There is currently no widely accepted investigation or treatment pathway, and management strategies focus on behavioural techniques ( Potgieter et al., 2020). Decreased sound tolerance is defined as reduced tolerance to sound, often accompanied by painful sensitivity to ordinary environmental sounds, with perceptual, psychological, and social dimensions ( di Stadio et al., 2018). Unilateral tinnitus with no identified aetiology is considered idiopathic and managed with tinnitus retraining therapy ( Jastreboff, 2015) based on a neuropsychological model and considered to offer significant help for 80% of patients. Unilateral tinnitus requires crosssectional imaging ( Tunkel et al., 2014) but the incidence of retrocochlear pathology is just 2.7% ( Choi et al., 2015), higher in patients with ipsilateral hearing loss. Various diagnostic algorithms aim to identify its origin ( Crummer and Hassan, 2004), with bilateral tinnitus of unknown aetiology often being assigned a psychogenic cause ( Miura et al., 2017) especially in patients with a history of psychiatric illness. Tinnitus is defined as a sound in the head or ears that occurs in the absence of any external acoustic source ( Baguley et al., 2013). It is therefore essential that we investigate and manage them optimally. These symptoms can have a profound effect on patients’ lives ( Nondahl et al., 2007). Tinnitus has a reported prevalence 5.1%–42.7% ( McCormack et al., 2016) in general populations, and hyperacusis 0.2%–17.2% ( Ren et al., 2021). Tinnitus and DST present frequently to ENT and Audiology services. The possibility of an ASD diagnosis in patients presenting to ENT and Audiology services with tinnitus and/or DST could therefore have a significant impact on our clinical practice, highlighting a learning need for professionals in ENT and Audiology, and potentially offering more focused management options to our patients. ASD prevalence studies in child populations ( Redfield et al., 2014) suggest that many adults with ASD remain undiagnosed ( Brosnan, 2020) and may present in adulthood with medical or neuropsychological complaints. However, evidence regarding the intersection of auditory symptoms and ASD remains surprisingly minimal, considering the potential clinical and diagnostic implications of this link.Ī recent meta-analysis ( Williams et al., 2021a) concluded that most individuals on the autistic spectrum experience DST at some point in their lives. Several aetiological theories for the link between tinnitus, DST and ASD have been proposed, including processing differences at brainstem ( Wilson et al., 2017 Ohmura et al., 2019) and auditory cortex level ( Matsuzaki et al., 2012), and abnormal behavioural responses to sound ( Lucker, 2013 Stiegler and Davis, 2010). Decreased sound tolerance (DST) as a collective term for hyperacusis, misophonia and phonophobia ( Jastreboff and Jastreboff, 2001) is used within this manuscript. There is a body of published work linking auditory symptoms such as tinnitus and decreased sound tolerance (DST) to ASD, largely within the neurodevelopmental literature. Atypical responses to the auditory environment in individuals with Autistic Spectrum Disorder (ASD) are not a new observation ( Rosenhall et al., 1999).
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