An adult patient with few months of hyperacusis and sound hypersensitivity, audiological assessments are within normal ranges;
It started to affect his Psychic stability.
Dear Dr. Askar,
As suggested by Dr. Cayonu, retraining therapy can help individuals with hyperacusis. In addition, systematic sound densensitization can be another technique which can tried and can work with many patients and audiologists are usually trained to provide such therapy for patients with hyperacusis.
Most often hyperacusis can be associated with psychological symptoms where the client may exhibit fear of sound - phonophobia or dislike of sound - misophonia and can have other psychological issues which needs to appropriately dealt by a psychologist/psychiatrist.
Please find the attached links of extensive review on hyperacusis management by Jastreboff and others.
Regards,
Prashanth
http://www.ncbi.nlm.nih.gov/pubmed/25726280
http://www.ncbi.nlm.nih.gov/pubmed/25103984
http://www.ncbi.nlm.nih.gov/pubmed/16329450
http://www.ncbi.nlm.nih.gov/pubmed/17117696
it is great to read this tow nice answers but I think the first step in the management is psychiatry consultation . All of us are exposed to stress going older being more fragile and having more problems giving me this sensation occasionally which does not alert me . But persistant c/o has to be investigated first by psychiatry.
Thanks, dear, Dr Dr Cayonu;Dr Prabhu,and Dr Hamed,
So, the patient needs the help of the audiologist; But, do you have accepted results; or it ll depend on the patient himself?
Dear Dr Sherif , I think this issue is a very good one to be focused by researchers.
The results mostly are subjective
Audiosensitivity ("hyperacusis") is due to a state of cochlear hyperactivity. There is no known psychiatric or neurological cause. It can be demonstrated by abnormalities of acoustic reflexes -- reversed stapedial reflexes and/or lowered stapedial reflex thresholds. PTA thresholds often fluctuate noticeably within and between ears yet still remain within normal limits. The usual (?only) cause of inner ear hyperactivity is endolymphatic hydrops, a very common but underrecognised result of anything that causes perilymph pressure to fall.
Dr Gordon, Thanks for your kind report;
Do you have suggestions in management?
"Do you have suggestions in management?"
There are a lot of medically remedial causes for low inner ear pressure (dehydration, CSF or vascular hypotension, weight loss, hyperventilation, perilymph or CSF fistulas, etc). Does the patient have any suggestion as to the cause of the problem?
As you say, it has started to affect his psychic stability. I would not refer to psychiatry unless it is clearly understood by all parties that this is essentially an ear not a mind problem. It may in fact be a great relief to the patient simply to be told that.
Sorry to disagree with some of the previous entries. In my opinion and expertise hyperacusis and misophonia are problems of the auditory system and its connections with other system in the brain. There are physiological, not psychological problems. We have 85% success rate (published in peer review literature) using TRT.
"In my opinion and expertise hyperacusis and misophonia are problems of the auditory system and its connections with other system in the brain"
I agree that hyperacusis (audiosensitivity) is a disorder of the auditory system, but only of the peripheral part (cochlea, possibly middle ear as well). I do not know of any case of audiosensitivity due to a brain lesion with proven normal cochleae.
Misophonia is often assumed axiomatically to be a neurological disorder, but it seems to me that it starts as an audiological disorder which then involves areas of the emotional brain. I don't think it is primarily a psychological or psychiatric disorder.
This are different things. Hyperacusis is only a clinical symptom and needs to be take care, and in many times the audiogram and related examinations are normal.
It is important to treat the patient with orientation by an audiologist, with auditory therapy, similar to TRT.
I hope thi could help you!
Best Regards
In my case I slowly developed hyperacusis after a loud scream in which a "popping" sound was heard in my rigth ear.
After this event, I noticed certain sounds above certain intensity levels were perceived as extremly loud, and progressively my LDL levels started to drop. I also noticed that when I spoke loudly,, I felt a painfull stabbing sensation in my inner ear.
Talking about the trigger event with an ENT doctor, he hypotesized that in that loud scream I damaged my stapedium muscle (maybe the popping sound was generated because of the dissattachtment of this muscle).
That would explain why speaking loudly hurts so much, as only the tensor tympani is working during the acoustic reflex.
Do you think there are any chances or treatment to regenerate the stapedyum muscle ligaments?
Could a stapedotomy work for some individuals where the auditory nerve is not extremely affected?
It is found that some NTM (non-tubercular mycobacterial infection) cause progressive nerve deafness with bizarre manifestations found in present case.
1. Test for thinking and tenderness of radial, ulnar and lateral popliteal nerve where they are passing over bare bones (example – radial nerve in radial groove of humerus).
2. Black patches on the skin behind elbow joint, inter phalangeal joint, lateral epicondyle of fibula and near about.
3. Trembling of fingers, tongue and toes.
4. Spasm of fingers, toes, calf muscles and sometime muscles of other parts of body.
5. Irritability or hypochondriac features.
6. Pain in spinal bones (especially cervical and lumbar)
7. Hypo-aesthesia of hand and foot.
All or some of these findings will indicate neural affection of NTM.
Next discussion after finding some of these symptomatology.
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