Evaluation and Treatment of Central Auditory Processing and Sound Tolerance Disorders

Abstract 1 Introduction: Central auditory processing disorder (CAPD) affects how a listener understands speech even though their peripheral auditory system is intact. Case Presentation: An adult female was seen for a CAPD evaluation after experiencing recent listening difficulties following an automobile accident while 20 weeks pregnant. Results from a comprehensive audiological evaluation revealed audiometrically normal hearing in both ears. Results from the CAPD evaluation suggested a prosodic deficit. Discussion: Although results from testing were consistent with a prosodic deficit, the patient’s case history, original complaints, and recommendations were more consistent with an integration deficit. Conclusion: This case demonstrates that clinicians should thoroughly examine a patient’s clinical history. For this case, recommendations aligned with an integration deficit, as opposed to a prosodic processing disorder. Abstract 2 Introduction: A sound tolerance disorder is when individuals have adverse (either physical or emotional) responses to everyday sounds. A sound tolerance disorder is a broad term that encompasses tinnitus, hyperacusis, misophonia, and phonophobia. Case Presentation: A young adult female was seen for a sound tolerance evaluation. Results from an audiological evaluation revealed normal hearing thresholds and results from a sound tolerance evaluation indicated that a majority of responses to uncomfortable listening levels were in the normal range, which is consistent with hyperacusis. Discussion: Due to reduced uncomfortable listening levels, the patient was diagnosed with hyperacusis and misophonia, and extensive counseling was conducted. The counselor explained what hyperacusis was and presented the various treatment options available to the patient, including sound therapy and cognitive behavioral therapy. Conclusion: This case demonstrates that there may be multiple options available to aid in successful treatment for the patient, while some options may require collaboration with mental health professionals

Somatic tinnitus

Modulation of tinnitus characteristics such as pitch and loudness has been extensively described following movements of the head, neck and limbs, vertical or horizontal eye gaze, pressure on myofascial trigger points, cutaneous stimulation of the hands, electrical stimulation of the median nerve, and transcranial direct current stimulation. Modulation of tinnitus follows complex interactions between auditory and somatosensory afferents and can be favored by underlying somatic disorders. When tinnitus appears to be preceded or strictly linked to a somatic disorder, and therefore related to problems of the musculoskeletal system rather than of the ear, it is defined somatic tinnitus. A correct diagnosis and treatment of somatic disorders underlying tinnitus play a central role for a correct management of somatic tinnitus. However, the identification of somatic tinnitus may be complex in some cases. In this paper, after a general review of the current evidences for somatic tinnitus available in the literature, we present and discuss some cases of patients in which somatic modulation of tinnitus played a role - although different from case to case - in their tinnitus, describing the diagnostic and therapeutic approaches followed in each individual case and the results obtained, also highlighting unexpected findings and pitfalls that may be encountered when approaching somatic tinnitus patients

Hyperacusis in children: a preliminary study on the effects of hypersensitivity to sound on speech and language

There is a growing awareness that children may experience hyperacusis, a condition that is often associated with behavioral and developmental disorders. This preliminary study was aimed to investigate the effects of hyperacusis alone on various components of speech and language in children without developmental disorders. This study was conducted on 109 children aged between 4 and 7 years attending kindergarten and primary school. Hyperacusis was assessed through behavioral observation of children and questionnaires for parents. Different components of speech and language were assessed through specific tests. Hyperacusis was diagnosed in fifteen children (13.8%); ten (66.7%) were attending primary school and five (33.3%) kindergarten. A significant difference between children with and without hyperacusis was found for tests evaluating the average number of words in a sentence and phonemic fluency; older children appeared to have more difficulties. Several differences in education profiles were found: parents of children with hyperacusis spent less time with their children compared to parents of children without hyperacusis. Our preliminary results suggest some difficulties in lexical access and the use of shorter sentences by children with hypersensitivity to sound; however, the small size of our sample and the largely unknown interactions between hyperacusis and developmental disorders suggest caution when interpreting these results. Further studies on larger samples are necessary to gain additional knowledge on the effects of hyperacusis on speech and language in children without developmental disorders

The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?

The decision made in the year 2004 by the U.S. Food and Drug Administration (FDA) to require a boxed warning on antidepressants regarding the risk of suicidality in young adults still represents a matter of controversy. The FDA warning was grounded on industry-sponsored trials carried one decade ago or earlier. However, within the past decade, an increasing number of reports have questioned the actual validity of the FDA warning, especially considering a decline in the prescription of the antidepressant drugs associated with an increase in the rate of suicidal events among people with severe depression. The present report provides an overview of the FDA black box warning, also documenting two Major Depressive Disorder patients whose refusal to undergo a pharmacological antidepressant treatment possibly led to an increased risk for suicidal behaviors. The concerns raised by the FDA black box warning need to be considered in real-world clinical practice, stating the associated clinical and public health implications

Do Alternative Therapies Have a Role in Autism?

Interventions considered to be branches of Complementary & Alternative Medicine (CAM) for autism are on the rise. Many new treatments have emerged & traditional beliefs of Ayurveda, Yoga, Behavioral therapy, Speech therapy and Homoeopathy have gained popularity and advocacy among parents. It is imperative that data supporting new treatments should be scrutinized for scientific study design, clinical safety, and scientific validity, before embarking on them as modes of therapy. Practitioners take care in explaining the rationale behind the various approaches that they practice, it is important to indicate possible limitations too during the initial clinical examination and interactive session. Clinicians must remember that parents may have different beliefs regarding the effectiveness of treatment since their information is derived more from the ‘hear-say’ route when they compare benefits/effects of CAM therapies on other children and often underestimate differential tolerance for treatment risks. It is thus significant that practitioners do not assume a "don't ask, don't tell" posture. The scientific validation and support for many interventions is incomplete and very different from the recommendations of the American Academy of Pediatrics Policy Statement. In this article, we discuss the various modes of CAM and their utilities and limitations in relation to autism

Subtyping somatic tinnitus: a cross-sectional UK cohort study of demographic, clinical and audiological characteristics

Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus

Pressure dependence of the sound velocity in a 2D lattice of Hertz-Mindlin balls: a mean field description

We study the dependence on the external pressure $P$ of the velocities $v_{L,T}$ of long wavelength sound waves in a confined 2D h.c.p. lattice of 3D elastic frictional balls interacting via one-sided Hertz-Mindlin contact forces, whose diameters exhibit mild dispersion. The presence of an underlying long range order enables us to build an effective medium description which incorporates the radial fluctuations of the contact forces acting on a single site. Due to the non linearity of Hertz elasticity, self-consistency results in a highly non-linear differential equation for the "equation of state" linking the effective stiffness of the array with the applied pressure, from which sound velocities are then obtained. The results are in excellent agreement with existing experimental results and simulations in the high and intermediate pressure regimes. It emerges from the analysis that the departure of $v_{L}(P)$ from the ideal $P^{1/6}$ Hertz behavior must be attributed primarily to the fluctuations of the stress field, rather than to the pressure dependence of the number of contacts

Characteristics of somatic tinnitus patients with and without hyperacusis

Objective: Determine if somatic tinnitus patients with hyperacusis have different characteristics from those without hyperacusis. Patients and methods: 172 somatic tinnitus patients with (n = 82) and without (n = 90) hyperacusis referred to the Tinnitus Unit of Sapienza University of Rome between June 2012 and June 2016 were compared for demographic characteristics, tinnitus features, self-administered questionnaire scores, nature of somatic modulation and history. Results: Compared to those without hyperacusis, patients with somatic tinnitus and hyperacusis: (a) were older (43.38 vs 39.12 years, p = 0.05), (b) were more likely to have bilateral tinnitus (67.08% vs 55.56%, p = 0.04), (c) had a higher prevalence of somatic modulation of tinnitus (53.65% vs 36.66%, p = 0.02) and (d) scored significantly worse on tinnitus annoyance (39.34 vs 22.81, p<0.001) and subjective hearing level (8.04 vs 1.83, p<0.001). Conclusion: Our study shows significantly higher tinnitus modulation and worse self-rating of tinnitus and hearing ability in somatic tinnitus patients with hyperacusis versus somatic tinnitus patients without hyperacusis. These differences could prove useful in developing a better understanding of the pathophysiology and establishing a course of treatment for these two groups of patients

The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: the development of the IGD-20 Test

Background: Over the last decade, there has been growing concern about ‘gaming addiction’ and its widely documented detrimental impacts on a minority of individuals that play excessively. The latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included nine criteria for the potential diagnosis of Internet Gaming Disorder (IGD) and noted that it was a condition that warranted further empirical study. Aim: The main aim of this study was to develop a valid and reliable standardised psychometrically robust tool in addition to providing empirically supported cut-off points. Methods: A sample of 1003 gamers (85.2% males; mean age 26 years) from 57 different countries were recruited via online gaming forums. Validity was assessed by confirmatory factor analysis (CFA), criterion-related validity, and concurrent validity. Latent profile analysis was also carried to distinguish disordered gamers from non-disordered gamers. Sensitivity and specificity analyses were performed to determine an empirical cut-off for the test. Results: The CFA confirmed the viability of IGD-20 Test with a six-factor structure (salience, mood modification, tolerance, withdrawal, conflict and relapse) for the assessment of IGD according to the nine criteria from DSM-5. The IGD-20 Test proved to be valid and reliable. According to the latent profile analysis, 5.3% of the total participants were classed as disordered gamers. Additionally, an optimal empirical cut-off of 71 points (out of 100) seemed to be adequate according to the sensitivity and specificity analyses carried