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Audiology Unit, Department of Oto-Rhino-Laryngology, Kasr-Al-Aini Faculty of Medicine, Cairo University, Cairo, Egypt
Department of Neurology, Kasr-Al-Aini Faculty of Medicine, Cairo University, Cairo, Egypt
Publication date: 2020-04-20
J Hear Sci 2011;1(2):50–53
Phonophobia describes sound intolerance, one of the characteristic symptoms associated with migraine attacks (Vingen et al., 1998).

This study included 25 normal hearing migraineurs with ictal phonophobia, tested with transient evoked otoacoustic emission (TEOAE) with and without contralateral acoustic stimulation (CAS) with white noise and speech in noise intelligibility (SIN) in the inter-ictal phase. They were compared to 25 well-matched controls.

to assess the function of the cochlear outer hair cells (OHC) and their efferent regulation by the medial olivocochlear reflex.

Migraineurs showed statistically significant lower TEOAE than controls in the higher frequency bands as well as in overall response, overall reproducibility and mean AB value reflecting OHC dysfunction. But the majority of cases showed pass TEOAE bilaterally. After CAS, migraineurs showed statistically non-significant weaker TEOAE suppression than controls. Around 60% of ears had suppressed TEOAE overall response. Loudness discomfort level (LDL) was significantly lower than controls but only 3 cases showed hyperacusis, LDL and migraine duration were not correlated. TEOAE suppression was significantly correlated with word discrimination% in different signal to noise ratios (SNR) at certain frequency bands; but was not correlated with SNR of speech reception threshold in noise. TEOAE and SIN tests were not correlated with LDL or migraine duration.

Outer hair cells and olivocochlear reflex dysfunction can occur in migraineurs with phonophobia, but still the majority remains unaffected, suggesting other mechanisms of phonophobia than efferent system dysfunction, while the affected minority may have associated sub-clinical hyperacusis.

Goadsby PJ, Lipton RB, Ferrari MD: Migraine-current understanding and treatment. N Engl J Med, 2002; 346: 257–70.
Vanagaite Vingen J, Pareja JA et al: Phonophobia in migraine. Cephalalgia, 1998; 18: 243–49.
Jastreboff PJ, Hazell JWP: A neurophysiological approach to tinnitus: Clinical implications. Br J Audiol, 1993; 27(1): 7–17.
Kumar UA, Vanaja CS: Functioning of olivocochlear bundle and speech perception in noise. Ear Hear, 2004; 25: 142–46.
Persson P, Harder H, Arlinger S, Magnuson B: Speech recognition in background noise: monaural versus binaural listen listening conditions in normal-hearing patients. Otol Neurotol, 2001; 22: 625–30.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia, 2004; 24 (Suppl. 1): 1–160.
Soliman SM: Speech discrimination audiometry using Arabic phonetically-balanced words. Ain Shams Med J, 1976; 27: 27–30.
Kemp DT: Otoacoustic emissions, travelling waves, and cochlear mechanisms. Hear Res, 1986; 22: 95–104.
De Ceeulaer G, Yperman M, Daemers K et al: Contralateral suppression of transient evoked otoacoustic emissions: Normative data for clinical test set-up. Otol Neurotol, 2001; 22: 350–55.
Goldstein B, Shulman A: Tinnitus – Hyperacusis and the Loudness Discomfort Level Test – A preliminary Report. Int Tinnitus J, 1996; 2: 83–89.
Katzenell U, Segal S: Hyperacusis: review and clinical guidelines. Otol Neurotol, 2001; 22: 321–26.
Ashkenazi A, Mushtaq A, Yang I, Oshinsk ML: Ictal and interictal phonophobia in migraine - a quantitative controlled study. Cephalalgia, 2009; 29, 1042–48.
Main A, Dowson A, Gross M: Photophobia and phonophobia in migraineurs between attacks. Headache, 1997; 37: 492–95.
Woodhouse A, Drummond PD: Mechanisms of Increased Sensitivity to Noise and Light in Migraine Headache. Cephalalgia, 1993; 13(6): 417–21.
Bolay H, Bayazit YA, Gündüz B et al: Sub-clinical dysfunction of cochlea and cochlear efferents in migraine: an otoacoustic emission study. Cephalalgia, 2008; 28(4): 309–17.
Murdin L, Premachandra P, Davies R: Sensory dysmodulation in vestibular migraine: an otoacoustic emission suppression study. Laryngoscope, 2010; 120(8): 1632–36.
Baguley DM, Axon PR, Winter IM, Moffat DA: The effect of vestibular nerve section upon tinnitus. Clin Otolaryngol, 2002; 27: 219–26.
Lautenschlager L, Tochetto T, Costa MJ: Recognition of speech in noise and relations with suppression of otoacoustic emissions and the acoustic reflex. Braz J Otorhinolaryngol, 2011; 77(1): 115–20.
Wagner W, Frey K, Heppelmann G et al: Speech-in-noise intelligibility does not correlate with efferent olivocochlear reflex in humans with normal hearing. Acta Oto-Laryngologica, 2008; 128: 53–60.