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Misophonia is a chronic condition in which specific sounds cause intense negative emotions and autonomic arousal. Misophonia is considered a psychological disorder without any relationship with specific alterations of hearing receptors and independent from physical characteristics of the sound. Moreover if misophonia can be defined as a specific psychiatric disorder or a correlate of other conditions is still under debate. The patients were two women and one man. In this case series we first identified the presence of triggers sounds inducing misophonia as reported during the psychotherapy sessions. At a qualitative level all the three patients perceived that the others were intentionally acting with the purpose of underline their maladaptive interpersonal schemas. All the patients were evaluated with the use of questionnaires. Regarding personality disorders (PD) all three patients suffered from at least one PD. As regard depression, one had moderate depression and one had severe depression. Two patients had moderate/severe anxiety. All the three patients can be considered as highly problematic in the interpersonal domain. Our findings have clinical implications for the treatment of misophonia because it seems to be sustained by underlying PD or maladaptive interpersonal schemas. The qualitative analysis of these cases has highlighted how patients with misophonia tended to ascribe intentionality to the people who emit the sounds that trigger their negative emotional reactions. Further studies are necessary to evaluate which kind of interpersonal patterns occur in these patients.

Recent research has highlighted the role of metacognitions as a moderator for psychological distress in patients with chronic diseases. The present study investigates the role of metacognitions and worry in the association between tinnitus distress, anxiety, and depression. A cross-sectional study was carried out with a sample of tinnitus-outpatients who completed the Tinnitus-Handicap Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Metacognition Questionnaire-30, Penn-State-Worry-Questionnaire. Associations of metacognitions, worries, tinnitus distress, anxiety and depression were investigated using structural equation models (SEMs). A sample of n = 107 patients was included in the study. In the first SEM, tinnitus distress significantly predicted depression (&beta, = 0.68, p &lt, 0.001) and anxiety (&beta, = 0.47, p &lt, 0.001). In the second model, worries and meta-cognitions were added as moderators. The explained variance substantially increased for depression (46 to 53%) and anxiety (22 to 35%) and the association of tinnitus distress with depression (&beta, = 0.57, p &lt, 0.001) and anxiety was weakened (&beta, = 0.32, p &lt, 0.001). Negative beliefs significantly predicted worries (&beta, = 0.51, p &lt, 0.001) and explained 41% of its variance. A good model fit for the final model was found (comparative fit index (CFI) = 0.98, (Tucker Lewis index) TLI = 0.96, root mean square error of approximation (RMSEA) = 0.067). Anxiety and depression in tinnitus patients might be influenced by worries, which is mainly predicted by negative beliefs about uncontrollability and danger of worries. Thus, psychotherapeutic approaches focused on alterations of metacognitions in patients with tinnitus should be investigated in future studies.3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.)

Tinnitus is defined as perception of a sound without sound stimulation. This study aims to investigate the correlation between chronic tinnitus and the most significant clinical comorbidities and pharmacological treatments. We recruited 130 consecutive outpatients with a tinnitus for least from three months and 100 subjects without tinnitus. All patients had a full medical and audiological evaluation and all filled in Tinnitus Handicap Inventory questionnaire and Khalfa’s Hyperacusis questionnaire. We also analyzed the qualitative variables: audiometry exam, tinnitus characteristics and psychometric questionnaires. Univariate logistic regression was performed to evaluate the associations between the presence of tinnitus and the presence of comorbidities and drug intake. The statistical analysis provided the following results in the group of patients with tinnitus. We obtained an Odds Ratio statistically significant for the following categories taken into consideration: the presence of anxiety and depression, neurological diseases, headache, temporomandibular joint (TMJ) disorders, intake of levothyroxine and proton-pump inhibitor. In this study, we tried to evaluate the audiological characteristics in the subjects affected by chronic tinnitus in order to find a possible correlation with the comorbidities and any drugs intake. We found a statistically significant correlation between tinnitus and comorbidities like anxiety, depression, TMJ disorders, dysthyroidism, headache and levothyroxine and PPI intake.

In the theory of the French Ear, Nose and Throat (ENT) doctor Alfred Tomatis, the voice emits the frequencies the ear can perceive. The auditory stimulation, through the treatment elaborated by Tomatis, can determine the stabilization or the improvement of some vocal parameters, as well as the effect on the formants of voice. A group of N = 19 subjects, singers and actors, were assessed by complete clinical ENT evaluations including fibrolaryngoscopy, otoscopy, and clinical audiometry. The voice analysis was carried out with the Multi-Dimensional Voice Program (MDVP) and with the Praat software. The results demonstrate that after the treatment entails an increase in the mean of energy density on the third formant of voice (F3). An improvement in the ability to maintain a constant intensity of the vocal emission resulted from MDVP analysis with a reduction on the standard deviation of the voice amplitude. The improvement in the auditory perception, particularly for 3 kHz, determines a better intelligibilit...

Validazione della versione italiana del Questionario sull’Accettazione dell’Acufene Cronico (CTAQ-I).L’acufene è un sintomo ampiamente diffuso, rappresenta una condizione cronica per circa il 10% della popolazione adulta. La maggioranza dei pazienti non si sente danneggiata dall’acufene, ma circa lo 0,5-3% della popolazione adulta sviluppa un grave disagio e si sente compromesso nella vita di tutti i giorni. Quanto grave sia il disagio provato può essere solo parzialmente spiegato dalle caratteristiche dell’acufene stesso (come intensità o durata). Le variabili psicologiche, come l’accettazione dell’acufene, sono sempre più indagate dalla ricerca. Lo scopo di questo studio è analizzare la qualità psicometrica della versione italiana del Chronic Tinnitus Acceptance Questionnaire, “Questionario sull’accettazione dell’acufene cronico” (CTAQ-I). Il CTAQ-I è un adattamento del questionario italiano sull’ accettazione del dolore cronico (CPAQ), adattato per lo scopo dello studio dell’acufene cronico. Studio multicentrico trasversale mediante questionario su 141 pazienti ambulatoriali con acufene cronico. I dati sociodemografici e clinici sono stati valutati con la Tinnitus Sample Case History (TSCH), l’accettazione dell’acufene con il “Questionario sull’accettazione dell’acufene cronico” (CTAQ-I), il disagio dell’acufene con la Tinnitus Handicap Inventory (THI) e il mini Questionnaire (TQ 12-I). Inoltre abbiamo valutato il disagio psicologico generale del paziente (Brief Symptom Inventory - BSI) e la qualità della vita correlata alla salute (SF-36). Sono state condotte valutazioni psicometriche e fattoriali del CTAQ-I. Per studiare l’influenza delle variabili sociodemografiche e numerose variabili cliniche sull’accettazione dell’acufene, abbiamo calcolato i coefficienti di correlazione, l’analisi della varianza e il test T per campioni indipendenti. L’analisi fattoriale ha rivelato una soluzione a due fattori (‘activity engagement’ e ‘tinnitus willingness’), che rappresentano il 41,1% della varianza. È stata trovata una buona coerenza interna per il punteggio totale (α = 0,84) ed entrambi i fattori (α = 0,80-0,88). Le moderate correlazioni negative con il disagio indicavano una buona validità. L’accettazione dell’acufene era ulteriormente correlata a un minore stress psicologico e minore volume dell’acufene soggettivo, oltre che ad un maggiore benessere emotivo. L’accettazione dell’acufene è considerata un’importante risorsa terapeutica di cambiamento nei trattamenti (comportamentali e di counseling professionale) per l’acufene. Il nostro studio mostra che il CTAQ-I è uno strumento affidabile e valido per misurare l’accettazione dell’acufene cronico da parte dei pazienti.Tinnitus is a widespread symptom that is chronically experienced by approximately 10% of the adult population. While the vast majority of individuals do not feel impaired by their ear noise, about 0.5-3% of the adult population develops severe distress and feels impaired in everyday life. The severity of the distress experienced can only partially be explained by the characteristics of the ear noise itself (e.g. objective tinnitus loudness or duration). Psychological variables such as tinnitus acceptance are being increasingly investigated by tinnitus research. The aim of this study was to analyse the psychometric quality of the Italian version of the “Chronic Tinnitus Acceptance Questionnaire” (CTAQ-I). The CTAQ-I is an adaption of the Italian “Chronic Pain Acceptance Questionnaire (CPAQ)” and altered for the study of tinnitus acceptance. This cross-sectional multicentre questionnaire study included 141 outpatients with chronic tinnitus. Sociodemographic and clinical data were assessed with the Tinnitus Sample Case History (TSCH), tinnitus acceptance with the Italian “Chronic Tinnitus Acceptance Questionnaire” (CTAQ-I), tinnitus distress with the Tinnitus Handicap Inventory (THI) and the Tinnitus Questionnaire Short Form (TQ 12-I). Furthermore, we assessed the patient’s general psychological distress (Brief Symptom Inventory - BSI) and Health Related Quality of Life (SF-36). Psychometric and factorial evaluation of the CTAQ-I were carried out. To investigate the influence of sociodemographic and numerous clinical variables on tinnitus acceptance we calculated correlation coefficients, analysis of variance and independent sample-t-tests. The factor analysis revealed a two-factor solution (“activity engagement” and “tinnitus willingness”), accounting for 41.1% of the variance. Good internal consistency for the total score (α = 0.84) and both factors (α = 0.80-0.88) was found. Moderate negative correlations with tinnitus distress indicated good validity. Tinnitus acceptance was further correlated with lower psychological distress and subjective tinnitus loudness, as well as increased emotional well-being. Tinnitus acceptance is considered to be an important source of therapeutic change in behavioural-based treatments as well as in professional counselling for tinnitus. Our study shows that the CTAQ-I is a reliable and valid instrument to measure the acceptance of patients suffering from chronic tinnitus.

The aim of this study was to explore the collapsibility of the Italian version of Khalfa’s hyperacusis questionnaire (HQ). We identified the more statistically significant items of the HQ and created the short hyperacusis questionnaire (SHQ). We recruited 117 consecutive outpatients with a primary complaint of tinnitus at least from 3 months. All patients filled in the complete Italian version of the HQ and underwent an audiological examination including uncomfortable loudness levels (ULLs). A logistic model was carried out getting odds ratios (ORs) estimates of hyperacusis according to the items responses. To create the SHQ, we selected six items that were the only ones to present a statistically significant ORs value different from 1. The internal consistency of the SHQ was assessed by means of Cronbach α index. A ROC analysis was performed and an optimal cut-off point was found using the Youden index. Our analysis showed a Cronbach α of 0.67. The area under the ROC curve (AUC), expression of the overall performance of the SHQ versus the ULLs test, was statistically significant (P&lt, 0.05). We found a cut-off of 0.24 as indicative of hyperacusis (sensitivity (Se) = 78.79%, specificity (Sp) = 42.50%). SHQ could be useful only in the initial screening of individuals with hyperacusis. We suggest further studies for the validation of a new questionnaire on hyperacusis.

The purpose of this study was to consider the possible role of autoimmune diseases and paraneoplastic syndrome in the genesis of tinnitus. The incidence of autoimmune inner ear disease (AIED) is rare, accounting for &lt, 1% of all cases of hearing impairment and dizziness. In presence of auditory and vestibular deficit in oncological patients, a paraneoplastic syndrome with cochleovestibulopathy should be considered. We described a 50-year-old Caucasian woman came to our attention with complaints of severe disabling bilateral tinnitus (Tinnitus Handicap Inventory, THI: 96), ear fullness and headache. The onset of tinnitus was associated to the last breast implant and prolonged antibiotic therapy. Serological autoimmunity tests were positive and a diagnosis of mixed connective tissue disease with notes of fibromyalgia was made. Pure tone audiometry testing revealed bilateral fluctuating mild hearing loss on high frequencies. The tinnitus was successfully treated with bilateral wideband sound generators (listening 8-9 hours for day) regulated at the mixing point. At 12 months follow up THI has shrunk considerably (THI: 4) and the patient has continued treatment only with the sound pillow. In conclusion significant progress is needed to better understand the role of autoantibodies in the pathogenesis and diagnosis of paraneoplastic cochleovestibulopathy. To our knowledge, our study is the first in which hearing loss and tinnitus is considered as a manifestation of a paraneoplastic syndrome.

The physiological age-related hearing loss is defined as presbycusis and it is characterized by reduced hearing sensitivity and problems in understanding spoken language especially in a noisy environment. In elderly the reduced speech recognition is generally caused by a reduction of the cochlear cells in the organ of Corti and degeneration of the central auditory pathways. In order to have a complete management strategy of central and peripheral presbycusis the diagnostic evaluation should include clinical ENT examination, standard audiological tests, and tests of central auditory function. Treatment should include not only the appropriate instruments for peripheral compensation but also auditory rehabilitative training and counseling to prevent social isolation and loss of autonomy. Other common hearing disorders in elderly are tinnitus and hyperacusis which are often undervalued. Tinnitus is characterized by the perception of a “phantom” sound due to abnormal auditory perception. Hyperacusis is defined as a reduced tolerance to ordinary environmental sounds. Furthermore auditory, visual, nociceptive, and proprioceptive systems may be involved together in a possible context of “sensorineural aging.” The aim of this review is to underline the presence of hearing disorders like tinnitus and hyperacusis which in many cases coexist with hearing loss in elderly.

Objective Tinnitus is an auditory phantom sensation experienced in the absence of a sound source. Cognitive dysfunctions, especially in working memory and attention, are frequently reported to be associated with tinnitus. The aim of this study was to investigate attentional functioning in a group of subjects with chronic tinnitus using ERPs, and in particular the P300 components. Methods We studied 20 patients with chronic tinnitus and 20 healthy subjects that performed a P300 Novelty task. Results P3a amplitude was significantly lower in tinnitus subjects than in controls. P3a latency was comparable in patients and controls. The P3b parameters were similar in the two groups. N1 latency for all the stimuli was significantly longer in tinnitus subjects than in controls. Conclusion These results point to a general slowing in early stimulus perception in tinnitus subjects. Moreover, a specific difficulty emerged in attentional switching to unexpected events during an orienting response, probably owing to a dysfunction in the ventral attention network. Significance Psychophysiological approach reveals selective attentional impairment and could provide useful data for rehabilitative strategies in chronic tinnitus.

We report a case of a patient with severe hyperacusis, photophobia, and skin hypersensitivity. The patient was initially treated with sound therapy and medical therapy for 4 months and successfully with a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy which improved her mood and the tolerance for sounds and light.

Tinnitus is a perception of sound in absence of sound stimulation. Tinnitus in many cases cannot be eliminated by conventional medical treatment with drugs or surgery. Some people who begin to notice tinnitus, whether spontaneous or induced by noise, trauma or other insult, will experience spontaneous resolution, but many patients will have persistent tinnitus. For some of them, tinnitus sensation will be joined by tinnitus suffering, with many adverse effects like anxiety, depression and sleep disorders. For these tinnitus sufferers the psychological and acoustic approach proposed by the Tinnitus Retraining Therapy and Acoustic Desensitization Protocol may be helpful. Periodically new treatments are suggested like low-frequency repetitive transcranial magnetic stimulation and sequential phase shift sound cancellation treatment based on the frequency and loudness matching of the tinnitus. The aim of this work is to review modern considerations for the treatment of tinnitus.

BACKGROUND Olfactory dysfunction is present since the earliest stage of Alzheimer's disease (AD). In AD patients, the olfactory impairment has been correlated with atrophy of some structures of the olfactory system, but the role of the olfactory bulb remains unclear. OBJECTIVE The aim of our work is to test if patients suffering from AD exhibit a statistically significant reduction of the average volume of the olfactory bulb (OBV) compared to healthy subjects. METHODS 78 subjects were enrolled in the study and divided into three groups: 28 healthy elderly (22 females, 6 males, mean age 69.4 ± 9.2), 25 patients with mild cognitive impairment (MCI) amnestic type (14 females, 11 males, mean age 74.5 ± 7.5), and 25 mild AD patients (14 females, 11 males, mean age 73.7 ± 6.8). Every subject underwent an MRI study of the olfactory bulb and an olfactory assessment with the Sniffin' Stick Extended Test. RESULTS The statistical analysis showed no correlation between the OBV and MCI or AD. Moreover, olfactory function and OBV were not correlated in any of the three groups. CONCLUSION The reduction of OBV does not seem to represent an index of neuronal damage in the earliest stages of AD.

We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

Background The aim of this pilot study was to verify the role of olfactory test and volumetric magnetic resonance imaging measure of hippocampus to predict conversion from mild cognitive impairment to Alzheimer disease (AD). Materials and methods Eighteen patients with amnesic mild cognitive impairment, broadly defined, were followed at 12 months. Hypothesized baseline predictors for follow-up conversion to AD were olfactory deficit and hippocampal volumes loss. Results In the 1-year follow-up, 5 patients converted to AD. The 2 clinical predictors olfactory test and hippocampal volume loss showed the same sensitivity of 92.3% but the olfactory test showed a higher specificity than the hippocampal volume loss (75% vs. 60%). Conclusions Our findings suggest the potential utility of olfactory test and hippocampal volume loss for early detection of AD.

Patients with tinnitus are heterogeneous and several factors influence the impact of this symptom on the quality of life. The aim of the study is to evaluate the relationship between age, gender, sleep disorders, hyperacusis and tinnitus annoyance and to demonstrate the utility of tinnitus questionnaires as screening tools for sleep disorders and hyperacusis in patients with tinnitus. 37 consecutive patients (18 males and 19 females) with subjective tinnitus lasting over 3 months were evaluated with a complete interview, otological examination, pure tone audiometry, Italian version of tinnitus sample case history (TSCH) and tinnitus handicap inventory (THI). Statistical analysis was performed with the Wilcoxon's rank sum test, the Spearman's rho non-parametric correlation and the logistic regression analysis. THI grades were slight (16%), mild (32%), moderate (30%), severe (19%) and catastrophic (3%). Based on the answers to TSCH 20 patients reported sleep disorders (54%) and 20 patients reported hyperacusis (54%). 11 patients (30%) reported sleep disorders and hyperacusis. No significant correlation was found between the severity of tinnitus and patients' age and gender. Significant correlation was found between sleep disorders (P = 0.0009) and tinnitus annoyance and between hyperacusis (P = 0.03) and tinnitus annoyance. TSCH and THI may be considered as screening tools in the clinical practice to evidence sleep disorders and hyperacusis in patients with tinnitus.

We describe a case of a 67-year-old woman with severe disabling right-sided tinnitus, mild hyperacusis, and headache. The tinnitus was associated with sudden right hearing loss and vertigo, which occurred about 18 months before. Magnetic resonance imaging (MRI) resulted in normal anatomical structures of the cochlea and of the cranial nerves showing a partial empty sella syndrome with suprasellar cistern hernia. Angio-MR revealed a bilateral contact between the anterior-inferior cerebellar artery (AICA) and the acoustic-facial nerve with a potential neurovascular conflict. Surgery was considered unnecessary after further evaluations. The right ear was successfully treated with a combination device (hearing aid plus sound generator). Shortly after a standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and headache which completely disappeared at the follow-up evaluation after 3, 6, and 12 months. This paper demonstrates that the combination device resulted in a complete tinnitus and hyperacusis suppression in a patient with unilateral sensorineural sudden hearing loss. Our paper further supports the restoration of peripheral sensory input for the treatment of tinnitus associated with hearing loss in selected patients.

Loss of olfactory function starts at 60 years and become significantly worse after 70. In many cases olfactory disorders may be a consequence of a disease. Different types of olfactory deficit may be revealed by smell evaluation. Anosmia is defined as inability to perceive all odors (total) or some odors (partial). Hyposmia or microsmia is a decreased sensitivity to odors. Dysosmia is a distorted smell percpeption. Olfactory agnosia is defined as failure to identify odors in presence of normal detection and discrimination. Olfactory allucinations are named phantosmias. Many common diseases may compromise the sense of smell, permanently or temporaneally. The range of diseases causing olfactory disorders varies from the common cold to neurodegenerative diseases. Most common causes of olfactory loss are local nasal diseases (allergic rhinitis, nasal polyposis, sinus disease), head trauma, viral and bacterial infections of upper airways. Some neurodegenerative diseases like Alzheimer's disease (AD) and various forms of Parkinson’s disease (PD) are accompanied, even from their earliest stages, by olfactory disorders. Dementia is defined by the American Academy of Neurology as a progressive and permanent decline in cognitive function and affects nearly 15% of people who live up to 65 years and 35% of those who reach the age of 85. The Alzheimer's Disease International (ADI) in Alzheimer World Report published in 2010 provides that an aging population with dementia the most common form is AD which is currently estimated to affect 35,6 million of people will nearly double in 20 years to reach 66 million in 2030 with a higher concentration in poor countries leading to enormous social costs. The research on AD is now oriented to an early diagnosis which is essential before the development of the irreversible and typical changes due to AD. In AD patients, a reduced capacity for olfactory detection, discrimination and identification is usually found and confirmed by several studies (Mesholam et al., 1998; Hawkes, 2003; Kovacs, 2004; Albers et al., 2006; Westervelt et al., 2007). In this chapter we present a review on the predictive role of hyposmia in the early diagnosis of AD patients.

The sense of smell significantly contributes to quality of life. In recent years much progress has been made in understanding the biochemistry, physiology and pathology of the human olfactory system. Olfactory disorders may arise not only from upper airway phlogosis but also from neurodegenerative disease. Hyposmia may precede motor signs in Parkinson's disease and cognitive deficit in Alzheimer's disease. These findings suggest the complementary role of olfactory tests in the diagnosis and management of neurodegenerative diseases. In this report we present a review of modern olfactory tests and their clinical applications. Although rarely employed in routine clinical practice, the olfactory test evaluates the ability of odour identification and is a useful diagnostic tool for olfaction evaluation. Olfactory screening tests are also available. In this work we strongly recommend the importance of an ENT evaluation before the test administration and dissuade from a self-administration of an olfactory test.

Mild cognitive impairment (MCI) is a transient status between physiologic ageing and dementia. Each year more than 12% of subjects with MCI develop Alzheimer's disease. This study evaluated the presence of an olfactory deficit in amnesic MCI (aMCI) patients. Twenty-nine patients diagnosed with aMCI and a homogeneous control group of 29 subjects were enrolled in the study. Olfactory function was assessed by the Sniffin' Sticks Screening Test (SSST) and the Mini Mental State Examination, the Clinical Dementia Rating, the Geriatric Depression Scale and the Mental Deterioration Battery were used to evaluate the neurocognitive status. aMCI patients showed a significant impairment of their olfactory identification compared to controls (SSST score: 8.3+/-2.1 vs. 10.8+/-0.9; p

The present study aims to evaluate and validate the Italian version of Khalfa's questionnaire on hyperacusis (HQ). We recruited 117 patients (64 men, 53 women, mean age 53 years, range 14-88) with tinnitus for at least 3 months as a primary disorder. All patients completed the THI and the Italian version of the HQ and underwent audiometry, pitch and loudness tinnitus matching, otoacoustic emissions with distortion products (DPOAE) and uncomfortable loudness level (ULL). The overall performance of the tests was evaluated and compared using the area under the RO C curve (AUC) relative to the tests. The cut-off of the HQ was calculated. We also assessed the Cronbach's alpha (αC) for the HQ and its three major dimensions (attentional - αC1, emotional - αC2 and social - αC3). Statistical analysis showed no correlation between DPOAE, audiometry, ULL and gender. We observed a high correlation (p0.05) between hyperacusis and ULL described by the Spearman's ρ index (rs = 0.72). We found a cut-off of 16 indicative of hyperacusis comparing the area under the RO C curve (AUC) of HQ and audiometry, taken as a diagnostic reference, (sensitivity = 67.9% and specificity = 72.2%). The reliability of HQ was confirmed by a high αC = 0.89. The αC for the single dimensional scales were, respectively, αC1 = 0.73, αC2 = 0.72 and αC3 = 0.81. The Italian version of the HQ is recommended for proper and complete classification of patients with tinnitus and hyperacusis. From our study, we found a cut-off of 16 instead of the cut-off of 28 described as very high by other authors. Moreover, ULL was an important variable and can be discriminating in the evaluation of hyperacusis.Il presente studio ha come scopo quello di valutare e dimostrare la validità della versione italiana del questionario sull'iperacusia di Khalfa (HQ). Sono stati reclutati 117 pazienti (64 uomini, 53 donne; età: 14-88 anni, media 53 anni) con acufene da almeno 3 mesi come disturbo primario. Tutti i pazienti hanno compilato il THI e la versione italiana del HQ e sono stati sottoposti ad esame audiometrico, acufenometria, otoemissioni acustiche con prodotti di distorsione (DPOAE) e soglia del fastidio (ULL). La performance complessiva dei test è stata valutata e confrontata usando l'area sotto le curve ROC (AUC) relative ai test. Il cut-off del HQ è stato calcolato. Inoltre abbiamo valutato l'alfa di Cronbach's (αC) per il HQ e per le sue tre scale dimensionali: attenzionale (αC1), emotiva (αC2) e sociale (αC3). La nostra analisi statistica non ha evidenziato alcuna correlazione tra DPOAE, esame audiometrico, ULL e sesso. Inoltre è stata osservata una elevata correlazione tra l'iperacusia e l'ULL, descritto dall'indice ρ di Spearman (rs = 0,72). È stato calcolato un cut-off di 16 indicativo di iperacusia, comparando l'area sotto la curva ROC (AUC) del HQ e l'audiometria, presa come riferimento diagnostico, (sensibilità = 67.89% e specificità = 72.22%). L'affidabilità del HQ è stata confermata da un alto αC = 0,89. L'αC per le singole scale dimensionali sono risultate rispettivamente αC1 = 0.73, αC2 = 0.72 e αC3 = 0.81. La versione italiana del HQ è consigliata per una classificazione appropriata e completa dei pazienti con iperacusia. Dal nostro studio abbiamo trovato un cut-off di 16 invece del cut-off di 28, descritto come molto alto da differenti autori. Inoltre, l'ULL risulta una importante variabile e può essere discriminante nella valutazione dell'iperacusia.