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Brasić and Perry1 convincingly describe a boy with unilateral otopathic auditory hallucinations. However, their literature review is very misleading, postulating dubious CNS causes for auditory hallucinations other than from a hyperactive ear. They also do not cite a relevant prior case.
Their paper starts: “Unilateral auditory hallucinations...are associated with contralateral CNS lesions”. Their only supporting reference is Toulouse (1892), who reviewed four adults with neurological disease and unilateral auditory hallucinations, allegedly of cortical origin. These turned out to be anything but. One case (Regis, 1881) had voices in his left ear aggravated by alcohol, sounds of a bell and water in his right, impaired hearing in his left ear (thought by Toulouse to be of cortical origin!); the 1888 case had bilateral auditory hallucinations, worse on the left, abolished by blocking off the ear which was full of pus; the 1890 case, an alcoholic wine merchant, had bilateral noises (bells, whistles, rattles, etc) which alternated and changed into voices in his right ear, but there was no examination of his ears or hearing; his 1892 case, also an alcoholic wine merchant, heard voices in her left ear, and had bilateral deafness from chronic otitis media. Whatever other lesions these four patients had, there were peripheral lesions sufficient to trigger tinnitus and auditory hallucinations, although in alcoholic patients these can probably be triggered from ears with relatively normal hearing.2 By contrast with these totally unconvincing cases of non-otological cortical origin, Toulouse reviewed seven cases of unilateral auditory hallucinations from homolateral ear disease, four of which were particularly convincing as the auditory hallucinations vanished (three cases) or waned (one case) with …