PROJECT SUMMARY/ABSTRACT In line with the funding goals of the National Institutes of Health and the R15 AREA program, this application proposes to investigate the feasibility of a remote counseling and sound therapy program for reducing reactions to hyperacusis. Hyperacusis is a hearing condition causing one’s perception of sounds to be abnormally loud, annoying, fearful, or painful. Clinical management of hyperacusis involves counseling to reduce negative reactions to sounds and sound therapy to improve loudness perception. Despite these helpful approaches, management of hyperacusis is restricted to highly specialized professionals located at large centers that are inaccessible by most hyperacusis patients. Further, research evidence from controlled trials on the effectiveness of these treatments for hyperacusis is lacking, involves only a small number of participants, and is limited to specific approaches, such as cognitive behavioral therapy and low-level background noise. In response to these needs, this research team developed Hyperacusis Activities Treatment (HAT), which includes two components: counseling and sound therapy. Its effectiveness was demonstrated through data obtained from clinical focus groups and small-scale research studies. There is additional potential for HAT to be remotely administered, thus addressing the access-to-care issue currently facing many rural and low-income Americans who are suffering from hyperacusis. The aim of this proposed R15 project is to gather early clinical evidence for the effectiveness of HAT in relieving hyperacusis using a novel, remote delivery approach. The innovative aspects of this project, including the remote delivery and analysis of patient-centered interventions, will inform evidence-based clinical guidelines that are currently lacking and produce more accessible solutions for hyperacusis management. The first aim will evaluate feasibility of the remote counseling program, which includes weekly modules on relevant topics, homework, and quizzes to keep participants engaged, and coaching to support participants. The second aim will compare the effectiveness of two remotely-administered sound therapy options recommended for hyperacusis relief but that are yet to be clinically evaluated—low-level background noise and successive approximations using bothersome sounds. In Aim 1, each participant will complete 4 weeks of baseline testing (control) followed by 4 weeks of counseling (treatment). In Aim 2, participants will be randomized into one of two sound therapy groups. At the end of the project, the research team will have the early clinical evidence needed to support larger, multi-site, future randomized clinical trials that will be designed to more fully evaluate the effectiveness of the remote delivery of HAT’s counseling and customized sound therapy components to reduce reactions to hyperacusis. As an R15 AREA award, the project will also have a significant impact through the research opportunities afforded to student researchers who will be actively involved in the project, and on the research environment by enhancing the PI’s work and advancing priorities of undergraduate research at Augustana College.

PROJECT NARRATIVE This project gathers early clinical evidence on the effectiveness of a novel, remotely-delivered treatment program for hyperacusis that affects an estimated 6–17% of all people and is characterized by perceiving sound as abnormally loud, annoying, fearful, or painful. Successful completion of the project will shift hyperacusis management by providing much-needed evidence about the clinical potential for this treatment program, and will facilitate larger, future randomized controlled clinical trials investigating the effectiveness of this program across a larger patient population. As an AREA R15 award, the proposed project will also have an extremely beneficial impact on the undergraduate students, including those from diverse backgrounds, who will be engaged in this NIH-funded research, as well as on the PI’s ongoing treatment program and on the quality of the research environment at Augustana College.