elevated thresholds in high-frequency audiometry.

Participants with hyperacusis showed poorer speech-in-noise perception.

Emotional intensity of natural sound perception is increased in hyperacusis.

Harmonic-to-noise ratio: a key acoustic characteristic of discomfort in hyperacusis.

Hyperacusis is a hearing disorder characterized by decreased sound tolerance. However, diagnostic methods remain debated to take into account both the subjective complaint and an objective measure of hearing impairment. This study aims to propose a quick screening method for hyperacusis using a visual analog scale, combined with hearing assessments to specify the physiological and emotional factors involved in this hearing discomfort. First, a threshold of 6/10 on the visual analogue scale led to a sensitivity of 1 and a specificity of 0.94, on the categorization of a sample of hyperacusis (N = 9) and non-hyperacusis (N = 18) participants, whose diagnosis was validated by the Hyperacusis Questionnaire. The association between hyperacusis and hearing loss was also explored using audiological tests, such as extended high-frequency audiometry and speech-in-noise perception. Participants with hyperacusis showed elevated hearing thresholds in extended high frequencies and poorer speech-in-noise abilities, supporting a link between hyperacusis and peripheral auditory damage involved in hidden hearing loss. Finally, an assessment of natural sounds was proposed to identify the acoustic characteristics of sounds causing discomfort in hyperacusis participants. The functional impairment in terms of emotional experience was also confirmed, with a higher assessment of emotional arousal when listening to natural sounds than for non-hyperacusis participants. Harmonic-to-noise ratio has been identified as an acoustic characteristic specifically involved in this emotional assessment in hyperacusis participants. Nevertheless, the diversity of hyperacusis profiles encourages the use of complementary diagnostic measures, both audiological and emotional, and broad screening particularly for populations exposed to noise.

Hyperacusis

Tinnitus

Visual analog scale

Extended high-frequency audiometry

Speech in noise

Natural sound

Hidden hearing loss

© 2025 The Authors. Published by Elsevier B.V.