BACKGROUND: Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known.
OBJECTIVE: This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service.
METHODS: A service evaluation of one-to-one therapy for patients with misophonia (n=19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures t-tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated.
RESULTS: Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change.
CONCLUSIONS: Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.

Misophonia has gained attention in scientific circles that utilise brain imaging to validate diagnoses. The condition is promoted as not merely a symptom of other psychiatric diagnoses but as a discrete clinical entity. We illustrate the social construction of the diagnostic category of misophonia through examining prominent claims in research studies that use brain imaging to substantiate the diagnosis. We show that brain images are insufficient to establish the \'brain basis for misophonia\' due to both technical and logical limitations of imaging data. Often misunderstood as providing direct access to the matter of the body, brain images are mediated and manipulated numerical data (Joyce, 2005, Social Studies of Science 35(3), p. 437). Interpretations of brain scans are further shaped by social expectations and attributes considered salient to the data. Causal inferences drawn from these studies are problematic because \'misophonics\' are clinically pre-diagnosed before participating. We argue that imaging cannot replace the social process of diagnosis in the case of misophonia, nor validate diagnostic measures or otherwise substantiate the condition. More broadly, we highlight both the cultural authority and inherent limitations of brain imaging in the social construction of contested diagnoses while also illustrating its role in the disaggregation of symptoms into new diagnoses.

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Superior semicircular canal dehiscence (SSCD) is caused by a fistula in the arcuate eminence, creating vestibular and auditory disturbances. We aim to determine the effects of gender and age on symptom prevalence and resolution in patients with SSCD. A Boolean search was conducted through four separate scientific databases. Full-text English articles for SSCD patients, who underwent surgery were included. Demographics and outcomes were extracted. A total of 198 patients were identified, and available for quantitative analysis. Between genders, there were no differences in the prevalence of pre- or post-operative symptomology. Both genders had statistically significant improvement in symptomatology with females experiencing significantly high rates of hearing loss improvement compared to male patients. Compared to their younger cohort, patients over 65 had similar symptom frequencies before and after surgery with similar rates of symptom resolution. SSCD repair is safe and effective for resolving auditory and vestibular symptoms. Gender and age may not be strong predictors of patient presentation or symptom resolution. Gender and age-associated factors may not influence patient outcomes.

An 80-year-old man with a history of diabetes mellitus and hypertension died of a progressive neurological disorder characterized by truncal ataxia, extraocular movement disturbance, and muscular rigidity. Neuroradiological examination showed progressive atrophy restricted to the pontine base. Autopsy revealed localized atrophy of the pontine base, in which both neurons and nerve fibers were lost, especially in the central region. Medium-sized and small arteries in the parenchyma of the pontine base showed marked fibro-hyalinous thickening of the walls with luminal stenosis, but no distinct tissue defect as seen in lacunar infarct was observed. Perivascular lymphocytic infiltration was mostly absent, and reactive astrocytic proliferation was weak. The pontine tegmentum, midbrain, and medulla oblongata were well preserved. Localized atrophy of the pontine base is a rare pathological condition, and its pathogenesis in the present case can be best explained by a prolonged ischemic state (hypoperfusion) due to marked sclerotic changes of perforating arteries. It is unique that the lesions were restricted to the pontine base and the formation of lacunas was not observed. Localized metabolic derangement resembling that seen in central pontine myelinolysis might have also contributed to the pathogenesis of this peculiar localized atrophy.

BACKGROUND: Patulous Eustachian tube is a benign but notoriously difficult condition to treat successfully. Symptoms include autophony of voice and breathing, and aural fullness.
METHODS: This paper presents a series of 8 patients (12 ears) for whom a novel computed tomography guided injection of silicone elastomer suspension implant (Vox) was used to treat patulous Eustachian tube. This is the largest and only series in the current literature using this technique.
RESULTS: The combined complete and partial symptom resolution rate was 91 per cent. Complications related to the procedure are described. The pros and cons of this novel approach are also discussed in relation to traditional endoscopic transnasal techniques.
CONCLUSIONS: Computed tomography guided injection of Vox for the treatment of patulous Eustachian tube is suggested to be a feasible alternative to endoscopic transnasal approaches, particularly for refractory cases.

Study about deliberate self-harm (DSH) in children with different types of disabilities was scarce. This study compared the incidence and patterns of DSH between children with and without disabilities aged 6-17 years using a matched case-control study in Beijing.
A total of 650 pairs of children with and without disabilities were surveyed. Characteristics of latest episode of self-harm within the 12 months were compared. Associations between disability status, sociodemographic factors, smoking, drinking, sleep problems, and self-harm were examined.
Children with disabilities showed significant higher incidence of DSH than children without disabilities. Two groups differed significantly in terms of self-harm methods, body parts injured, premeditation, wishing to be known by others and help-seeking behavior. The adjusted OR for self-harm was 4.76 (2.99-7.55) for children with disabilities compared with children without disabilities. Children who slept fewer than 6 h per night, had difficulty falling asleep at night sometimes/often, and went to sleep after midnight 1 to 3 nights per month or at least once a week were at elevated risk of self-harm.
This study highlights a strong relationship between disability, sleep problems, and DSH. Interventions to reduce self-harm should target disability and sleep problems as important risk factors.

BACKGROUND: An epidermoid cyst is a rare tumor of the cerebellopontine angle region. It usually presents with ipsilateral compressive symptoms. The contralateral trigeminal neuralgia is an unusual presentation in such cases. We did not find such case reports in the literature.
METHODS: Here, we report a case of a 62-year-old female with a right cerebellopontine angle epidermoid cyst presenting with right hearing impairment and the contralateral trigeminal neuralgia.
CONCLUSIONS: The possible mechanism leading to the contralateral trigeminal neuralgia is discussed here along with the diagnosis and management of the case.

BACKGROUND Although rehabilitation for balance disorders is commonly undertaken following a stroke, hearing dysfunction is rarely investigated, even though hearing loss affects the ability to maintain balance. This report presents a case of restoration of balance and unilateral hearing using an alternating and filtering auditory training (AFAT) protocol in a patient with subarachnoid hemorrhage (SAH) and shunt-treated hydrocephalus. CASE REPORT A 54-year-old woman with a five-month history of SAH due to a ruptured aneurysm in the anterior communicating artery and hydrocephalus treated with a shunt was admitted to our unit for neurorehabilitation. The patient had a history of anorexia. Her initial neurological examination on admission for rehabilitation therapy showed postural instability, hemi-hyposthenia, proprioceptive left-sided ataxia, a confusional state including temporospatial disorientation, memory disorder and hearing loss. Two weeks after the start of her neurorehabilitation program the AFAT program was commenced. Pure tone audiometry (PTA) showed lower left hearing thresholds, extending from a hearing level (HL) of between 5-25 decibel (dB) or more when compared with the right ear. With a rapid and improved regain of unilateral hearing loss, balance, cognitive, and motor function also improved. CONCLUSIONS This case report supports that patients who undergo rehabilitation following stroke, SAH, and hydrocephalus might benefit from a rehabilitation program that includes hearing assessment and early improvement of hearing loss, leading to a shorter rehabilitation time.