Hyperacusis Questionnaire as a Tool for Measuring Hypersensitivity to Sound in a Tinnitus Research Population

Abstract

Hypersensitivity to external sounds is often comorbid with tinnitus and may be significant for adherence to certain types of tinnitus management. Therefore, a clear measure of sensitivity to sound is important. The aim of this study was to evaluate the validity and reliability of the Hyperacusis Questionnaire (HQ) for use as a measurement tool using data from a sample of 264 adults who took part in tinnitus research. We evaluated the HQ factor structure, internal consistency, convergent and discriminant validity, and floor and ceiling effects. Internal consistency was high (Cronbach's alpha = 0.88) and moderate correlations were observed between the HQ, uncomfortable loudness levels, and other health questionnaires. Confirmatory factor analysis revealed that the original HQ three-factor solution and a one-factor solution were both a poor fit to the data. Four problematic items were removed and exploratory factor analysis identified a two-factor (attentional and social) solution. The original three-factor structure of the HQ was not confirmed. All fourteen items do not accurately assess hypersensitivity to sound in a tinnitus population. We propose a 10-item (2-factor) version of the HQ, which will need to be confirmed using a new tinnitus and perhaps nontinnitus population.

Figure 1

Theoretical 3-factor structure of the Hyperacusis Questionnaire (HQ). The model represents the proposed relationships between the items (observed variables), the first-order factors consistent with attentional, social, and emotional subscales, and the second-order factor consistent with the global measure of “hypersensitivity to sound” (variance fixed at 1). Variance fixed at 1 for second-order factor and items 2, 5, and 11. The unidirectional black arrows represent the direct effects of the second-order factor onto the three first-order factors and the direct effects of the first-order factors onto the observed variables. The fourteen observed variables are represented as HQ1 to HQ14, with all items only associated with their designated factor. The unidirectional grey arrows represent the error variance (e) associated with each variable, each freely estimated on their designated factor with zero loadings on the other factors with error variance assumed to be uncorrelated and random (constrained to zero). e = residual variance (error and uniqueness terms).

Figure 2

Distribution of Hyperacusis Questionnaire total scores. The diagnostic criterion is represented with a black bold line (—). The mean score for the current study is presented as a black bold dotted line (- - - - -). According to the criteria identified by Khalfa et al. [31], only 7% of participants indicate hypersensitivity, whilst 47% of participants were above our mean score.