James A. Henry, PhD, is a retired research audiologist who obtained a doctorate in behavioral neuroscience. He studied tinnitus for 35+ years, and has it himself along with loudness hyperacusis. His career has fostered great accomplishments: for 43 projects and grants he acted as principal or co-principal investigator with 28 million dollars in funding; he employed his knowledge of the complex auditory system through countless lectures and presentations all around the world, receiving several awards along the way; and he authored and coauthored 257 publications, 142 of them published in scientific peer-reviewed journals. He’s still an active author, lending his expertise to ear-related topics and studies. He wrote three books regarding tinnitus, and recently published The Hyperacusis and Misophonia Book.

Hyperacusis Central contacted Dr. Henry to talk about his new, exciting book at length.

J. D.: Thank you for participating in this interview, Dr. Henry. Hyperacusis Central is very thankful for everything you’re doing for the hearing disabled, and your book is a stellar contribution to the cause.

Dr. Henry: Thank you very much. Thanks for having me.

J. D.: You’re welcome. I read your book and found it fascinating, so much so I wrote too much initially, and had to shorten my questions and thoughts. A compliment to you.

Your book provides a wealth of information for not just the people who think they have hyperacusis or what it describes as the five distinct “sound hypersensitivity disorders” but also the clinicians who strive to treat each one. One of The Hyperacusis and Misophonia Book’s resounding themes is that “hyperacusis” itself is used as a blanket term for many different conditions involving sound hypersensitivity, two relating to physical disabilities of the auditory system, and several others that are psychological or behavioral conditions relating to people’s relationships with sound. In other words, hyperacusis is a word that has many conflicting meanings in the medical establishment.

You bring some order to the vast confusion by noting that the five distinct sound hypersensitivity disorders are loudness hyperacusis, pain hyperacusis, misophonia, noise sensitivity, and phonophobia.

Let’s start by explaining each condition.

Dr. Henry: Certainly. Although these disorders have always existed, the different types of disorders are still being distinguished, described, and named. Unfortunately, we are nowhere near reaching consensus, creating confusion with the term “hyperacusis,” as you pointed out. Establishing consensus is necessary to unify this young and emerging field.

Historically, hyperacusis has referred to any form of decreased tolerance to sound. Whereas both forms of hyperacusis involve physical discomfort when exposed to sound, loudness hyperacusis is often described as uncomfortable-to-unbearable physical sensations in the ears or head, with sound perception being overwhelmingly loud and intense, while pain hyperacusis (noxacusis) is the experience of burning, stabbing, or jabbing pain in the ears or head when exposed to, and/or following, any sound at an intensity level that would be comfortable for most people. Misophonia and noise sensitivity are characterized by emotional reactions to sound. With misophonia, the person reacts to certain sounds that usually come from the mouth or nose of other people. The reactions usually involve strong negative emotions. Noise sensitivity refers to hypersensitivity to sound in general, regardless of its source. People with noise sensitivity typically prefer to be in quiet or sound-controlled environments. Sound that reaches a certain level causes irritation/annoyance. Phonophobia does not refer to reactions to sound but rather to an unhealthy fear that sound will be uncomfortable for any reason. It is a phobia that is characterized by anxiety, and it can accompany one or more of the other sound hypersensitivity disorders.

(For the conditions outlined in this book, medical literature does exist, and the extensive amount of care that was taken to write this book included making note of the existing pertinent studies available. As a result, over 200 references are cited.)

J. D.: It is great that you bring order and clarity to all of these disorders. Is your hope that by reading this book, clinicians will begin to understand that using “hyperacusis” as a one-size-fits-all/simple term for vastly different symptoms of the auditory system and the mind’s relationship to sounds in daily life, is something that does a great disservice to the patients with conditions which are oftentimes dissimilar? And what all inspired you to write this informative book?

Dr. Henry: It was my goal after I retired to write books about the different auditory disorders people experience. I started with three books about tinnitus, the first being an overview of tinnitus and the second and third focusing on specific methods of tinnitus management. I also knew that a book addressing sound hypersensitivity disorders was needed. As you’ve pointed out, “hyperacusis” has been a term that is often used to cover all types of sound hypersensitivity disorders. That’s unfortunate because there really are five distinctly different disorders. Before I wrote the book, I became aware of noise sensitivity as a specific condition from my colleague Dr. Sarah Theodoroff, whose research has focused on tinnitus and sound hypersensitivity disorders. I also had a long conversation with David Treworgy, who opened my eyes about pain hyperacusis.

(David suffers from pain hyperacusis and wrote the Forward to The Hyperacusis and Misophonia Book. And he’s later featured in Chapter 13, too—”Treating Pain Hyperacusis”—to share what happened when he tried to treat it.)

When I started writing the book I mainly used the scientific literature as my source of information. The literature is consistent on some issues but inconsistent on many others. It is clear, however, that these disorders exist and have distinctly different symptoms. The field of sound hypersensitivity disorders is in its infant stage. We have a long way to go just to reach consensus on identifying and defining the different disorders and the distinctions between them. If we could just agree on that to start, then research would be more coordinated and effective.

My personal journey is that I’ve had tinnitus and hearing loss since the “loud music” days of my youth and the years of sound exposures relating to carpentry work, and I’ve also had loudness hyperacusis since the 1990s. I don’t have pain hyperacusis nor any of the other four sound hypersensitivity disorders. But having tinnitus, hearing loss, and loudness hyperacusis has enabled me to better understand what people are going through. I cannot, however, fully grasp the seriousness of pain hyperacusis because I’ve never experienced it.

J. D.: But you’re certainly sympathetic toward it, and that’s what matters most. Despite not having it yourself, you understand it’s real, and that the hells the sufferers describe are not exaggerations. For his piece in Hearing Health, Hearing Health Foundation’s magazine, David Treworgy said, “It’s impossible to describe how much suffering this condition entails,” which you noted in your book and sympathized with, along with other descriptions that capture the magnitude of pain hyperacusis’s devastation.

I want to talk about the rarity of loudness hyperacusis and pain hyperacusis. Your book mentions how it has been reported that hyperacusis’s prevalence probably could fall between 3.2 and 17.2 percent of adults (Jacquemin, Schecklmann, and Baguley, 2024). Obviously these numbers are skewed by the fact that “hyperacusis” is a term that covers many different meanings. A number as large as 17 percent would be almost one in five adults. If loudness hyperacusis and pain hyperacusis were that common, the medical establishment would know of their existence, instead of scratching its head like it often does when crossing paths with this rare, unheard-of (hyper-whatchamacallit?), strange condition. But take into account that misophonia, noise sensitivity, phonophobia, etc., are bundled into the term “hyperacusis,” it makes more sense that the numbers would be so high.

Pain hyperacusis is rarer than loudness hyperacusis, that’s established in your book, and I have my own ideas on just how rare it could be. I live in Columbus, Ohio, a city of about a million people, and in its entire population I’m aware of only two cases of pain hyperacusis (one being myself) that reach the level of “extreme disorder,” which is the term your book uses to note the most disabling stage of any sound hypersensitivity disorder. Yet, overall, no one really knows how rare these conditions are, and scientific data needs to answer that. Even if 500 people per million had loudness hyperacusis and pain hyperacusis, that’s still extremely rare. And I think that’s a generous number, given what I’ve witnessed as a part of global hyperacusis communities where not a lot of people get these conditions in the big picture. A sign of how rare these conditions are, too, can be found in the fact that most ENTs (otolaryngologists) claim they’ve never met a hyperacusis patient in the course of their career, which may have been several decades. And they should have had the highest probability of meeting such a person. That shows you how rare that these conditions must be.

So I want to ask you, did you ever encounter a hyperacusis patient in your clinic while working for several decades? I know you specialized in tinnitus, but often, as you know, these two conditions coexist.

Dr. Henry: Well, during my years at the VA, I encountered one person with an extreme case of hyperacusis. I don’t know if he had loudness hyperacusis, pain hyperacusis, or both. I certainly was aware of many people with milder hyperacusis, probably loudness hyperacusis. Since retiring, I’ve spoken to quite a few people who have the different forms of hyperacusis. We don’t know how many people have loudness hyperacusis and pain hyperacusis because studies have not defined these terms in a consistent fashion, nor have they differentiated them from misophonia, noise sensitivity, and phonophobia. The only way we will ever know the prevalence of these disorders is to conduct a large-scale, high-quality epidemiology study that uses consistent terminology and definitions.

J. D.: That makes sense. And if the data existed, I think the medical establishment would be more receptive to patients who report these conditions. Tying into that, how can we get clinicians to acknowledge loudness hyperacusis and pain hyperacusis as real physical conditions? Because oftentimes patients report they don’t. I can vouch for this, as over the 20 years I’ve dealt with these conditions, a slew of doctors failed to believe me. Even ENTs. Even audiologists.

As you know, a recent study from Dr. Kelly Jahn (Hyperacusis Central’s Scientific Advisor) and colleagues reported a survey that showed audiologists, on average, receive about five hours of hyperacusis training. The 102 US audiologists who responded to the survey had vastly different understandings of what hyperacusis is (Jahn, Cohen, & Llodra, 2025).

Dr. Henry: Audiologists and ENTs need to be educated about the different sound hypersensitivity disorders. They should pass qualifying exams to be certified. Those exams currently don’t include much, if anything, about sound hypersensitivity disorders. Therefore, grad training curricula should include that information, and then the qualifying exams need to include relevant questions. That would be a long-term goal; i.e., to get ENT and audiology training programs to teach the material and be held accountable to do so. In the short term, audiologists and ENTs need to be trained about the different disorders to at least be able to identify them and refer the patients to an appropriate specialist. I have a detailed list of almost 500 audiologists in this country who claim to provide tinnitus clinical services. I will be mailing each one of them to inform them about my book.

J. D.: That is excellent, and hopefully it educates the ones who need it.

I want to shift to treatments now. Your book notes how off-label drug use exists for loudness hyperacusis and pain hyperacusis, such as antidepressants, benzodiazepines, opioids, and other pharmaceuticals. Tinnitus Retraining Therapy (also known as TRT), created for tinnitus initially, is often prescribed for hyperacusis, too, and over time its purpose has morphed into a hyperacusis treatment just as much as a tinnitus one. Surgical options exist as well, such as the oval and round window surgery, and ossicle disarticulation surgery.

Of course these options come with varied outcomes of success and failure. Perhaps loudness hyperacusis is a better candidate for Tinnitus Retraining Therapy or other forms of sound therapy, but even those can worsen the condition when trying them, as reported by the sufferers themselves, and also a recent study—A Phenotypic Comparison of Loudness and Pain Hyperacusis: Symptoms, Comorbidity, and Associated Features in a Multinational Patient Registry, published in AJA, American Journal of Audiology. It says that 18 percent of people with loudness hyperacusis worsened when trying sound therapy, and 28 percent with pain hyperacusis. And that tinnitus worsened for many in the study (Williams, Suzman, & Woynaroski, 2021).

The other treatments have also gathered mixed results, where sometimes they help and sometimes they hurt. The 2025 study from Jahn et al. in The Journal of Pain showed how medications can offer different outcomes, good and bad. A lot of times, reactive tinnitus throws a monkey wrench In someone’s ability to tolerate a treatment, since that condition coexists with loudness hyperacusis and pain hyperacusis frequently. For those who’ve sailed the murky waters of pharmaceuticals, they often say they worsened their tinnitus permanently, and that’s because ototoxicity or adverse reactions are somewhat common, especially with an already compromised auditory system.

In your opinion, Dr. Henry, why are the outcomes so varied with these treatments?

Dr. Henry: Outcomes of treatments are variable between people for a number of reasons: (1) people react differently to sound; it’s helpful for most people but exacerbates tinnitus and sound hypersensitivity for other people; (2) it is likely there is a genetic basis for why some people are more susceptible to acquiring these disorders and also how they react to sound and different meds; (3) inconsistent terminology and definitions completely confuse the picture of what therapies should be used with which disorder; (4) we simply don’t know what works in many cases, so it’s largely guesswork. A great deal of research is needed.

The hope or goal of treatment for any sound hypersensitivity disorder is for the person to be able to comfortably tolerate normal, everyday sounds. How to achieve that goal is the question. If a person wants to try TRT, or any form of sound therapy intended to desensitize the central auditory system, they should first try listening to sound on their own. This is easy with today’s technology—just listen to sounds from a smartphone. If TRT is of interest, then listen to the type of broadband noise that is typically used with TRT (usually pink or white noise). So, that’s one thing—don’t sign up for any sound therapy that might make things worse until you’re sure the sound therapy won’t be detrimental. If sound doesn’t exacerbate symptoms, then use it as much as possible—ideally 24/7. But only use sound that is comfortable and not annoying; not causing physical pain or discomfort, in other words. If sound is uncomfortable for any reason, avoid it. Wear earplugs/earmuffs as much as necessary, but always with the goal to eventually be exposed to more sound.

The use of any medication should be approached with caution because all meds cause side effects. There is no drug known to improve any sound hypersensitivity disorder, but different drugs might be helpful for different people.

J. D.: Yeah, it becomes a stressful and scary journey for many sufferers, as treatments tend to pose risks. And people feel they can’t afford to worsen when their quality of life is already next to none.

So, another topic of interest. One of the debates among hyperacusis individuals is whether pain hyperacusis is a more extreme version of loudness hyperacusis or an altogether different condition. What is your opinion, Dr. Henry? Because it seems like they’re two different conditions, and while your book indicates that pain hyperacusis is a more extreme manifestation of hyperacusis than loudness hyperacusis is, it seems to side with the notion that they could be separate entities since different parts of the ears are compromised.

Dr. Henry: I believe the strongest argument is that loudness hyperacusis and pain hyperacusis are two different disorders. It’s still theoretical, but loudness hyperacusis can be explained by an increase in central auditory gain—usually after damage to the cochlea. Pain hyperacusis seems to be caused by (1) hyperactive type II fibers that connect the outer hair cells to the brain stem, (2) tensor tympani syndrome, (3) inflammation affecting the trigeminal nerve, and/or (4) central hypersensitivity (as explained in my book).

J. D.: Yes, the auditory system is a complex-working, small machine with many parts inside of it, and parallels a complicated wristwatch, like the 1,483 components of the Franck Muller Aeternitas Mega 4 watch (The Franck Muller group, 2019). Sometimes I worry that the ears are just too intricate, that when they go kaput, it’s a good-luck-finding-the-source-of-the-problem type of thing. That watch is notoriously difficult to fix. So are the ears. Hopefully that’s just pessimism talking, and the future’s research and treatment evolution changes the narrative.

But while we’re on the topic of coexisting conditions, one of the things that your book discusses is that people can have multiple sound hypersensitivity disorders at the same time, such as loudness hyperacusis, pain hyperacusis, and phonophobia.

Your book also says it’s less common to have misophonia with loudness hyperacusis and pain hyperacusis. Misophonia was, and still likely is by some clinicians, confused with loudness hyperacusis and pain hyperacusis. But The New York Times article authored by Joyce Cohen and featuring audiologist Marsha Johnson in 2011 (click HERE to read it) played an important role in getting the medical establishment to understand that misophonia and loudness hyperacusis and pain hyperacusis are not the same conditions.

I’m a rare example of someone who may have a mild case of misophonia in addition to loudness hyperacusis and pain hyperacusis. I haven’t been formally diagnosed with misophonia, but I’m confident I have it. My cat used to bug me when I tried to watch movies since he had a habit of licking his paws aggressively. The same with people eating with slurping sounds. These sounds were distracting, yes, indeed, but it was more than that. There was this overwhelming urge, or maybe great compulsion, to stop them or get away from them, like I couldn’t focus until they would stop. An annoyance that transcended comprehension, and to make this clear (it was when my loudness hyperacusis and pain hyperacusis were much milder), I want to note that the triggering sounds in question didn’t cause me loudness discomfort or pain like the hyperacusis duo . . . that wasn’t why I got annoyed; they were mental irritants. Which is something that hyperacusis patients don’t want to confuse with their conditions, because clinicians and people in general oftentimes believe that loudness hyperacusis and pain hyperacusis are mental conditions when in fact they’re wholly physical, causing intense discomfort and painful sensations due to a broken auditory system.

Has there ever been a study to investigate how common it is for each of these conditions to coexist?

Dr. Henry: No such study has been conducted to my knowledge. An epidemiology study that uses consistent and accurate terminology and definitions could determine how often these different disorders coexist. I’m sorry that you’ve dealt with those coexisting conditions.

J. D.:Thank you. I appreciate that.

Your book does an awesome job explaining how clinicians can identify if patients have sound hypersensitivity disorders or not, how they should evaluate and treat them, the whole ball of wax.

(If clinicians suspect that a person has a sound hypersensitivity disorder, they can evaluate him or her by using the Sound Hypersensitivity Interview outlined in Dr. Henry’s book. This will ensure that an accurate diagnosis is achieved.)

How did you come up with such an intricate, effective way to diagnose these sound hypersensitivity disorders? Are similar protocols employed for other invisible conditions in the medical field?

Dr. Henry: The entire time I was involved in tinnitus research, we always had to address the fact that many of these people had loudness hyperacusis (which we just referred to as “hyperacusis” because we didn’t know about pain hyperacusis). When we developed Progressive Tinnitus Management, we had to build into the protocol the possibility that people with tinnitus also had hyperacusis. So when we developed the Tinnitus and Hearing Survey, we added two items to screen for hyperacusis. If a person had a severe case of hyperacusis, they needed to be more fully evaluated. For that reason, we developed the Sound Tolerance Interview. It addressed loudness hyperacusis, but that’s all. I wrote an article that covered loudness hyperacusis, misophonia, noise sensitivity, and phonophobia, and the Sound Tolerance Interview was updated to address all four of those disorders. When writing this new book, I included pain hyperacusis, and so I further updated the Sound Tolerance Interview to address all five of the sound hypersensitivity disorders. I renamed it the Sound Hypersensitivity Interview.

J. D.: Very interesting. It’s an effective way to diagnose.

Where do you feel “reactive tinnitus” falls into this discussion about sound hypersensitivity disorders? That is, tinnitus that worsens in the presence of sound, and sometimes exists without loudness hyperacusis or pain hyperacusis.

Dr. Henry: A person’s tinnitus can be “reactive” if certain everyday sounds cause the tinnitus to become louder/more intense for hours or days, or worse, permanently in the most extreme cases. Hyperacusis can also be reactive if the person becomes more sensitive to sound as a result of being exposed to certain everyday sounds. A person can have reactive tinnitus only, reactive hyperacusis only, or both. It would be highly unusual to have reactive hyperacusis without tinnitus because most people with hyperacusis have tinnitus. I have both reactive tinnitus and reactive loudness hyperacusis. I think if a person has both tinnitus and loudness hyperacusis, then if one is reactive, both are reactive. We don’t have any data on that, which a good epidemiology study could address.

J. D.: Yeah, I have both, too, unfortunately.

As you mentioned earlier, your book addresses the theories behind the causes of loudness hyperacusis and pain hyperacusis. (Dr. Henry, of course, gathers this information from established medical literature. Animal models are a source of data, as well as reports from sufferers themselves. There are different schools of thought regarding underlying mechanisms, especially for pain hyperacusis.)

For certain individuals, it is also possible that these conditions could be hereditary. Hyperacusis Central featured Shane’s Story recently (click HERE to read it), and it made a compelling case for that, as he comes from a family with a history of hyperacusis (his mother and sister have it, and his grandfather did as well, the dad of Shane’s mom).

When thinking of the causes, though, one of the strange realities of loudness hyperacusis and pain hyperacusis (and even tinnitus) often is discussed: how throughout their lives, two individuals can have the same noise exposure histories, similar medication use, similar head traumas, etc., etc., etc. (common links to these conditions), and one ends up getting them while the other doesn’t. Why, in your opinion? Does this go back to genetics? That some are more susceptible, or their auditory systems weaker from the start? That maybe they were born that way? Like, for my situation, what’s weird is that I come from a family whose relationship with hunting or firing guns is high. My father and brothers never used protection for their ears. They fired guns like crazy. I myself never fired a gun in my life, nor was I ever around one during discharge. They also took medications much more than I did. Nonetheless, they have zero ear problems.

So something is missing from the puzzle, isn’t it? If getting hyperacusis was contingent on who did what in life (math, in other words), more people would get these conditions and my aforementioned family would have gotten them for sure, since I was doing less than them, sound- and medication-wise. Sufferers often say the same thing: that their friends and families did far more. These cases, of course, oppose a hereditary link to these conditions.

Dr. Henry: Yes, different people have different susceptibilities to different disorders, and of course that includes loudness hyperacusis, pain hyperacusis, tinnitus, hearing loss, etc. Some people have “tough ears” while others have more sensitive ears that are vulnerable to being damaged. I think genetics would have to play the major role in why people have different susceptibilities.

J. D.: That was what my gut suspected, too: genetics.

So now my final question: in your opinion, Dr. Henry, what needs to happen in the future for loudness hyperacusis, pain hyperacusis, and even tinnitus, to get the funding they deserve and proper recognition? What needs to happen to take these conditions from off the map to on?

Dr. Henry: This is really the question that tinnitus researchers around the world should be able to answer with a unified and cohesive response. I would therefore suggest the need to form an international consortium of tinnitus researchers who meet on a regular basis to develop a plan for coordinated and systematic research that would most efficiently address the current gaps in providing care for both tinnitus and sound hypersensitivity disorders.

The needed research would be conducted along two tracks: (1) basic science/laboratory research to understand the underlying mechanisms of these disorders with the eventual goal of finding cures; and (2) clinical research to evaluate the effectiveness of existing methods of treatment and to develop new methods.

The basic science research is currently underway in many laboratories around the world. This work should obviously continue, but it could be made more efficient if basic science researchers were to communicate with each other on a regular basis to share findings and coordinate their efforts.

Clinical research is needed to evaluate clinical methods for assessing and treating tinnitus and sound hypersensitivity disorders. Assessment is critical to properly diagnose the different disorders, to refer patients as needed to relevant healthcare specialists, and to determine if treatment is needed. Many treatments exist and these treatments need to be evaluated to determine their relative effectiveness. New and modified methods of treatment should be similarly evaluated. The placebo effect cannot be ruled out for behavioral methods of treatment, and determining the contribution of the placebo effect should be a priority of research. Outcomes of treatment should be standardized so that all research and clinical data use a consistent outcome metric.

One approach to systematically conduct clinical research is to use a “learning health network” (LHN) model. LHNs involve networks of clinics that all have the same objective to answer clinical questions about a specific disease or healthcare condition. This model is tried and true for many healthcare conditions. The model can be used for tinnitus and sound hypersensitivity disorders, and my belief is that this is how future clinical research should be most efficiently conducted. An effort is currently underway to develop a Tinnitus LHN (TLHN) and I am involved with that effort (stopthering.org). The TLHN would also address sound hypersensitivity disorders. Because the TLHN is in an early stage of development, this presents an opportunity for anyone to become involved and contribute to this effort.

J. D.: Brilliant answer. Hyperacusis Central, the community who suffers with sound hypersensitivity disorders, and myself, are all grateful for the work you and others are doing to make that TLHN a reality. If anyone reading this wants to get involved, again, the link is stopthering.org. What you just described is exactly what needs to happen to get us on the right track for these conditions.

I want to thank you for taking part in this interview, Dr. Henry. It has been fantastic! And thanks again for writing The Hyperacusis and Misophonia Book, and all your efforts to help the people who suffer from sound hypersensitivity disorders.

If anyone reading this would like to purchase Dr. Henry’s book, it is sold online through all the major bookselling sites: Amazon (click HERE), HORIZON Books (click HERE), Barnes & Noble (click HERE), etc. And his website is earsgonewrong.org to learn more about his other books available.

Dr. Henry: You’re welcome. It was a pleasure.

*AI (Artificial Intelligence) WASN’T used to write or edit this interview.

REFERENCES

[1]. Treworgy D. My hope is to turn pain into progress. Hearing Health. 2023;39(2):30-33.

[2]. Jacquemin L, Schecklmann M, Baguley DM. Hypersensitivity to sounds. In: Schlee W, Langguth B, DeRidder D, Vanneste S, Kleinjung T, Møller AR, eds. Textbook of Tinnitus. 2^nd ed. Springer; 2024:25-34.

[3]. Jahn KN, Cohen J, Llodra O. What patients say and what audiologists say. Hyperacusis Research. Mar 2025. https://hyperacusisresearch.org/pain-hyperacusis-what-patients-say-and-what-audiologists-say/?fbclid=IwY2xjawJVFFlleHRuA2FlbQIxMQABHS3aWv8pblG-pkyKPuzejV7ZwLhqRos5oRDFI2gblJIprtzwe0Y0XlBoNQ_aem_wAL5oZxapWpTJL6P9ifwfA.

[4]. Williams, ZJ, Suzman E, Woynaroski TG. A Phenotypic Comparison of Loudness and Pain Hyperacusis: Symptoms, Comorbidity, and Associated Features in a Multinational Patient Registry. American Journal of Audiology. Jan 2021. www.researchgate.net/publication/349107176_A_Phenotypic_Comparison_of_Loudness_and_Pain_Hyperacusis_Symptoms_Comorbidity_and_Associated_Features_in_a_Multinational_Patient_Registry.

[5]. Jahn KN, Kashiwagura ST, Yousuf MS. Clinical phenotype and management of sound-induced pain: Insights from adults with pain hyperacusis. The Journal of Pain. 27(104741);1-11. 2025. Doi.org/10.1016/j.jpain.2024.104741.

[6]. The Most Complicated Watch Ever Made. The Franck Muller group. 2019. https://www.franckmuller.com/aeternitas.

[7]. Cohen J. When a Chomp or a Slurp Is a Trigger for Outrage. The New York Times. Sept 2011.. 2019. .https://www.nytimes.com/2011/09/06/health/06annoy.html.