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Cephalalgia : An International Journal... Nov 2022Past studies do not account for avoidance behaviour in migraine as a potential confounder of phonophobia.
BACKGROUND
Past studies do not account for avoidance behaviour in migraine as a potential confounder of phonophobia.
OBJECTIVE
To analyse whether phonophobia is partially driven by avoidance behaviour when using the classic methodology (method of limits).
METHODS
This is a case-control study where we tested phonophobia in a cohort of high-frequency/chronic migraine patients (15.5 ± 0.74 headache days/month) and non-headache controls. Auditory stimuli, delivered in both ears, were presented using three different paradigms: the method of limits, the method of constant stimuli, and the adaptive method. Participants were asked to report how bothersome each tone was until a sound aversion threshold was estimated for each method.
RESULTS
In this study, we successfully replicate previously reported reduction in sound aversion threshold using three different methods in a group of 35 patients and 25 controls (p < 0.0001). Avoidance behaviour in migraine reduced sound aversion threshold in the method of limits (p = 0.0002) and the adaptive method (p < 0.0001) when compared to the method of constant stimuli. While thresholds in controls remained the same across methods (method of limits, p = 0.9877 and adaptive method, p = 1).
CONCLUSION
Avoidance behaviour can exacerbate phonophobia. The current methodology to measure phonophobia needs to be revised.
Topics: Humans; Hyperacusis; Case-Control Studies; Avoidance Learning; Migraine Disorders
PubMed: 35815637
DOI: 10.1177/03331024221111772 -
Journal of Medical Case Reports Jun 2023Bath-related headache (BRH) is a rare primary headache disorder with only about 50 cases reported from 2000 to 2017 and none since. It is an abrupt onset excruciating...
BACKGROUND
Bath-related headache (BRH) is a rare primary headache disorder with only about 50 cases reported from 2000 to 2017 and none since. It is an abrupt onset excruciating headache occurring predominantly in middle-aged Asian women, most commonly following exposure to hot water. This is the first report in a Sri Lankan woman.
CASE PRESENTATION
A 60-year-old Sri Lankan woman presented with an abrupt onset, severe throbbing holocephalic headache immediately following a hot-water shower. The headache was not associated with photo- or phonophobia, nausea, or vomiting, and she did not report a past history of migraine. However, she had experienced a similar headache 2 years previously precipitated by a hot-water shower. Her neurological examination, blood investigations, and magnetic resonance imaging of brain and intracranial vessels were normal. She was treated with opioid and nonsteroidal antiinflammatory drug analgesics, but the headache resolved only after treatment with nimodipine. The headache did not recur during a follow-up of 2 years since she avoided hot-water showers.
CONCLUSIONS
Bath-related headache is a thunderclap primary headache disorder with a benign prognosis, but its recognition requires awareness to differentiate it from subarachnoid hemorrhage. It warrants inclusion in the International Classification of Headache Disorders.
Topics: Middle Aged; Humans; Female; Magnetic Resonance Imaging; Headache; Headache Disorders; Headache Disorders, Primary; Brain
PubMed: 37270506
DOI: 10.1186/s13256-023-03960-8 -
Autism & Developmental Language... 2022Humans communicate primarily through spoken language and speech perception is a core function of the human auditory system. Among the autistic community, atypical...
BACKGROUND AND AIMS
Humans communicate primarily through spoken language and speech perception is a core function of the human auditory system. Among the autistic community, atypical sensory reactivity and social communication difficulties are pervasive, yet the research literature lacks in-depth self-report data on speech perception in this population. The present study aimed to elicit detailed first-person accounts of autistic individuals' abilities and difficulties perceiving the spoken word.
METHODS
Semi-structured interviews were conducted with nine autistic adults. The interview schedule addressed interviewees' experiences of speech perception, factors influencing those experiences, and responses to those experiences. Resulting interview transcripts underwent thematic analysis. The six-person study team included two autistic researchers, to reduce risk of neurotypical 'overshadowing' of autistic voices.
RESULTS
Most interviewees reported pronounced difficulties perceiving speech in the presence of competing sounds. They emphasised that such listening difficulties are distinct from social difficulties, though the two can add and interact. Difficulties were of several varieties, ranging from powerful auditory distraction to drowning out of voices by continuous sounds. Contributing factors encompassed not only features of the soundscape but also non-acoustic factors such as multisensory processing and social cognition. Participants also identified compounding factors, such as lack of understanding of listening difficulties. Impacts were diverse and sometimes disabling, affecting socialising, emotions, fatigue, career, and self-image. A wide array of coping mechanisms was described.
CONCLUSIONS
The first in-depth qualitative investigation of autistic speech-perception experiences has revealed diverse and widespread listening difficulties. These can combine with other internal, interpersonal, and societal factors to induce profound impacts. Lack of understanding of such listening difficulties - by the self, by communication partners, by institutions, and especially by clinicians - appears to be a crucial exacerbating factor. Many autistic adults have developed coping strategies to lessen speech-perception difficulties or mitigate their effects, and these are generally self-taught due to lack of clinical support.
IMPLICATIONS
There is a need for carefully designed, adequately powered confirmatory research to verify, quantify, and disentangle the various forms of listening difficulty, preferably using large samples to explore heterogeneity. More immediate benefit might be obtained through development of self-help and clinical guidance materials, and by raising awareness of autistic listening experiences and needs, among the autistic community, communication partners, institutions, and clinicians.
PubMed: 36382084
DOI: 10.1177/23969415221077532 -
The Clinical Journal of Pain Feb 2021In complex regional pain syndrome (CRPS), sensory deficits and/or hyperalgesia often extend beyond the affected limb to encompass other sites on the ipsilateral side of...
OBJECTIVES
In complex regional pain syndrome (CRPS), sensory deficits and/or hyperalgesia often extend beyond the affected limb to encompass other sites on the ipsilateral side of the body. The aim of this study was to determine whether hyperalgesia in the ipsilateral forehead reflects disinhibition and/or sensitization of trigeminal afferent or second-order neurons on the CRPS-affected side.
PARTICIPANTS AND METHODS
To investigate this, blink reflexes to supraorbital electrical stimuli (a 2 mA triple pulse delivered using a concentric electrode) were recorded bilaterally in 30 CRPS patients and 20 controls of similar age and sex distribution. In addition, the effect of acoustic startle stimuli on pain and blink reflexes to supraorbital electrical stimuli was explored.
RESULTS
Supraorbital electrical stimulation was more painful on the affected than unaffected side in patients (P<0.05), and was more painful on both sides in patients than controls (P<0.001). In addition, electrical stimulation of the ipsilateral forehead increased loudness and auditory discomfort to acoustic startle stimuli (P<0.05). However, blink reflexes were similar on both sides in patients, and smaller in amplitude and of longer latency in patients than controls (P<0.05).
DISCUSSION
These findings suggest that trigeminal sensory nerve input activates sensitized and/or disinhibited nociceptive circuits in the thalamus or higher cortical centers in CRPS. This not only evokes ipsilateral supraorbital hyperalgesia but also compromises auditory perception. Hence, crosstalk between auditory and nociceptive signals at sites of convergence within the central nervous system may generate hyperacusis in CRPS.
Topics: Complex Regional Pain Syndromes; Humans; Hyperalgesia; Pain; Pain Measurement; Pain Threshold
PubMed: 33136610
DOI: 10.1097/AJP.0000000000000893 -
Frontiers in Neurology 2023Research interest in understanding tinnitus has increased severalfold in the last decade to find a cure for this auditory disorder. Hyperacusis can also accompany...
Research interest in understanding tinnitus has increased severalfold in the last decade to find a cure for this auditory disorder. Hyperacusis can also accompany tinnitus, although the mechanisms involved in hyperacusis and tinnitus are different. Millions of people suffer from some degree of tinnitus with hearing loss. Tinnitus is believed to be a form of sensory epilepsy, spawning neuronal hyperactivity from the cochlear nucleus and inferior colliculus of the auditory brainstem region. Cannabis has been used for recreation, medicinal purposes, and served as an entheogen from time immemorial. With the current and increasing global medical and recreational cannabis legalization, there is renewed enthusiasm for the use of cannabinoid drugs, and the role of the endocannabinoid system (ECS) in several health disorders including tinnitus which is associated with COVID-19. The ECS signaling pathways have been proposed to affect the underlying pathophysiology of tinnitus. Cannabinoid receptors (CBRs) have been found in the auditory system, raising interest in ECS signaling in hearing and tinnitus. However, previous studies mostly in animal models of tinnitus did not investigate the involvement of CB2Rs but focused on CB1R-based responses, which suggested that CB1R ligands had no effect and may even be harmful and worsen tinnitus. With new molecular techniques and transgenic approaches used to dissect the complexity of the ECS, the role of ECS/CB2R neuroimmunological function in the auditory system and tinnitus is emerging. This perspective proposes the role of emerging neuroimmune crosstalk of the ECS in sound-sensing structures of the auditory system as a potential pharmacogenomic therapeutic target using cannabinoid CB2R ligands in tinnitus in the era of the COVID-19 pandemic.
PubMed: 37305742
DOI: 10.3389/fneur.2023.1148327 -
Revue Medicale Suisse Oct 2021Superior canal dehiscence syndrome is due to a defect in the bone coverage of this canal. The presence of this « third window » alters the biomechanics of the inner...
Superior canal dehiscence syndrome is due to a defect in the bone coverage of this canal. The presence of this « third window » alters the biomechanics of the inner ear and can induce cochleo-vestibular symptoms, most commonly bone conduction hyperacusis, autophony, pulsatile tinnitus, and pressure- or sound-induced vertigo. Although the etiology remains unknown, it could be congenital. Head trauma or a Valsalva maneuver may also trigger the symptoms. The diagnosis is based on the association of specific symptoms, a characteristic auditory and vestibular workup and the presence of a dehiscence on a high-resolution CT-scan. Management can be medical or surgical in selected cases.
Topics: Humans; Semicircular Canal Dehiscence
PubMed: 34614311
DOI: No ID Found -
International Journal of Environmental... Jun 2022Misophonia is a scarcely known disorder. This systematic review (1) offers a quantitative and qualitative analysis of the literature since 2001, (2) identifies the most... (Review)
Review
Misophonia is a scarcely known disorder. This systematic review (1) offers a quantitative and qualitative analysis of the literature since 2001, (2) identifies the most relevant aspects but also controversies, (3) identifies the theoretical and methodological approaches, and (4) highlights the outstanding advances until May 2022 as well as aspects that remain unknown and deserve future research efforts. Misophonia is characterized by strong physiological, emotional, and behavioral reactions to auditory, visual, and/or kinesthetic stimuli of different nature regardless of their physical characteristics. These misophonic responses include anger, general discomfort, disgust, anxiety, and avoidance and escape behaviors, and decrease the quality of life of the people with the disorder and their relatives. There is no consensus on the diagnostic criteria yet. High comorbidity between misophonia and other psychiatric and auditory disorders is reported. Importantly, the confusion with other disorders contributes to its underdiagnosis. In recent years, assessment systems with good psychometric properties have increased considerably, as have treatment proposals. Although misophonia is not yet included in international classification systems, it is an emerging field of growing scientific and clinical interest.
Topics: Anger; Anxiety Disorders; Emotions; Humans; Hyperacusis; Quality of Life
PubMed: 35682372
DOI: 10.3390/ijerph19116790 -
Medeniyet Medical Journal 2020The aim of this study is to adapt Khalfa Hyperacusis Questionnaire (HQ) into Turkish for the use in the diagnosis and treatment of patients with hyperacusis.
OBJECTIVE
The aim of this study is to adapt Khalfa Hyperacusis Questionnaire (HQ) into Turkish for the use in the diagnosis and treatment of patients with hyperacusis.
METHOD
HQ and Beck Anxiety Inventory (BAI) were administered to a total of 529 participants (320 female, 209 male), aged 18 to 73 (mean age: 29.76±10.59) years who were randomly selected from the general population. For the evaluation of the data, confirmatory and exploratory factor analysis, correlation analysis, descriptive statistics, t-test, analysis of variance, and Sidak correction test were used.
RESULTS
In the reliability analysis, the Cronbach's alpha (aC) internal consistency coefficient was found to be 0.81. Factor analysis revealed three subdimensions (attentional, social, and emotional). The total variance of these three subdimensions were 63%, and the internal consistency of the subdimensions was also high (αC >0.70). Confirmatory factor analysis and structural equation modeling results indicated that three-factor solutions with 14 items met the criteria for the adequacy of fit among the Turkish patients. The mean score for hyperacusis was estimated as 15.69±6.63 points.There was a positive, weak, but significant association between hyperacusis and anxiety (r=0.357, p=0.01, p<0.05). The patients who were exposed to noise were found to have higher levels of hyperacusis, compared to those who were not (t=6.78, p=0.01, p<0.05). The patients who had decreased noise tolerance over time were found to be higher hyperacusis levels than those without (t=4.83, p=0.01, p<0.05).
CONCLUSION
Based on these measurements, 14 questions and three-factor solutions were found to be a valid and reliable tool.
PubMed: 32733764
DOI: 10.5222/MMJ.2020.97947 -
Frontiers in Neuroscience 2022
PubMed: 36685217
DOI: 10.3389/fnins.2022.1077097 -
American Journal of Audiology Oct 2021Purpose Tinnitus and hyperacusis are debilitating conditions often associated with age-, noise-, and drug-induced hearing loss. Because of their subjective nature, the... (Review)
Review
Purpose Tinnitus and hyperacusis are debilitating conditions often associated with age-, noise-, and drug-induced hearing loss. Because of their subjective nature, the neural mechanisms that give rise to tinnitus and hyperacusis are poorly understood. Over the past few decades, considerable progress has been made in deciphering the biological bases for these disorders using animal models. Method Important advances in understanding the biological bases of tinnitus and hyperacusis have come from studies in which tinnitus and hyperacusis are consistently induced with a high dose of salicylate, the active ingredient in aspirin. Results Salicylate induced a transient hearing loss characterized by a reduction in otoacoustic emissions, a moderate cochlear threshold shift, and a large reduction in the neural output of the cochlea. As the weak cochlear neural signals were relayed up the auditory pathway, they were progressively amplified so that the suprathreshold neural responses in the auditory cortex were much larger than normal. Excessive central gain (neural amplification), presumably resulting from diminished inhibition, is believed to contribute to hyperacusis and tinnitus. Salicylate also increased corticosterone stress hormone levels. Functional imaging studies indicated that salicylate increased spontaneous activity and enhanced functional connectivity between structures in the central auditory pathway and regions of the brain associated with arousal (reticular formation), emotion (amygdala), memory/spatial navigation (hippocampus), motor planning (cerebellum), and motor control (caudate/putamen). Conclusion These results suggest that tinnitus and hyperacusis arise from aberrant neural signaling in a complex neural network that includes both auditory and nonauditory structures.
Topics: Animals; Auditory Cortex; Auditory Pathways; Humans; Hyperacusis; Ototoxicity; Tinnitus
PubMed: 33465315
DOI: 10.1044/2020_AJA-20-00023