In this research study, the investigators will develop and test a novel, remote counseling
program to reduce reactions to hyperacusis (Aim 1), and compare effectiveness of two sound
therapy options fitted remotely for managing hyperacusis symptoms (Aim 2). In Aim 1, all
participants will complete 4 weeks of weekly monitoring (control) before beginning counseling
(treatment) using the approach of Hyperacusis Activities Treatment through a combination of
recorded videos, hands-on activities, discussion forums, and quizzes for an additional 4
weeks. The investigators will share materials including the videos, hands-on activities, and
quizzes, via a secure learning management system that will provide easy access to all
participants. The counseling materials from HAT will focus on education about the auditory
system, loudness perception and mechanisms for hyperacusis, and the rationale for sound
therapy. After remote counseling, participants from Aim 1 will receive one of two sound
therapy approaches for hyperacusis relief in Aim 2. The investigators will randomize the
participants into one of two groups: 1) Group 1: listen to their individually chosen
bothersome sounds that trigger hyperacusis and 2) Group 2: listen to low-level, continuous
background noise (i.e., white noise). In both groups, participants will be fit remotely with
the devices and use sound therapy for four weeks. For Group 1, the student researchers will
record the three to four most bothersome sounds for the individual participant, provide
recordings of waveforms, and send equipment to participants for their use. In Group 2,
participants will listen to continuous, low-level broadband noise using sound generators
programmed and dispensed by the PI and student researchers. For both groups, the
investigators will track use and volume settings during the four-week trial using the
devices' data logging features. To determine the effectiveness of the two major components of
HAT in Aims 1 and 2, the investigators will employ quantitative measurements of the Inventory
of Hyperacusis (IHS), the Hyperacusis Problems Questionnaire (HPQ), the psychoacoustic test
using natural sounds, the Hyperacusis Disability and Handicap Scale, and the Meaning of Life
Questionnaire. The investigators will administer these measurements before and after
treatment for Aim 1, and before and after treatment for Aim 2. The primary interest is to
determine if the treatments show promise in treating hyperacusis. The investigators will
analyze the data by comparing mean difference scores using paired t-test within the same
group and independent samples t-test between the two groups for each treatment in Aim 2. The
results from power analyses suggest a reasonable effect size of 0.75 with a sample size of 29
subjects per group for Aim 2. A sample size of 30 per group is deemed appropriate to detect
significant differences for all proposed analyses. The power analysis is based on Aim 2;
therefore, there is ample power in Aim 1 to detect pre- and post-treatment differences. The
goal of enrolling 30 participants per group for this feasibility study is reasonable for the
research team (i.e., enroll two participants per month during the academic year and four
participants per month during the summer months).