MGA News Summer 2006

For several years I have complained that at certain times Mrs Gravis shouts at me. Not the ‘having a row’ kind of shout, but the ‘poor old buffer is deaf’ kind. Other noises such as passing vehicles or people talking at parties are deafening and drown out other sounds completely. Musical concerts are agony; Mrs Gravis now makes these a girl’s night out with her friends, whilst I have a silent night in. My GP arranged a hearing test, but this only revealed a loss of hearing in the range of the female voice, which explained Mrs Gravis’ claims that at times I didn’t answer her when she spoke. Well that’s my story.

This state of affairs went unexplained for many years until, during a break at an MGA meeting. I was sitting talking to a couple of myasthenic friends and a friendly boffin from Oxford. “Everyone seems to shout at me these days” complained Carol, “even cars seem to make more noise”. We chatted further about the problem and it seemed that all the myasthenics in the group had at one time or another experience the same thing. “Oh, you are talking about hyperacusis” said the boffin, “It’s a condition often encountered in myasthenia”. This may be so, but further research indicates that in the UK it is not commonly considered in connection with MG.

In basic terms, hyperacusis is a defect in the ears’ automatic volume control system. It seems that the same myasthenic muscle weakness which affects other voluntary muscles can also affect two small muscles in the inner ear; the ones which help to moderate sound levels. Although they seem to work automatically, they actually belong to the ‘voluntary’ group (like the ones we use to breathe).

To try and find out more I had a look on the internet. The RNID’s medical fact sheet says, “If you have hyperacusis you will have an increased sensitivity to the sounds that most people are able to tolerate. People with hyperacusis are not all affected by the same type of sounds”; well that sounds very familiar. It also says, “If you have hyperacusis you may also have tinnitus. This is the word for noises that some people hear ‘in the ears’ or ‘in the head’, such as buzzing, ringing, whistling, hissing and other sounds”. Yes, got that too, even when sober.

Finally I read, “If you have hyperacusis you are likely to have normal hearing: however, you may have difficulty understanding speech in noisy places, such as a train station. I am only too familiar with that and also frustrated by it, as is Mrs Gravis.

Using three different search engines (for the benefit of those like Mrs Gravis who will have nothing to do with nasty computers, these are the gismos that ferret out where information is located on the web) and found that the UK sources offered did not make detailed reference to hyperacusis and MG, using the American US based sites I found much more. In fact there some doctors suggest audiotympanometric tests, the posh name for hearing tests, as a diagnostic tool for MG.

Why is it not widely considered in the UK? Perhaps it is something that patients fail to mention, putting it down to other things like ‘the poor old buffer is deaf’. Also, although it is very distressing, it is not potentially life-threatening in the way that myasthenic weakness of the respiratory or mouth and throat muscles can be.

What is the remedy for hyperacusis? I suspect that if your hyperacusis is due to MG, then the answer is good control of your MG. If the Stapedius, along with Tensor Tympani, which is a muscle of the middle ear, are strong, then there should be an improvement. The RNID warn against the use of earplugs or earmuffs saying that in the long term it could make the problem worse. Bang goes another excuse for not hearing Mrs Gravis.

If you have experienced hyperacusis, please let me know, care of MGA HQ or you can email me direct at gravis@mga-charity.org.

References:
RNID - www.rnid.org.uk
Morioka WT, Neff PA, Boisseranc TE, Hartman PW, Cantrell RW. Arch Otolaryngol. 1976 Apr;102(4):211-3.

Webmaster's Note:
You can read Mr Gravis' follow-up article from the Autumn 2006 edition HERE

MGA NEWS Summer 2006

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