Minimally Invasive Surgery for the Treatment of Hyperacusis

OBJECTIVE To evaluate the efficacy of a minimally invasive surgical procedure in patients with severe hyperacusis. STUDY DESIGN Prospective, longitudinal design. SETTING Tertiary referral center. PATIENTS Adult patients with history of severe hyperacusis. INTERVENTION Using a transcanal approach, the round and oval window was reinforced with temporalis fascia or tragal perichondrium in six subjects (nine ears) and was subdivided into two groups (unilateral or bilateral reinforcement procedure). MAIN OUTCOME MEASURES Pre- and postoperative noise tolerance was measured using uncomfortable loudness level (ULL) test scores. In addition, a self-report hyperacusis questionnaire (HQ) was used to assess hypersensitivity to sound before and after the intervention. RESULTS Analysis of the data reveals improved postoperative mean ULL test scores of 14 dB (confidence interval [CI], 70-98 dB) in the unilateral group. For the bilateral group, improved mean scores were 13 dB (CI, 63-88 dB) in the first ear and 8 dB (CI, 71-86 dB) for the second ear. Further, a negative linear trend was observed in the mean subjective scores for the HQ when both groups measures were analyzed together decreasing from a mean score of 32.0 (standard deviation [SD] = 3.32) preoperative to a mean score of 11.5 (SD = 7.42) after surgery. Postoperatively, the patients reported no change in hearing and improved quality of life after the procedure. CONCLUSION The results suggest that reinforcement of the round and oval window with temporalis fascia or tragal perichondrium may offer significant benefit for individuals with severe hyperacusis that has not responded to traditional therapy. ULL scores and self-report measures postoperatively demonstrate improved noise tolerance, high patient satisfaction, and enhanced quality of life.