title: Elevated Acoustic Startle Responses in Humans: Relationship to Reduced Loudness Discomfort Level, but not Self-Report of Hyperacusis.
abstract: Increases in the acoustic startle response (ASR) of animals have been reported following experimental manipulations to induce tinnitus, an auditory disorder defined by phantom perception of sound. The increases in ASR have been proposed to signify the development of hyperacusis, a clinical condition defined by intolerance of normally tolerable sound levels. To test this proposal, the present study compared ASR amplitude to measures of sound-level tolerance (SLT) in humans, the only species in which SLT can be directly assessed. Participants had clinically normal/near-normal hearing thresholds, were free of psychotropic medications, and comprised people with tinnitus and without. ASR was measured as eyeblink-related electromyographic activity in response to a noise pulse presented at a range of levels and in two background conditions (noise and quiet). SLT was measured as loudness discomfort level (LDL), the lowest level of sound deemed uncomfortable, and via a questionnaire on the loudness of sounds in everyday life. Regardless of tinnitus status, ASR amplitude at a given stimulus level increased with decreasing LDL, but showed no relationship to SLT self-reported via the questionnaire. These relationships (or lack thereof) could not be attributed to hearing threshold, age, anxiety, or depression. The results imply that increases in ASR in the animal work signify decreases in LDL specifically and may not correspond to the development of hyperacusis as would be self-reported by a clinic patient.
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. inge_knudson@meei.harvard.edu.|Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. inge_knudson@meei.harvard.edu.|Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA, 02114, USA. inge_knudson@meei.harvard.edu.
authors.forename: Inge M
authors.identifier: 0000-0003-2774-8011
authors.initials: IM
authors.lastname: Knudson
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.|Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.|Speech and Hearing Bioscience and Technology Program, Harvard Division of Medical Sciences, Boston, MA, USA.|Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA, 02114, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Melcher
mesh_terms: D000328:Adult; D001309:Auditory Threshold / Q000502:physiology*; D005260:Female; D006801:Humans; D012001:Hyperacusis / Q000503:physiopathology*; D008144:Loudness Perception; D008297:Male; D008875:Middle Aged; D013216:Reflex, Startle / Q000502:physiology*
keywords: acoustic reflex; hyperacusis; sound-level tolerance