Hyperacusis Question

[art212]

Dr Nagler,

Is it possible to have transitory unilateral hyperacusis accompanied by a varying decrease in hearing acuity and a tensor tympani syndrome like ear thump in one ear? The intensity of the thump seems to be correlated to the loudness of the irritating sound.

I have been managing tinnitus and cochlear hydrops for quite some time and this condition strikes randomly. Is this an indication that my hydrops is worsening? This problem usually gets better over time. At least it has in the past. I am currently going through another episode.

Any information or insights in this situation would be appreciated.

Thanks.

Art

 

[Dr. Nagler]

@art212 asked:

Dr Nagler,

Is it possible to have transitory unilateral hyperacusis accompanied by a varying decrease in hearing acuity and a tensor tympani syndrome like ear thump in one ear? The intensity of the thump seems to be correlated to the loudness of the irritating sound.

I have been managing tinnitus and cochlear hydrops for quite some time and this condition strikes randomly. Is this an indication that my hydrops is worsening? This problem usually gets better over time. At least it has in the past. I am currently going through another episode.

Any information or insights in this situation would be appreciated.

Thanks.

Art

..........

Hi Art -

I confess that I am not as knowledgeable about the various manifestations of TTTS as I should be, so I took the liberty of forwarding your question on to a good friend of mine in Australia, Myriam Westcott, who is one of the world's leading authorities on this condition. I am copying Myriam's response below in its entirety and will also attach her TTTS guide at the bottom of this post. I hope this helps.

All the best -

Dr. Stephen Nagler

.........

Hi Stephen,

All is good with me, thank you, I'm just back from a lovely holiday with my husband and friends in Thailand and Laos. I hope you and your family are well, and wish you a happy 2015.

Re this patient's query – as you would be aware, generally hyperacusis is not a transitory/episodic phenomenon, although I have seen patients where this is the case. His symptoms could be a manifestation of cochlear hydrops, resulting in episodes of reduced hearing with recruitment causing an altered perception of loudness growth, potentially affecting his sound tolerance and triggering episodic hyperacusis.

It has been my experience that TTTS symptoms can become involuntarily triggered in patients with an anxiety-based "need to protect" the health and/or hearing of their ear from a perceived threat. In the case of hyperacusis it can become triggered by a threatening sound (rather than an irritating sound). More generally, I have documented the presence of these symptoms in the unaffected ear of patients with a chronic unilateral aural pathology, such as endolymphatic hydrops, Meniere's Disease, sudden onset hearing loss or chronic middle ear disease, who become highly anxious about any threat to the health and hearing of their only functional ear. TTTS could also develop in an ear with an intermittent pathology, as an anxiety reaction.

The specific symptom cluster consistent with TTTS can include sensations of muffled hearing and a rhythmic type of tinnitus or tympanic flutter, which could be interpreted as a 'thump'.

So his symptoms are a diagnostic challenge and could be:

· purely due to hydrops episodes with fluctuating hearing loss and recruitment

· due to hydrops episodes with recruitment, leading to hyperacusis and TTTS

· purely due to hyperacusis and TTTS, as an anxiety-based "protective" response.

I'm sure that is probably more confusing than helpful! A medical history looking at his 'episodes' in detail may tease apart these possibilities. I have attached a guide I have written on TTTS for the medical profession.

I would exclude or treat any pathological basis for the development of these symptoms, and provide reassurance….

Cheers,

Myriam