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Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The lecture addressed (1) the theoretical foundations of CBT for these conditions, (2) clinical evidence on CBT delivered by psychologists, audiologists, and digital self-help, and (3) the proportion of patients who may benefit from CBT. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia. Both psychologist- and audiologist-delivered CBT approaches have demonstrated significant improvements in reducing the impact of tinnitus, hyperacusis, and misophonia on patients’ quality of life, while guided internet-based CBT also demonstrates positive outcomes. Unguided internet-based CBT is also effective, though it faces challenges such as higher dropout rates. Despite these promising results, not all patients experience the same level of benefit. Some continue to experience distress even after completing CBT, highlighting the need for alternative or complementary interventions and ongoing support. This paper estimates that approximately 1 in 52 individuals with tinnitus require CBT, indicating that while tinnitus is relatively common, the need for intensive therapy is comparatively small. To enhance treatment outcomes, future research should compare the effectiveness of psychologist- and audiologist-delivered CBT, explore hybrid models that combine face-to-face and digital interventions, and address challenges with internet-based CBT, particularly for hyperacusis and misophonia. Furthermore, incorporating neuroimaging and physiological measures in future randomised controlled trials could provide objective insights into the neural mechanisms underlying symptom improvement, ultimately helping to refine CBT interventions. Identifying characteristics of non-responders to CBT may also guide the development of more tailored therapeutic approaches.

The objectives of this study were to (1) assess if previously reported unidimensional factor structure of the Misophonia Impact Questionnaire (MIQ), Tinnitus Impact Questionnaire (TIQ), and Hyperacusis Impact Questionnaire (HIQ) can be confirmed in a nonclinical population, and (2) examine test-retest reliability and establish the minimum detectable change (MDC) for MIQ, TIQ and HIQ. 451 people completed the MIQ and HIQ sections of an online survey. A sub-sample of 173/451 who had tinnitus completed the TIQ too. 130/451 participants completed the second survey with 2 weeks interval for the MIQ and HIQ and 32/173 participants with tinnitus completed the TIQ in the second survey. All questionnaires showed excellent internal consistency, with Cronbach’s α of 0.93 for both the MIQ and TIQ and 0.91 for the HIQ. Confirmatory factor analysis (CFA) showed that the MIQ, TIQ and HIQ were all one-factor questionnaires. Based on the intra-class correlation coefficients (ICC) values, the test-retest reliability was good for MIQ and HIQ and it was excellent for TIQ. Based on the MDC values, when these questionnaires are used for repeated measurements, the minimum amount of change that constitutes a true change is ≥ 8 for the total score of MIQ, ≥ 4 for the TIQ, and ≥ 7 for the total score of HIQ. In conclusion, the MIQ, TIQ and HIQ can be used in clinical practice or research setting to measure the impact of misophonia, tinnitus and hyperacusis on the individual’s life, respectively, as one-factor questionnaires with excellent internal consistency and good to excellent test-retest reliability.

Typically emerging within a month of the stressor, adjustment disorder remains a diagnosable mental disorder. [...]distinguishing between reactive and endogenous depression may not necessarily reduce the proportion of patients with comorbid psychiatric conditions among those with hyperacusis or misophonia. In this role, audiologists must screen for symptoms of mental illness and refer patients to mental health services where appropriate. [...]developmental vulnerability and biological divergence complicate a simple “reactive versus endogenous” classification.

Background/Objectives: The Sound Sensitivity Symptoms Questionnaire version 2 (SSSQ2) is a brief clinical tool with six items designed to be used (1) as a measure for severity of sound sensitivity symptoms in general (based on its total score) and (2) as a checklist to screen different forms of sound sensitivity. The objective of this study was to assess the psychometric properties of the SSSQ2. Method: This was a cross-sectional study. A total of 451 people completed the online survey. A total of 154 people completed the survey twice with a two-week interval to establish test–retest reliability. The average age of the participants was 36.5 years (range 18 to 86 years). Results: Confirmatory factor analysis showed that the SSSQ2 is a one-factor questionnaire. Cronbach’s α was 0.80. The test–retest reliability was good for the total SSSQ2 score and was moderate for the sum of items 1 and 3 (indicating loudness hyperacusis), item 2 (for pain hyperacusis), item 4 (for misophonia), item 5 (for fear hyperacusis), and item 6 (for noise sensitivity). The minimum amount of change that constitutes a true change in the total SSSQ2 score is ≥5 points. Conclusions: The SSSQ2 can be used in clinical practice or research setting to measure the severity of general sound sensitivity as a one-factor questionnaire with acceptable internal consistency and good reliability. In addition, the individual items in the SSSQ2 can be used as a checklist to screen for various forms of sound sensitivity.

A confirmatory factor analysis (CFA) of the Tinnitus Impact Questionnaire (TIQ) was performed. In contrast to commonly used tinnitus questionnaires, the TIQ is intended solely to assess the impact of tinnitus by not including items related to hearing loss or tinnitus loudness. This was a psychometric study based on a retrospective cross-sectional analysis of clinical data. Data were available for 155 new patients who had attended a tinnitus and hyperacusis clinic in the UK within a five-month period and had completed the TIQ. The mean age was 54 years (standard deviation = 14 years). The TIQ demonstrated good internal consistency, with Cronbach’s α = 0.84 and McDonald’s ω = 0.89. CFA showed that two items of the TIQ had low factor loadings for both one-factor and two-factor models and their scores showed low correlations with scores for other items. Bi-factor analysis gave a better fit, indicated by a relative chi-square (χ 2 ) of 18.5, a Root-Mean Square Error of Approximation (RMSEA) of 0.103, a Comparative Fit Index (CFI) of 0.97, a Tucker Lewis Index (TLI) of 0.92, and a Standardized Root-Mean Residual (SPMR) of 0.038. Total TIQ scores were moderately correlated with scores for the Visual Analogue Scale of effect of tinnitus on life and the Screening for Anxiety and Depression-Tinnitus questionnaire, supporting the convergent validity of the TIQ. The TIQ score was not correlated with the pure-tone average hearing threshold, indicating discriminant validity. A multiple-causes multiple-indicator (MIMIC) model showed no influences of age, gender or hearing status on TIQ item scores. The TIQ is an internally consistent tool. CFA suggests a bi-factor model with sufficient unidimensionality to support the use of the overall TIQ score for assessing the impact of tinnitus. TIQ scores are distinct from the impact of hearing impairment among patients who have tinnitus combined with hearing loss.

Background: The aim of this study was to conduct a systematic review of the research literature on the prevalence of psychiatric comorbidities in patients with hyperacusis and misophonia. Method: Four databases were searched: PubMed, PsycINFO, Scopus, and Web of Science (Wis)—last search conducted on the 16th of April 2024 to identify relevant studies. The methodological quality of each study was independently assessed using the JBI Critical Appraisal Checklist. Results: Five studies were included for the prevalence of psychiatric comorbidities in hyperacusis, and seventeen studies for misophonia. Among patients with hyperacusis, between 8% and 80% had depression, and between 39% and 61% had any anxiety disorder as measured via a diagnostic interview and/or self-report questionnaires. For misophonia, nine studies provided data on various forms of mood and anxiety disorders, with prevalences ranging from 1.1% to 37.3% and 0.2% to 69%, respectively. Conclusions: Although the 22 included studies varied considerably in design and scope, some recurring patterns of comorbidity were noted. However, apparent trends—such as the higher prevalence of mood and anxiety disorders compared to other psychiatric conditions—should be interpreted with caution, as most studies did not comprehensively assess a full range of psychiatric disorders. This likely skews prevalence estimates toward the conditions that were specifically investigated.

This paper evaluates the proportion and the audiological and other characteristics of patients with symptoms of misophonia among a population seeking help for tinnitus and/or hyperacusis at an audiology clinic (n = 257). To assess such symptoms, patients were asked “over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling angry or anxious when hearing certain sounds related to eating noises, lip-smacking, sniffling, breathing, clicking sounds, tapping?”. The results of routine audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Measures included: pure tone audiometry, uncomfortable loudness levels (ULLs), and responses to the tinnitus impact questionnaire (TIQ), the hyperacusis impact questionnaire (HIQ), and the screening for anxiety and depression in tinnitus (SAD-T) questionnaire. The mean age of the patients was 53 years (SD = 16) (age range 17 to 97 years). Fifty four percent were female. Twenty-three percent of patients were classified as having misophonia. The presence and frequency of reporting misophonia symptoms were not related to audiometric thresholds, except that a steeply sloping audiogram reduced the likelihood of frequent misophonia symptoms. Those with more frequent misophonia symptoms had lower values of ULLmin (the across-frequency average of ULLs for the ear with lower average ULLs) than those with less frequent or no reported symptoms. The reported frequency of experiencing misophonia symptoms increased with increasing impact of tinnitus (TIQ score ≥9), increasing impact of hyperacusis (HIQ score >11), and symptoms of anxiety and depression (SAD-T score ≥4). It is concluded that, when assessing individuals with tinnitus and hyperacusis, it is important to screen for misophonia, particularly when ULLmin is abnormally low or the TIQ, HIQ or SAD-T score is high. This will help clinicians to distinguish patients with misophonia, guiding the choice of therapeutic strategies.

The aim was to assess the effectiveness of cognitive behavioral therapy (CBT) for tinnitus and/or hyperacusis delivered by audiologists working in the National Health Service in the United Kingdom. This was a retrospective study, based on questionnaires assessing tinnitus and hyperacusis and insomnia before and after CBT. Data were gathered for 68 consecutive patients (average age = 52.5 years) who enrolled for CBT. All measures showed significant improvements after CBT. Effect sizes for patients who completed CBT were 1.13 for Tinnitus Handicap Inventory scores; 0.76 for Hyperacusis Questionnaire scores; 0.71, 0.95, and 0.93 for tinnitus loudness, annoyance, and effect on life, respectively, measured using the Visual Analog Scale; and 0.94 for the Insomnia Severity Index score. An analysis including those who dropped out also showed significant improvements for all measures. Audiologist-delivered CBT led to significant improvements in self-report measures of tinnitus and hyperacusis handicap and insomnia. The methods described here may be used when designing future randomized controlled trials of efficacy.

Hyperacusis is highly prevalent in the autism spectrum disorder (ASD) population. This auditory hypersensitivity can trigger pragmatically atypical reactions that may impact social and academic domains. Objective: The aim of this report is to describe the relationship between decreased sound tolerance disorders and the ASD population. Topics covered: The main topics discussed include (1) assessment and prevalence of hyperacusis in ASD; (2) etiology of hyperacusis in ASD; (3) treatment of hyperacusis in ASD. Conclusions: Knowledge of the assessment and treatment of decreased sound tolerance disorders within the ASD population is growing and changing.