Azalmış Ses Toleransı Bozukluklarının Ayırt Edilmesinde Kullanılacak Ölçek Geliştirilmesi

Abstract

Decreased sound tolerance (DST) is defined as a person's negative reaction to a sound that does not cause any reaction in the average person. Hyperacusis, phonophobia and misophonia are subclasses of DST. They are different from each other and their treatment is different as well. There is no audiological method or scale that distinguishes these three conditions in the literature. Our aim in this thesis research is; to develop a screening scale that distinguishes these three type of DST. The study included 257 individuals aged 18-65 years with normal hearing who volunteered to participate in the study from the general population. Cronbach's alpha coefficient, item-total correlation and item discrimination of Decreased Sound Tolerance Scale-Screening (DSTS-S) were evaluated. The construct validity of the DSTS-S was performed by using Explanatory Factor Analysis (EFA) by using Varimax rotation with Kaiser normalization, and to assess the structural fit, the data were analyzed by Confirmatory Factor Analysis (CFA). The total scores obtained from the scale were compared with the Mann Whitney-U test for problem (+) and problem (-). The reference-dependent validity of DSTS-S was assessed by ROC analysis. The internal consistency analysis was tested by calculating Cronbach’s alpha value and its invariability over time was tested with test-retest reliability. The Cronbach's alpha value for the hyperacusis, phonophobia and misophonia section of the DSTS-S was 0.881; 0.775; 0.938 respectively. The independent samples t-test showed that the difference between the items was statistically significant (p <0.01). The factor structure of the phonophobia section of the DSTS-S was analyzed by EFA and the factor structure of the misophonia section was analyzed by EFA by Varimax rotation with Kaiser normalization. CFA was used to assess the structural fit of the hyperacusis section. The factor structure of the scale showed that the model fit well with the data set. Consequently the hyperacusis and phonophobia section exhibited a single-factor structure, and the misophonia one did a 2-factor structure. The Mann Whitney-U test showed a statistically significant difference between the median values of the total scores of hyperacusic and non-hyperacusic; phonophobic and non-phonophobic; misophonic and non-misophonic groups (HTS, FTS, MTS, respectively) (p <0.05). As a result of the ROC analysis, it was found that HTS had a value in predicting the presence of hyperacusis, FTS had a value in predicting the presence of phonophobia and MTS had a value in predicting the presence of misophonia ( p <0.001). Cut-off values for HTS, FTS, MTS are ≥ 7; ≥ 1; ≥ 4 respectively. For reliability assessment, intra-class coefficients of the internal consistency analysis for hyperacusis, phonophobia and misophonia were found to be 0.833; 0.752; 0.834 respectively. According to this, hyperacusis and misophonia sections showed high reliability and phonophobia one showed highly reliable levels. The correlation between the test and retest scores of the total scores was found to be statistically significant using the Kappa test (p <0.001). The results of the study revealed that the Decreased Sound Tolerance Scale- Screening is a validated and reliable one for distinguishing subtypes of DST.