Elsevier

American Journal of Otolaryngology

Volume 30, Issue 6, November–December 2009, Pages 432-434
American Journal of Otolaryngology

Case Report
Brain activation in patients with idiopathic hyperacusis

https://doi.org/10.1016/j.amjoto.2008.08.005Get rights and content

Abstract

The neural network associated with idiopathic hyperacusis is still not well known. We studied the brain activation of 3 middle-aged patients with mild to moderate hyperacusis by functional magnetic resonance imaging while they were listening to white noise binaurally. In addition to the temporal lobes, in all patients, sound elicited activation in the frontal lobes (superior, middle, or inferior frontal gyri) and occipital lobes (precuneus, cuneus, superior occipital gyrus, lingual gyrus, or fusiform gyrus). The parahippocampus was activated in 2 of 3 patients. Furthermore, the precentral and postcentral gyri, superior and inferior parietal lobules, thalamus, midbrain, claustrum, insula, posterior cingulated gyrus, and orbital and rectal gyrus were also activated in one patient. The neural network associated with idiopathic hyperacusis might be associated with the frontal lobes and parahippocampus.

Introduction

Hyperacusis is distinguished as a general hypersensitivity to sound of any frequency and phonophobia as an anxious sensitivity toward specific sound, largely independent of its volume. The pathophysiology of hyperacusis probably involves a central rather than a peripheral mechanism, although it can be also caused by pathologic conditions of the peripheral auditory system or hormonal and infectious diseases. In addition, hyperacusis and/or phonophobia are often combined with psychosomatic reactions [1]. However, the neural network associated with idiopathic hyperacusis is still not well known. Therefore, we used functional magnetic resonance imaging to investigate the activation patterns in this type of patient during binaural stimulation with white noise.

In this project, we studied the brain activation of 3 otherwise healthy middle-aged patients with mild to moderate idiopathic hyperacusis by functional magnetic resonance imaging while they were listening to white noise binaurally. The clinical data for the 3 patients are shown in Table 1. We selected 3 age-matched and sex-matched healthy subjects with normal hearing and without hyperacusis, phonophobia as the control group. Our Institutional Committee for Human Studies approved our experimental protocol, and informed consent was obtained from each subject.

After scanning, all patients complained of very uncomfortable sensations. The activation patterns were shown in Fig. 1.

Voxels with positive blood-oxygen-level dependent signal were mainly clustered in the middle temporal gyrus (Brodmann area (BA) 39) and the superior occipital (BA 19), postcentral (BA 2, 40), rectal (BA 11), precentral (BA 4, 6), and middle frontal gyri (BA 9) of the right hemisphere. Activation was also found at the lingual (BA 18, 19), superior temporal (BA 22, 29, 38), and middle temporal gyri (BA 21, 22, 37, 39); the precuneus (7, 19), the orbital, and (BA 11, 47) inferior frontal gyri (BA 46, 47); and the inferior parietal lobule (BA 40) of both hemispheres. The superior parietal lobule (BA 7), insula (13), posterior cingulate (BA 31), superior frontal gyrus (BA 10), and fusiform gyrus (BA 20) of the left hemisphere were also activated. In addition, the bilateral parahippocampal gyrus (BA 35), the bilateral medial dorsal nucleus and right pulvinar of the thalamus, the red nucleus of left midbrain, and the right claustrum were also activated.

The activations were mainly located in the middle frontal gyrus (BA 10) and precuneus (BA 31) of the left hemisphere and the superior frontal gyrus (BA 10, 11), cuneus (BA 7, 19), and superior temporal gyrus (BA 22, 13) of both hemispheres.

The activations were mainly located in the middle temporal gyrus (BA 21, 19), superior occipital gyrus (BA 19), cuneus (BA 19), angular gyrus (BA 39), superior frontal gyrus (BA 11) of the left hemisphere; the superior temporal gyrus (BA 22) of the right hemisphere; and the inferior frontal gyrus (BA 44, 9, 47,11) of both hemispheres. In addition, the right parahippocampal gyrus was also activated.

The activations were mainly clustered in the right superior temporal gyrus (BA 22). Activation was also noted in the superior frontal (BA 10) and postcentral gyri (BA 40) in control 1 and in the cuneus (BA 19) in control 2.

Section snippets

Discussion

Cohen [2] suspected that the brain lesions causing mass effects in the pons could result in hyperacusis. Fukutake and Hattori [3] reported the appearance of hyperacusis and palinacousis in a 49-year-old man without previous psychiatric or epileptic illness after a small hemorrhagic infarction located mainly in the right medial geniculate body. Khalil [4] reported one case of aneurysm in a middle cerebral artery that presented as isolated hyperacusis. Weber [5] found that 3 patients with central

Conclusion

The neural network associated with idiopathic hyperacusis might be highly associated with both the ventral and dorsal emotion systems such as the frontal lobes and parahippocampus.

Acknowledgment

This project was supported by a grant from National Science Council of Taiwan (Taipei, Taiwan) (NSC-93-2314-B-002-111) and approved by Institutional Review Board of National Taiwan University Hospital (Taipei, Taiwan) (NTUH-IRB-9261701438).

References (10)

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