A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience
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[ V O L U M E 1 2 , N U M B E R 7 – 8 , J U L Y – A U G U S T 2 0 1 5 ] Innovations in CLINICAL NEUROSCIENCE 31 ABSTRACT The authors report a case of a 47- year-old man who presented with treatment-resistant anxiety disorder. Behavioral observation raised clinical suspicion of auditory neuropathy spectrum disorder. The presence of auditory neuropathy spectrum disorder was confirmed on audiological investigations. The patient was experiencing extreme symptoms of anxiety, which initially masked the underlying diagnosis of auditory neuropathy spectrum disorder. Challenges in diagnosis and treatment of auditory neuropathy spectrum disorder are discussed. INTRODUCTION Auditory neuropathy spectrum disorder (ANSD) is the consensually approved terminology 1 in the literature to describe a disorder with wide variations in clinical symptomatology and audiological manifestations. The presumed sites of lesions for this disorder occur within the auditory system and include the inner hair cells (the sensory cells of the cochlea), the synapses between the inner hair cells and the fibers of the VIII nerve (vestibulocochlear nerve), the ganglion neurons, the VIII nerve fibers themselves, or any combination of these sites. 2 Hearing acuity may vary from normal hearing to severe hearing loss and may also demonstrate fluctuations in hearing threshold. 3 The cardinal feature of ANSD is speech perceptual difficulty that is disproportionate to the hearing acuity of the individual. Patients with ANSD often demonstrate good identification of nonspeech sounds; however, the presence of specific difficulties in understanding speech often leads to significant disability in social interactions and may even impact psychosocial well-being. 4 We report a case of a man who presented with anxiety disorder that was resistant to conventional treatment with anti-anxiety agents. The diagnosis of ANSD was missed initially as it was overshadowed by the anxiety disorder. Eventually, a diagnosis of ANSD was confirmed via audiological investigations. Consent by RISHIKESH V. BEHERE MD; MUKUND G. RAO, MD; SHREE MISHRA, MD; SHIVARAMA VARAMBALLY, MD; SHIVASHANKAR NAGARAJARAO, PhD; and BANGALORE N. GANGADHAR, MD Dr. Behere is with the Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India; Dr. Rao is Registrar, North West Area Mental Health Service, Coburg, Melbourne, Australia; Drs. Mishra, Varambally, and Gangadhar are with the Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India; and Dr. Shivashankar is with the Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. Innov Clin Neurosci. 2015;12(7–8):31–33 FUNDING: No funding was received for the preparation of this manuscript. FINANCIAL DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Rishikesh V. Behere, Assistant Professor, Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal – 576104 Karnataka, India; Phone: +918202922217 Email: rvbehere@gmail.com Fax: +918202571930 KEY WORDS: Primary Auditory Neuropathy, Anxiety Disorder, Social Anxiety, Diagnostic confusion, Audiometry [ C A S E R E P O R T ] Auditory Neuropathy Spectrum Disorder Masquerading as Social Anxiety