Auditory hallucinations in tinnitus patients: Emotional relationships and depression

Introduction: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. Aims: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. Method: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. Results: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. Conclusions: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective...

Auditory hallucinations in tinnitus patients: Emotional relationships and depression.

INTRODUCTION: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. AIMS: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. METHOD: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. RESULTS: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. CONCLUSIONS: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective.

Musical hallucination associated with hearing loss.

In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.

A afecção vestibular infantil: estudo da orientação espacial / Vestibular disorders in childhood: study of spatial disorders

OBJETIVO: verificar como é a percepção do espaço na criança com vertigem periférica. MÉTODOS: estudo prospectivo de 18 crianças, com faixa etária de três a 15 anos, sob acompanhamento no Ambulatório de Otorrinolaringologia / Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A percepção espacial foi avaliada por meio de atividade livre (desenho livre) e dirigida (blocos lógicos e teste de Frostig). Das 18 crianças avaliadas, nove constituíram o grupo estudo (diagnóstico de vestibulopatia e queixa de tontura) e nove constituíram o grupo controle (sem história de vestibulopatia e sem queixa de tontura). Foram excluídas crianças que apresentassem comprometimento de Sistema Nervoso Central que interferisse na interpretação da avaliação. Os resultados obtidos foram comparados entre o grupo estudo e controle qualitativamente. RESULTADOS: em relação ao desenho livre, 77,78 por cento das crianças do grupo controle e 55,55 por cento do grupo estudo utilizaram o papel inteiro. Quanto à proporção dos objetos, 100 por cento das crianças do grupo controle e apenas 48,86 por cento das crianças do grupo estudo desenharam com proporção adequada. Nos blocos lógicos, houve maior dificuldade do grupo estudo. No teste de Frostig, foi observada diferença significativa do ponto de vista clínico entre os grupos quanto ao Quociente Perceptual. CONCLUSÃO: as crianças com vestibulopatia, ao desenhar, aproveitaram o papel de forma menos homogênea, com maior dificuldade para desenhar figuras humanas e proporção inadequada entre os objetos. Desta forma, é importante que seja realizado o diagnóstico de vestibulopatia precocemente, para que o tratamento/reabilitação seja iniciado e sintomas, como a desorientação espacial, não influenciem na aprendizagem da criança.

PURPOSE: to check how is the child's spatial perception in vestibular disorder. METHODS: prospective study of 18 children, between 3 and 15-year old, under treatment in Ambulatório de Otorrinolaringologia/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Space perception was assessed through a free activity (free drawing) and two directed activities: the Frostig test and an adaptation of the Token Test. Of the 18 evaluated children, 09 composed the study group (diagnosed as having a vestibular disorder) and 09 composed the control group (with no history of vestibular disorder or dizziness). Children who showed central nervous system impairments were excluded. RESULTS: in relation to the free drawing, 77.78 percent of the control group and 55.55 percent in the study group used the whole sheet of paper provided. Regarding the proportion of the objects, 100 percent of the control group showed an adequate proportion in their drawings and it was found in 48.86 percent of the study group. In the adapted Token Test, the study group showed a major difficulty. In the Frostig test, a small difference between the groups in the Perceptual quotient was observed. CONCLUSION: the children with vestibular disorders, while drawing, used the sheet of paper in a less homogeneous way, showing more difficulty to draw human pictures and an inadequate proportion among the drawn objects. In this way, it is important that the vestibular diagnosis should be done the earliest possible in order to anticipate the treatment/rehabilitation. This may prevent the impairment of spatial perception from negatively influencing the learning process.

Aspectos emocionais da criança portadora de vestibulopatias: achados preliminares baseados em desenhos e histórias / Emotional aspects of vestibular disease in children: preliminary results

Os distúrbios vestibulares na infância estão associados ao desenvolvimento de reações emocionais e alterações comportamentais que podem prejudicar a inserção da criança em seu meio social. Poucos trabalhos abordam esses aspectos psicológicos relacionados a vovência das tonturas neste grupo de pacientes.