 Hello, everyone. First of all, I would like to thank to the organizing and scientific committee. My name is Murat Erinj, and I am a PhD student and also research assistant at Marmara University. Today I'm going to present behavioral and electrophysiological evaluation of laupus growth in clinic and normal hearing tinnitus patients with and without hyperpyses. Tinnitus is a phantom auditory sensation in the absence of external sounds. It's a very common symptom which seen in 10 to 20% in the general population. Hyperpyses is an intolerance to everyday sounds that make daily life challenging. These ordinary sounds that do not disturb others can be overwhelming to loud or intense. And these two of them can often seem together. While 86% of hyperpyses patients has tinnitus, 40% of tinnitus patients has hyperpyses. This comorbidity shows that makes us think that they may have common mechanisms and these mechanisms are still under study. Most hypothesis state that they are related to the central auditory system. And to date, there is still uncertainty on the neural correlates of tinnitus and hyperpyses. Neural gain model is a very popular model and it's recognized by many researchers. In this model, neural gain in the central auditory pathway is triggered by a decrease in peripheral input, which is hearing loss. But in cochlear synaptopathy or hidden hearing loss, decrease in peripheral input can also be seen in the clinic and normal hearing people. In hyperpyses results from abnormal gain along the auditory pathway in response to sound evoked activation. And tinnitus is results from increased central noise. Central gain mechanisms are common mechanisms for tinnitus, hyperpyses and loudness perception. So in our study, we aim to evaluate the loudness growth function of tinnitus patients with and without hyperpyses using behavioral and electro physiological methods. In our study, we have a total of 60 adults with clinical normal hearing. We chose to work with normal hearing people because we don't want to recruitment to interfere our loudness growth evaluation and also N1P2 wave amplitudes and latencies are affected by the hearing loss. So we have three groups and each group has 20 subjects. We tried to balance AIDS and genders as possible as we can. In control group, 10 male and 10 female and the mean age are 39.8. In tinnitus group, patients has idiopathic subjective continuous, unilateral or bilateral tinnitus and they have tinnitus complaints more than three months. 10 male and 10 female and mean age are 40.9. In our hyperpyses group, they have tinnitus same as tinnitus group, plus we have three criteria for hyperpyses, which are first they should have hyperpyses complaints and hyperpyses questionnaires scores more than 15. And at least one of the loudness comfortable results is less than 90 dbh. In this group, we have 7 male and 13 female, mean age are 38.7. And we have different types of questionnaires visual on the scale team to sign the copy inventory and hyperpyses questionnaire. We did loudness discomfort levels test with the same instructions for for each subject. In categorical loudness scale we use two different stimulus which is 502,000 hertz narrowband noise with seven loudness categories. In loudness cortically work potentials we examine N1P2 components with the same two stimuli with 40, 60, 80 dbhL and these are representing soft, medium and loud sounds. In each questionnaire, hyperpyses group results are higher than the tinnitus group, but in tinnitus handicap inventory, hyperpyses questionnaire, tinnitus annoyance and tinnitus effect on life were significantly different. In loudness discomfort level result results in hyperpyses group there's again significant differences between the other two groups, but it's an expected results because our one of the hyperpyses groups criteria is loudness discomfort levels, which is it should be less than 90 dbh. In loudness scale test results, we have a significantly different in hyperpyses group in medium loud and very loud categories. And it shows that, for example, in hyperpyses group subjects tends to say 87 dbh is loud while in control group subjects says 92 dbh is loud. They perceived difference differently. In auditory cortically work potentials, we couldn't find any statistically significant differences. In N1 latency P2 latency and N1 P2 peak amplitude, we could not find any differences. And this figure shows that they are grant mean average waveforms. And again in different intensities and different groups, which has different colors. We could not see any differences in the waveforms. In the hyperpyses group, not only loudness discomfort levels, but also medium and loud sound intensities according to the categorical loudness scale results were lower than other groups. And these results indicate that hyperpyses subjects interpret moderate sounds in daily life as louder than they are. We need to pay attention that in daily life they do not have any control over sounds. It's different from our safe test environments. For example, 80 db is okay for them in our safe test environment. But in daily life, maybe they feel uncomfortable with that noise. There was no significant differences between the groups in cortical evaluations and there may be some possible reasons for this. N1 P2 amplitude and latency are affected by alertness and attention. It's because there are some interpersonal differences. And in our study, primary complaint was tinnitus and the secondary complaint was hyperpyses. And some subjects in the tinnitus group met some of the three criteria for inclusion in the hyperpyses group. In auditory cortical evoke potentials, loudness perception occurs at the cortical level. And hyperpyses can sometimes be related to the meaning of the sounds or the emotion state of the person. So P300 seems more logical because it also includes cognitive processes. But our goal was only to observe the effect of loudness. So we examine N1 and P2 responses which does not require active participation and it's the highest intensity dependent cortical potential. In conclusion, hyperpyses group had significant differences between the groups in behavioral tests but not in electrophysiological tests. As a result, it can be suggested that the subjective responses of the patients are still the most prominent findings in the evaluation of hyperpyses. In our attempt to differentiate tinnitus and hyperpyses with electrophysiological tests based on the loudness growth function, we found that evaluating N1 and P2 responses were not seen as a suitable method, but it's worth to try with different setups or other auditory evoke potentials also. However, it appears to be beneficial to use categorical loudness scales in addition to loudness discomfort that was used in behavioral tests. Thank you for listening.