Teenager hears herself too loud. Crazy? No.

The Pediatric Insider

© 2014 Roy Benaroch, MD

Amanda wrote in: “I know this sounds crazy, but my teenage daughter has been complaining that she hears herself talk very loudly. She’s self-conscious to begin with, so now she tries to talk very quietly, and no one can even hear her at all! She also says that she can hear her heart beating and her own breathing, and all of this is making her very anxious. We took her in for a hearing test, and it was OK, and I think the doctor thought she was making this up (she does have problems with anxiety, too.) Is this just all in her head?”

As a general sort of rule, I don’t usually answer specific medical questions about individual cases on my blog here. I can’t examine patients, and I can’t really get the kind of information I need to make a diagnosis; besides, I’m not your doctor. My advice for most people writing in for my help figuring out what’s wrong with your child is to go see your own doctor.

But Amanda’s question caught my attention. I hate that her daughter was “blown off” by her doc. I get it, she has anxiety issues, and that can lead to a lot of physical symptoms (typically headaches, belly aches, nausea, and dizziness.) But even while we’re thinking that psychological factors may be contributing to physical symptoms, doctors need to keep in mind that kids can have more than one thing going on. Yes, there’s anxiety. But guess what? I think Amanda’s daughter may also have a physical diagnosis. So I’m going to bend my own rule here, and toss out a possible diagnosis—and I hope Amanda’s mom takes her into a different doctor to get this checked out for real.

The symptoms described—hearing one’s own voice, breathing, and heartbeat excessively loudly, to the point where it’s annoying and distracting—can be caused by what’s called a “patulous eustacian tube” (another term, patulous auditory tube, is more correct, but people don’t really call it that.) To understand what’s going on, we’ll have to do a (brief) anatomy lesson.

Your middle ear is a small, air-filled space behind the eardrum. When you go up in a plane, the drop in air pressure around you allows that air in the middle ear to expand, so you feel a “pressure” in your head. A small tube connects the middle ear to the nasal cavity, which allows pressure to equalize—you hear or feel a little “pop”, and that funny sensation of fullness goes away. Something similar happens when you descend. Most of the time, that little tube (called a eustacian tube, or auditory tube) stays closed—it just pops open now and then to equalize the pressure on either side of your eardrum. Usually, it pops open for a moment when you swallow (which is why chewing gum is a good way to clear your ears after a flight).

With a patulous eustacian tube, the tube stays open all of the time. That allows sound waves from within your head to get directly to the middle and then inner ear, bypassing the dampening effect of the eardrum and middle ear structures. The bottom line: you hear the noises from your own body much louder than you ought to, and noises like your own voice, breathing, and heartbeat can even sound louder than noises from the outside world.

Ordinarily, the eustacian tube is kept closed by surrounding fat and other tissues. Being slender, or losing a lot of weight quickly, seems to be a risk factor for developing a patulous eustacian tube. It can also occur after certain kinds of ear surgery, or during pregnancy. Sometimes, there’s no apparent cause. The presence of a patulous eustacian tube can sometimes be confirmed during the physical exam, by looking at the eardrum while the patient breathes or talks. Sure enough, you can sometimes see the drum vibrate at those times if the eustacian tube is staying abnormally open all of the time.

There aren’t a lot of great treatment options for this—but I’ve found it’s very helpful to reassure the patient that while this is, in fact, all in their heads, it is not “all in their heads.” I found this news report of a new method being tried in England, sticking a bit of putty on the eardrum to dampen sounds. If that pans out as truly effective, it can bring some serious relief to a lot of people. But, as the news article says, do NOT try this at home!

More resources here

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