More than one tinnitus after hearing loss?

Background

Complex auditory hallucinations such as music or voices occur more frequently in elderly females with hearing loss and increase with the severity of the impairment. The aetiology remains unclear, but a deafferentation phenomenon due to sensory deprivation, or spontaneous brain activity is suspected.

Case report

A 67-year-old female patient presented to our clinic with hearing loss, ringing in the ears and dizziness that had been present for three days. Relevant secondary diseases were depression, arterial hypertension and hypothyroidism. The audiometry revealed a pantonal hearing loss with functional surdity. A central or peripheral pathomorphological correlate of the vertigo was excluded functionally and neurologically. We initiated cortisone therapy. At the end of the therapy, a slight improvement in hearing in the medium and high frequencies of about 20 dB was already noticeable.During the therapy, the patient reported acute auditory hallucinations, which were independent of the ambient sound level. She had been hearing whole songs continuously for days. Further diagnostics such as EEG and cMRI, as well as a psychiatric examination were unremarkable. After stopping the cortisone, an antipsychotic was started (Risperdal 0.5mg 1-0-1). After a few days, the patient showed up again with persistent hallucinations. So the transfer to a psychiatric hospital was organised for adjustment of quetiapin 50mg 1-0-1, which resulted in symptom attenuation.

Conclusion 

Patients with pre-existing mental health conditions such as depression should be informed of the risk of possible permanent complex hallucinations before starting steroid therapy. Intratympanic cortisone injection as a potential alternative should be discussed.

Publication History

Article published online:
24 May 2022