Song Jae-Jin, Mertens Griet, Deleye Steven, Staelens Steven, Ceyssens Sarah, Gilles Annick, de Bodt Marc, Vanneste Sven, De Ridder Dirk, Kim Euitae, Park Sung Joon, Van de Heyning Paul
*Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; †Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Antwerp, Edegem, Belgium; ‡Molecular Imaging Center, University of Antwerp, Edegem, Belgium; §School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas, U.S.A.; ∥Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Edegem, Belgium; ¶Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; #BRAI2N, Sint Augustinus Hospital, Antwerp, Belgium; and **Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.
Otol Neurotol. 2014 Dec;35(10):1780-4. doi: 10.1097/MAO.0000000000000560.
Conversion deafness is characterized by sudden hearing loss without any identifiable cause. In the current study, we investigated presumed conversion deafness in a cochlear implant user using H₂¹⁵O-positron emission tomography (PET) scan with speech and noise stimuli in conjunction with audiologic tests such as impedance test and auditory response telemetry. Also, by performing a follow-up PET scan after recovery and comparing prerecovery and postrecovery scans, we attempted to find possible neural substrates of conversion deafness.
A 51-year-old man with conversion deafness after 4 years of successful cochlear implant use.
Supportive psychotherapy.
Prerecovery and postrecovery H₂¹⁵O-PET scans
The prerecovery H₂¹⁵O-PET scan revealed auditory cortex activation by sound stimuli, which verified normal stimulation of the central auditory pathway. Notably, compared with the prerecovery state, the postrecovery state showed relative activation in the right auditory cortex both under the speech and noise stimulus conditions. Moreover, the bilateral prefrontal and parietal areas were activated more in the postrecovery state than in the prerecovery state. In other words, relative deactivation of the prefronto-parieto-temporal network, a network responsible for conscious sensory perception, or relative dysfunction of top-down and bottom-up attention shifting mediated by the ventral and the dorsal parietal cortices, may have resulted in conversion deafness in the patient.
Relative deactivation of the prefronto-parieto-temporal network or dysfunction in the ventral and the dorsal parietal cortices may be related to the development of conversion deafness.
癔症性聋的特征是突然听力丧失且无任何可识别的病因。在本研究中，我们对一名人工耳蜗使用者的疑似癔症性聋进行了研究，使用H₂¹⁵O正电子发射断层扫描（PET）结合言语和噪声刺激，并进行了诸如阻抗测试和听觉反应遥测等听力学测试。此外，通过在恢复后进行随访PET扫描并比较恢复前和恢复后的扫描结果，我们试图找到癔症性聋可能的神经基础。
一名51岁男性，在成功使用人工耳蜗4年后出现癔症性聋。
支持性心理治疗。
恢复前和恢复后的H₂¹⁵O-PET扫描
恢复前的H₂¹⁵O-PET扫描显示声音刺激可激活听觉皮层，这证实了中枢听觉通路的正常刺激。值得注意的是，与恢复前状态相比，恢复后状态在言语和噪声刺激条件下右侧听觉皮层均出现相对激活。此外，双侧前额叶和顶叶区域在恢复后状态下比恢复前状态下激活更明显。换句话说，负责有意识感觉感知的前额叶-顶叶-颞叶网络相对失活，或由腹侧和背侧顶叶皮层介导的自上而下和自下而上注意力转移的相对功能障碍，可能导致了该患者的癔症性聋。
前额叶-顶叶-颞叶网络相对失活或腹侧和背侧顶叶皮层功能障碍可能与癔症性聋的发生有关。
