Lots of neuroimaging and animal studies have revealed that tinnitus and hyperacusis share the same patterns in the bottom up central auditory process. The aim was to identify the abnormal central patterns commonly observed in both tinnitus and hyperacusis in humans. We investigated two cases of normal hearing: a tinnitus patient and a hyperacusis patient. We compared the differences between the severe temporal hyper-activated state (STHS), with spikes, fast beta and gamma frequencies after noise exposure, and the mild temporal hyper-activated state (MTHS), in no sound exposed condition. The power of the gamma band in the two cases was increased in both auditory cortices compared to the other brain regions. Our results of human with normal hearing were the first to identify how tinnitus and hyperacusis caused by sound are abnormally active and how they maintain constant pathological states.
Animals ; Auditory Cortex ; Brain ; Electroencephalography ; Hearing ; Humans ; Hyperacusis ; Neuroimaging ; Noise ; Tinnitus

BACKGROUND AND PURPOSE: Cluster headache (CH) can present with migrainous symptoms such as nausea, photophobia, and phonophobia. In addition, an overlap between CH and migraine has been reported. This study aimed to determine the differences in the characteristics of CH according to the presence of comorbid migraine. METHODS: This study was performed using data from a prospective multicenter registry study of CH involving 16 headache clinics. CH and migraine were diagnosed by headache specialists at each hospital based on third edition of the International Classification of Headache Disorders (ICHD-3). We interviewed patients with comorbid migraine to obtain detailed information about migraine. The characteristics and psychological comorbidities of CH were compared between patients with and without comorbid migraine. RESULTS: Thirty (15.6%) of 192 patients with CH had comorbid migraine, comprising 18 with migraine without aura, 1 with migraine with aura, 3 with chronic migraine, and 8 with probable migraine. Compared to patients with CH without migraine, patients with CH with comorbid migraine had a shorter duration of CH after the first episode [5.4±7.4 vs. 9.0±8.2 years (mean±standard deviation), p=0.008], a lower frequency of episodic CH (50.0% vs. 73.5%, p=0.010), and a higher frequency of chronic CH (13.3% vs. 3.7%, p=0.033). Psychiatric comorbidities did not differ between patients with and without comorbid migraine. The headaches experienced by patients could be distinguished based on their trigeminal autonomic symptoms, pulsating character, severity, and pain location. CONCLUSIONS: Distinct characteristics of CH remained unchanged in patients with comorbid migraine with the exception of an increased frequency of chronic CH. The most appropriate management of CH requires clinicians to check the history of preceding migraine, particularly in cases of chronic CH.
Classification ; Cluster Headache ; Comorbidity ; Headache ; Headache Disorders ; Humans ; Hyperacusis ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Nausea ; Photophobia ; Prospective Studies ; Specialization

OBJECTIVES: To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography. METHODS: Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months. RESULTS: Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided. CONCLUSION: Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.
Angiography ; Colon, Sigmoid* ; Cranial Sinuses ; Deception ; Diverticulum ; Head ; Hearing Loss, Sensorineural ; Humans ; Hyperacusis ; Magnetic Resonance Angiography* ; Medical Records ; Operating Tables ; Phlebography ; Recurrence ; Tinnitus*

Headache associated with moyamoya disease (HAMD) has been reported in about 20-30% of pediatric cases with moyamoya disease. However, the characteristic patterns of HAMD during disease progression are not completely known, although much is known on the incidence of HAMD and on the treatment effects of bypass surgery. In a child who presented with HAMD and had no infarction or hemorrhage till bypass surgery, we described the characteristic patterns of headache progression. At first presentation, the patient complained of severe bilateral headache despite mild stenosis only in the left internal carotid artery on brain magnetic resonance angiography. During all stages of progression, headache was severe and pressing in nature rather than throbbing. Nausea and vomiting were present even in the early stage, but photophobia, phonophobia and neck stiffness developed in the late stage. Headache was aggravated by menstruation and was relieved by analgesics and topiramate in the early stage, although the medication failed to provide relief when the headache increased in frequency and duration.
Analgesics ; Brain ; Carotid Artery, Internal ; Child* ; Constriction, Pathologic ; Disease Progression ; Female ; Headache* ; Hemorrhage ; Humans ; Hyperacusis ; Incidence ; Infarction ; Magnetic Resonance Angiography ; Menstruation ; Moyamoya Disease* ; Nausea ; Neck ; Photophobia ; Vomiting

Consensus ; Humans ; Hyperacusis ; therapy ; Iowa ; Practice Guidelines as Topic ; Tinnitus ; therapy

Superior semicircular canal dehiscence syndrome (SCDS) is characterized by cochleovestibular hyper-responsiveness symptoms including sound- and pressure-evoked vertigo and oscillopsia, autophony, hyperacusis and ear fullness. The typical audiometric feature of SCDS is known as conductive hearing loss at low frequency. A 43-year-old man presented with unilateral sudden deafness after several events of heading during soccer game. High-resolution temporal bone computed tomography revealed a dehiscence of superior canal encased by superior petrous sinus. We reviewed audio-vestibular findings in this patient and speculated potential pathogenic mechanisms of sudden deafness in SCDS with literature review.
Adult ; Deafness ; Ear ; Head ; Hearing Loss, Conductive ; Hearing Loss, Sudden ; Humans ; Hyperacusis ; Semicircular Canals ; Soccer ; Temporal Bone ; Vertigo

Decreased sound tolerance includes hyperacusis and/or misphobia (phonophobia). As a commonly subjective symptom, tinnitus is defined to be a sound perceived in the ear or head without corresponding sound or electrical stimulus in the surrounding environment. It is usually occurred with or without hearing loss or harmful psychic reaction, which includes dyssomnia, annoy, rage, anxiety, depress, hard to concentrate, etc. Frequently, tinnitus is accompanied by decreased sound tolerance, while this text is aimed to review the correlated concepts of decreased sound tolerance,and focus on the hyperacusis which is a more common symptom.
Humans ; Hyperacusis ; Tinnitus

BACKGROUND: Bell's palsy (BP) is the most frequent disease of the seventh cranial nerve, and has a relatively good prognosis. However, the precise etiology of the disorder has not been well understood. During the last decade, many researchers have focused on the conditions that are associated with BP, including diabetes, hypertension, and viral infection. We therefore analyzed that the etiology and clinical course of acute BP in patients in one university hospital. METHODS: The study comprised 241 BP patients who were examined over a 60-month period. Their clinical history was taken, and neurologic examinations, laboratory tests, electrophysiologic studies, and brain imaging was performed. The clinical severity of the facial palsy was assessed using the House-Brackman (HB) facial nerve grading scale. Patients were followed up once a week during the first month, and for up to 2 months. RESULTS: Of the 241 patients, 103 (43.5%) were men and 138 (56.5%) were women, whose ages were 46.4+/-16.6 and 48.4+/-17.6 years, respectively (mean+/-SD). The initial examination revealed that 36.7% of the cohort had an HB grade below 4, while in 63.3% the HB grade was above 3. Combined symptoms were as follows: postauricular pain (77.5%), increased tear flow (23.4%), taste change (15.6%), and hyperacusis (15.1%). The initial facial nerve conduction study performed within 1 week of presentation revealed a low compound muscle action potential amplitude in 140 (57.8%) and an absent blink reflex in 225 (93%). On follow-up examination, 134 (59%) of the patients exhibited a partial improvement by 4 weeks, and 166 (79.8%) had recovered completely within 2 months. CONCLUSIONS: We describe the epidemiologic, clinical, electrophysiologic, and radiologic characteristics of BP patients at one university hospital.
Action Potentials ; Bell Palsy ; Blinking ; Cohort Studies ; Facial Nerve ; Facial Paralysis ; Female ; Follow-Up Studies ; Humans ; Hyperacusis ; Hypertension ; Male ; Muscles ; Neuroimaging ; Neurologic Examination ; Prognosis ; Tears

PURPOSE: Migraine is a common disorder in childhood. Its associated symptoms such as nausea or dizziness etc. are frequently complained about and worsen discomfort in cases of pediatric migraine. This study aimed to investigate the relieving effect of preventive therapy on the associated symptoms as well as headache-related characteristics. METHODS: We reviewed the clinical data of subjects aged seven to eighteen years who were diagnosed with migraine and had received prophylactic medication for more than two months. The headache-related characteristics and associated symptoms were analysed with prophylactic drugs at one month and three months after medication. RESULTS: The gender ratio was 11:10 and the mean age was 10.8 years. One month after medication, the duration of headache was reduced in ten of nineteen, a reduction in frequency was observed in fourteen, and improvement in headache intensity in nine. The duration time was shortened in three of eight subjects three months after initiation of medication, the frequency reduced in five, and decreased intensity in seven. Nausea was absent in eight of fifteen one month after treatment, abdominal pain in seven of thirteen, dizziness in five of sixteen, photophobia in six of seventeen, and phonophobia in seven of sixteen. The ratio of disappearance of associated symptoms increased three months after initiation of treatment. CONCLUSION: Prophylactic medication may be effective in relieving migraine-associated symptoms as well as improving headache-related characteristics.
Abdominal Pain ; Adolescent ; Aged ; Child ; Dizziness ; Headache ; Humans ; Hyperacusis ; Migraine Disorders ; Nausea ; Photophobia

INTRODUCTIONThis study aimed to examine the relationship between the air-bone gap (ABG) and the size of the superior semicircular canal dehiscence (SSCD) as measured on a computed tomography (CT) scan.

MATERIALS AND METHODSThe study design was a case series with chart review. Twenty-three patients (28 ears) from a tertiary referral centre were diagnosed with SSCD. The size of the dehiscence on CT scans and the ABG on pure-tone audiometry were recorded.

RESULTSThe size of the dehiscence ranged from 1.0 to 6.0 mm (mean, 3.5 ± 1.6 mm). Six ears with a dehiscence measuring less than 3.0 mm did not have an ABG (0 dB). The remaining 18 ears showed an average ABG at 500, 1000, and 2000 Hz (AvABG(500-2000)) ranging from 3.3 to 27.0 dB (mean, 11.6 ± 5.7 dB). The analysis of the relationship between the dehiscence size and AvABG(500-2000) revealed a correlation of R(2) = 0.828 (P <0.001, quadratic fit) and R(2) = 0.780 (P <0.001, linear fi t). Therefore, the larger the dehiscence, the larger the ABG at lower frequencies on pure-tone audiometry.

CONCLUSIONIn SSCD patients, an ABG is consistently shown at the low frequency when the dehiscence is larger than 3 mm. The size of the average ABG correlates with the size of the dehiscence. These findings highlight the effect of the dehiscence size on conductive hearing loss in SSCD and contribute to a better understanding of the symptomatology of patients with SSCD.

Adult ; Aged ; Audiometry, Pure-Tone ; instrumentation ; methods ; Bone Conduction ; Female ; Hearing Loss, Conductive ; diagnosis ; pathology ; Humans ; Hyperacusis ; diagnosis ; pathology ; Male ; Middle Aged ; Reference Values ; Retrospective Studies ; Semicircular Canals ; pathology ; Statistics as Topic ; Temporal Bone ; pathology ; Tomography, X-Ray Computed ; Vertigo