Central Annals of Pediatrics & Child Health

Review Article *Corresponding author Jay R Lucker, Department of Communication Sciences & Disorders, School of Communication, 4th and Bryant Auditory Hypersensitivity in Streets, Howard University, NW, Washington, DC 20059, USA, Tel: 301-254-8583; Email: Submitted: 29 November 2014 Children with Lyme Disease Accepted: 31 January 2015 Jay R Lucker* Published: 02 February 2015 Department of Communication Sciences & Disorders, Howard University, USA Copyright © 2015 Lucker

Abstract OPEN ACCESS Four cases of children with Lyme disease having auditory hypersensitivity are Keywords presented. Auditory testing revealed no consistent pattern of problems except for the low loudness discomfort levels (LDL) found. Medical professionals who see children with • Lyme disease Lyme disease should consider audiological testing to include LDL measures. Treatments • Auditory hypersensitivity for auditory hypersensitivity are discussed. • Loudness discomfort • Auditory processing • Systematic desensitization AUDITORY PROBLEMS IN CHILDREN WITH LYME • Listening therapy DISEASE Some research h Parents who have children with Lyme disease are very auditory manifestations of people after they have contracted concerned with the impact of the disease on their children’s Lyme disease. Shotlandas et been al. [5] done reported looking a reduction specifically in loudness at the bodies. One factor that is not well addressed with such children tolerance in 31% of their subjects. They further reported this is how the Lyme disease may affect the child’s abilities to process reduced loudness tolerance was seen in many subjects in spite what is heard. Hearing abilities relate to two factors. One is of having normal hearing or minimal loss of hearing. Bamiou, threshold sensitivity, and hearing loss has been reported in some people with Lyme disease [1]. For example, [2] reported that (APD) could be due to Lyme disease and may remain with these hearing problems were found in 48% of patients with late stage peopleMusiek, long & Luxon after treatment [4] stated of that the auditorydisease has processing been successful. deficits Lyme disease. The other factor is auditory processing which has What is missing from their study is that they do not indicate the to do with how we take in and use the auditory information we hear. with Lyme disease or whether the problems were seen in adults, childrenspecific types or both of auditoryage groups. processing problems present in people One aspect of auditory processing seen with people who have Lyme disease is hypersensitivity to sound [1-5]. Auditory hypersensitivity relates to a person being overly sensitivity to children who contracted Lyme disease and for whom concerns In the course of the author’s clinical work, he has met some sound. The University of California Medical Center at San Francisco has a website focusing on auditory hypersensitivity which they and understanding what they heard. One group of patients includedwere observed three children with these all from children the same having family difficulties who contracted listening Lyme disease after going on a family camping trip. The other todefine everyday using sounds” another [6,7]. term Some called sounds hyperacusis. can be Hyperacusiseveryday ones is patient is a high school student who noticed problems listening suchdefined as doorsby them closing as “a orreduced children tolerance crying [3]. and Baguley increased [8] sensitivity describes hyperacusis as intolerance to ordinary, environmental sounds When discussing the medical histories regarding these four and “hearing” one year after he had been treated for Lyme disease. that lead to the person with hypersensitive hearing to react cases, the parents and adolescent reported that they were told inappropriately compared with how other people with the same by the children’s primary care physicians about the Lyme disease normal hearing would react to such sounds. Often, the reactions and the treatment for the disorder, they were told of some of the behavioral manifestations they may encounter, but they were never told by their medical doctors about auditory problems cases,are autonomic some have nervous referred system to this responsesover sensitivity such as as phonophobia in the “fight that their hearing was normal. Thus, it appeared that hearing or misophoniaflight” reaction [9]. a person may have when frightened. In such lossthey wasmight the experience only focus onceof hearing the medical concern professionals raised by the identified medical Research has demonstrated that people with Lyme disease professionals, but their doctors never discussed problems with who report they were able to tolerate sounds prior to contracting auditory intolerance also known as auditory hypersensitivity. the disease notice an intolerance to loud sounds afterwards [2,4,5]. This intolerance can become so severe that it has even to sound which might be treatable. The following is a discussion led to people taking their own lives [3]. ofYet, the all auditory four of theseprocessing patients results have found significant for these hypersensitivities four cases with

Cite this article: Lucker JR (2015) Auditory Hypersensitivity in Children with Lyme Disease. Ann Pediatr Child Health 3(1): 1035. Lucker (2015) Email: Central a general discussion of what might be recommended regarding normally expected levels (see Lucker, 2013) [9]. When asked treatment. For all cases, parents provided written informed about this low level of tolerance, he reported that this was one of consent allowing their children’s records to be used in this study. the listening problems he noticed during the past few months. He stated that prior to this time, he had no problems tolerating loud CASE STUDIES sounds, but now, a little over one year post treatment for Lyme Case of a 16 year old, high school student

evendisease, his hefriends found calling he could to each not tolerate other. loud noises such as traffic began noticing problems understanding his teachers in class and noise, motorcycles, sirens from fire trucks and ambulances, and evenThe conversations first case is with of a his 16 friends, year old, especially high school when student. there were He Results of the auditory processing tests for this subject noises present, about a year after having been diagnosed with Lyme disease. His complaints led his mother to bring her son to his primary care physician. measures.are presented As canin (Table be seen 1). from Information this table, in LDL that results table indicatesrevealed normal findings vs. abnormal findings for each of the APD Background information of this boy indicated that he lived in of speech understanding in noise tests were normal so the the state of Maryland and had gone camping with his family in the annoyingsignificantly effect lower reported than normally for background expected noises [9]. However,did not interfere results mountain area of West Virginia not far from Harpers Ferry, WV. with the boy’s abilities to understand speech in noise. Other than The family spent a summer vacation in that area including outdoor camping one weekend of that summer. However, the symptoms leading to the boy seen by his medical doctor were not noticed heardthe LDL in problem, the same the order only in deficit which found they on were APD heard, tests butwas being with until about three months after the family returned from their ableorganization to repeat (i.e., back difficulties all of the correct repeating words back in a different series of order). words summer vacation. The boy complained of joint pain, intolerance Otherwise, his auditory processing abilities were found to be to sound, being annoyed by the noises in the street and at school, normal except for the hypersensitivity. are other noises present, especially loud, background noises. THREE CHILDREN FROM THE SAME FAMILY and difficulties listening in class and in conversations when there When the boy’s medical doctor checked him out, the lab tests The second case report is of three children from the same family. The children were a 7 year old boy, a 9 year old girl, and a that he suspected the boy had been bitten by a tick during one of 12 year old girl. They came in for the auditory processing testing theverified family’s that outingshe had Lymeduring disease. their camping The doctor trip in told the the mountains parents six months after they had been diagnosed with and treated for of West Virginia. The doctor believed that the boy had been Lyme disease by their pediatrician. The parents reported noticing infected with borrelia burgdorferi bacterium due to being bitten what they heard starting a few months after the Lyme disease developing Lyme disease. The doctor then prescribed the use of wasdifficulties diagnosed with and all treatment three children for the listening Lyme disease and understanding was started. antibioticsby a black-legged to cure tickthe Lymecalled disease Ixodes andscapularis reduce which the symptoms. led to him The Lyme disease was diagnosed in the three children after The medical doctor also checked the boy’s ears via otoscopic returning from a family camping trip in the Blue Ridge Mountains to have the boy’s hearing tested by an audiologist. The audiologist Table 1: completedexamination a finding standard they hearing looked evaluationnormal and includingreferred the pure mother tone children with Lyme disease. Results are indicated only for those Audiological and auditory processing test findings in four and speech (SRT) thresholds, word recognition testing in quiet, measures that were abnormal (Low for LDL is abnormal). All other measures were normal as noted at the end of the table.* otoacoustic emission testing (OAE), and middle ear immittance testing (tympanometry). Audiological testing revealed normal Measures Case 1 Case 2 Case 3 Case 4 hearing thresholds and normal middle ear functioning as well Age in Years 16 7 9 12 as excellent word recognition in quiet. Thus, there were no Gender Male Male Female Female hearing problems for the child. Furthermore, the parents and LDL Low Low Low Low the boy reported that he had no symptoms of upper respiratory infection or allergies or exposure to loud sounds. Therefore, the WRS-N Normal Normal Abnormal Normal SCAN-3 Test problems tolerating loud sounds and background noises. Filtered Words Abnormal Normal Normal Normal normal hearing findings did not explain why the boy was having Auditory Figure-Ground Normal Normal Abnormal Normal understanding teachers in school and friends in conversations, Competing Words Abnormal Normal Normal Normal the As mother the boy decided continued to bring to complain her son of to difficulties the author hearing for hearing and Ear Diff. Abnormal Normal Normal Normal and auditory processing testing suspecting he had a hearing loss although previous hearing evaluations revealed no problems SSW Test with his hearing. RC condition Abnormal Normal Normal Normal Results of the hearing testing indicated he had normal Reversals Abnormal Normal Abnormal Normal hearing via pure tone air and bone conductions audiogram testing in both ears consistent with the previous hearing tests. measures, word recognition in quiet, SCAN-3 and SSW all other measures not*Normal listed, findings Comprehensive for all four subjects Test of for: Phonological Hearing thresholds, Processing, immittance and the However, loudness discomfort level (LDL) testing was well below Auditory Continuous Performance Test

Ann Pediatr Child Health 3(1): 1035 (2015) 2/4 Lucker (2015) Email: Central west of their home in the state of North Carolina. The parents CONCLUSIONS remembered that three of their children had noticeable rashes on the calves of their legs when the family was on their camping From review of these four cases, what was found was that all trip. The children reported that they believed the rashes came four had problems with loudness tolerance (lower than normally from the children scrapping their legs and scratching the area expected LDLs) [9]. One had problems with speech understanding in noise, another had auditory integration processing problems, where they were scrapped. The parents also noticed that the while two others had problems with organization. Thus, what children were complaining of joint pain and irritability to things these four cases support is a conclusion that it is likely that touching them as well as complaints tolerating loud sounds and children who contract Lyme disease may have problems with background noises. They complained that they could not tolerate auditory hypersensitivity and other possible auditory processing things like recess at school, the noise level in the gym, or trying to follow and understand what people were saying to them in a conclusion that people who contract Lyme disease should the noisy halls at school, in the lunch room, and in other noisy expectdeficits to (APD). have auditory Overall, processing the present problems four cases as dosuggested not support from listening environments. The mother reported that when she had complained about only reveal a consistent pattern of auditory hypersensitivity in all of these problems with the joint pain, touch sensitivity, and the research by Bamiou, Musiek, and Luxon [4]. The findings listening problems to the children’s pediatrician, the pediatrician was concerned with the rashes and the joint pain and feelings of 18these patients cases. withThe findings, post-treatment however, Lyme do agree disease with was Shotland, auditory et being irritable but not the hearing problems. The pediatrician al. [5] who found that the greatest auditory difficulty with their had all three children seen for a complete physical examination. indicating that people with Lyme disease may have auditory hypersensitivityhypersensitivity. (Baiata, The findings 2009); also Keate, agree 2010; with other Lyme literature Disease pediatrician ran because she suspected that the children may Action, 2011) [1-3]. haveIncluded been with bitten the byexamination ticks carrying was asome series disease of blood that tests might the TREATMENT FOR AUDITORY HYPERSENSITIVITY cause things like Rocky Mountain spotted fever or Lyme disease. The blood tests came back normal for the three children. The One of the important factors in treating patients is whether pediatrician believed that the children had positive indications of Lyme disease caused by a deer tick bite (amblyomma americanum), and began antibiotic treatments for the three auditorythere are hypersensitivity.programs to improve There any havedeficits been that two may treatments be found. children with Lyme Disease. usedIn the with case of people these having four clients, auditory they hypersensitivity. were all found to have One focuses on desensitizing the person using what psychologists Over the course of the six months, the children were reported refer to as systematic desensitization [10]. The other is to have improvements in their joint pain and irritability to touch, using a listening therapy or sound intervention which may but the children still complained about tolerance to sound and reduce negative emotional reactions when listening to loud misunderstanding what they heard, especially in school. This and annoying sounds so that hypersensitivity can be reduced led the mother to bring the children to an audiologist to rule ([9,11]; www.thelisteningprogram.com). Thus, a combination out hearing loss. The audiologist completed a standard hearing of these two approaches was suggested and tried with these evaluation of pure tone and speech (SRT) thresholds as well as four cases. From the parents’ reports for the cases presented word recognition testing in quiet and middle ear immittance here, after completing the listening therapy (i.e., The Listening testing (tympanometry). Results of the audiological testing Program, www.thelisteningprogram.com), all four children were revealed normal hearing and normal middle ear functioning for reported to have less hypersensitivity and negative behavioral reactions to loud and annoying sounds. For these cases, the constantly misunderstanding what they heard or complaining only desensitization used was to slowly involve the children in all three children. It was not until the parents noticed the children hearing loud and annoying sounds starting with a short period of professional specializing in auditory processing. Results of the listening to loud sounds to longer listening periods. Thus, what hearingabout sounds and auditory being “too processing loud” that testing they completedcontacted thefor theauthor, three a children are also presented in (Table 1). having auditory hypersensitivity to sound following a diagnosis these four cases demonstrate is that when a child is identified as Hearing thresholds for air and bone conduction audiogram of and treatment for Lyme disease one should evaluate the child’s tolerance of loud sounds to determine whether the child the prior audiological evaluation. However, LDL measures were has hypersensitive hearing, and then consider using a listening measures were normal for all of the children as identified on therapy and desensitization approach to improve tolerance of children (the 9 year old) had problems on measures of speech loud and annoying sounds. significantly lower than normally expected. Only one of the understanding in noise. One other (12 year old) revealed a pattern The focus of this paper was to highlight the importance of of problems related to auditory integrative processing (i.e., a considering auditory hypersensitivity as a problem when medical type of auditory processing disorder (APD) in which listening professionals see children who have contracted Lyme disease. to different words in both ears and reporting the two words These treatment options seem to help reduce the annoying heard cannot be appropriate accomplished by the listener). This effects of loud sounds and, thus, provide better listening for such same one also revealed problems with organization. Except for children. Thus, medical professionals should let patients and lower than normally expected LDLs, the third child revealed no problems with any of the other measures of auditory processing. disease may become overly sensitivity to loud sounds. Thus, if families know that children and adolescents identified with Lyme Ann Pediatr Child Health 3(1): 1035 (2015) 3/4 Lucker (2015) Email: Central listening or sound tolerance problems are noticed, the medical professionals should refer such patients to audiologists who 361-365. of auditory processing disorders--a review. Arch Dis Child. 2001; 85: should do not just measure hearing threshold and middle ear 5. functioning, but should perform measures of loudness tolerance Pikus AT. Audiologic manifestations of patients with post-treatment Shotland LI, Mastrioanni MA, Choo DL, Szymko-Bennett YM, Dally LG, recommendations for treatments such as listening therapies and 6. University of California Medical Center at San Francisco, UCSF (i.e., LDL measures). If reduced loudness tolerance is found, Lyme disease syndrome. Ear Hear. 2003; 24: 508-517. sound desensitization should be considered. (2014a). Hyperacusis. ACKNOWLEDGEMENT 7. University of California Medical Center at San Francisco, UCSF

The author wishes to acknowledge Roni Pinch, M.S., CCC-SLP, 8. (2014b). Hyperacusis: Signs and Symptoms. cases of individuals with Lyme disease. 9. BaguleyLucker JR. DM. Auditory Hyperacusis. hypersensitivity J R Soc Med. in 2003;children 96: with 582-585. autism spectrum Owner and Director of SpeechW.I.S.E. for her help in identifying REFERENCES 10. disorder.Koegel RL, Focus Openden Autism D,Other Koegel Dev Disabl. LK. A 2013; systematic 20: 1-8. desensitization 1. Lyme Disease Action. About Lyme. 2011. paradigm to treat hypersensitivity to auditory stimuli in children with autism in family contexts. Research and Practice for Persons with 2. Keate B. Lyme Disease, Hyperacusis, and Tinnitus. 2010. 3. 11. SevereLucker Disabilities. JR, Doman 2004; A. Auditory 29: 122–134. hypersensitivity in children. Autism 4. BaiataBamiou J. DE,All SheMusiek Lost: FE, My Luxon Sister’s LM Battle . Aetiology with andLyme clinical Disease. presentations 2010. Science Digest. 2012; 4: 103–108.

Cite this article Lucker JR (2015) Auditory Hypersensitivity in Children with Lyme Disease. Ann Pediatr Child Health 3(1): 1035.

Ann Pediatr Child Health 3(1): 1035 (2015) 4/4