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You are here: The Neuro Holocaust » Case Report: Dutch Patient with Complex Auditory Verbal Hallucinations, Severe Tinnitus, Progressive Unilateral Hearing Loss, Paresthesia, and Multifaceted Neurological Symptoms
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casereport [06/12/2025 21:15] – created danielcasereport [11/12/2025 16:46] (current) – [References] daniel
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 multi-voiced, contextually adaptive interactions that incorporate real-time environmental cues multi-voiced, contextually adaptive interactions that incorporate real-time environmental cues
 in ways inconsistent with standard schizophrenic AVH phenomenology (Thakur & Gupta, in ways inconsistent with standard schizophrenic AVH phenomenology (Thakur & Gupta,
-2023; Waters & Fernyhough, 2017). These AVH remitted spontaneously for a period, +2023; Waters & Fernyhough, 2017). 
-persisting even after discontinuation of antipsychotics, consistent with reports of+ 
 +These AVH remitted spontaneously for a period, persisting even after discontinuation of antipsychotics, consistent with reports of
 non-psychotic individuals achieving voluntary control or natural remission of AVH without non-psychotic individuals achieving voluntary control or natural remission of AVH without
 ongoing pharmacotherapy, potentially mediated by enhanced metacognitive awareness or ongoing pharmacotherapy, potentially mediated by enhanced metacognitive awareness or
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 patient to discontinue them, consistent with documented risks of second-generation patient to discontinue them, consistent with documented risks of second-generation
 antipsychotics causing metabolic, affective, and neurocognitive adverse events in up to antipsychotics causing metabolic, affective, and neurocognitive adverse events in up to
-30-50% of users (Leucht et al., 2013; Fusar-Poli et al., 2015). Notably, serial audiometric+30-50% of users (Leucht et al., 2013; Fusar-Poli et al., 2015). 
 + 
 +Notably, serial audiometric
 assessments revealed progressive sensorineural hearing loss predominantly in the left ear, assessments revealed progressive sensorineural hearing loss predominantly in the left ear,
 with thresholds escalating from mild-moderate high-frequency elevations (e.g., 40 dB at 4 with thresholds escalating from mild-moderate high-frequency elevations (e.g., 40 dB at 4
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 though the unanalyzed MRI overlooked potential subtle microstructural changes like reduced though the unanalyzed MRI overlooked potential subtle microstructural changes like reduced
 white matter integrity in auditory pathways, as observed in analogous cohorts (Verma et al., white matter integrity in auditory pathways, as observed in analogous cohorts (Verma et al.,
-2019). The profound intensity and atypical complexity of the symptom cluster prompted+2019). 
 + 
 +The profound intensity and atypical complexity of the symptom cluster prompted
 psychiatric referral and hospitalization under a presumed psychotic disorder diagnosis. psychiatric referral and hospitalization under a presumed psychotic disorder diagnosis.
 Despite the patient's insistence that the acute, non-bizarre presentation—lacking formal Despite the patient's insistence that the acute, non-bizarre presentation—lacking formal
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 substantially reduce AVH severity by processing trauma-based memories and restoring substantially reduce AVH severity by processing trauma-based memories and restoring
 prefrontal-auditory inhibitory control (Isham et al., 2021; Hardy et al., 2023; Brand et al., prefrontal-auditory inhibitory control (Isham et al., 2021; Hardy et al., 2023; Brand et al.,
-2015). This remission pattern, coupled with the post-onset hearing deterioration and+2015). 
 + 
 +This remission pattern, coupled with the post-onset hearing deterioration and
 selective AVH resolution post-2023 hospitalization, further underscores a non-primary selective AVH resolution post-2023 hospitalization, further underscores a non-primary
 psychotic etiology, potentially fitting criteria for an Anomalous Health Incident (AHI) as per psychotic etiology, potentially fitting criteria for an Anomalous Health Incident (AHI) as per
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 hyperhidrosis, palpitations, lancinating and pulsatile extremity pains, distal paresthesias, hyperhidrosis, palpitations, lancinating and pulsatile extremity pains, distal paresthesias,
 vibratory dysesthesias (both focal and diffuse), and no prior psychiatric history beyond vibratory dysesthesias (both focal and diffuse), and no prior psychiatric history beyond
-substance-related issues resolved months earlier. The progressive left unilateral hearing+substance-related issues resolved months earlier. 
 + 
 +The progressive left unilateral hearing
 loss, documented audiometrically as worsening high-frequency thresholds post-symptom loss, documented audiometrically as worsening high-frequency thresholds post-symptom
 onset, likely amplified deafferentation processes, wherein peripheral auditory deprivation onset, likely amplified deafferentation processes, wherein peripheral auditory deprivation
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 neurological syndromes involving auditory-vestibular pathways, particularly given the qEEG neurological syndromes involving auditory-vestibular pathways, particularly given the qEEG
 patterns indicative of thalamocortical dysrhythmia rather than psychotic signatures (Azulay, patterns indicative of thalamocortical dysrhythmia rather than psychotic signatures (Azulay,
-2025a; Vanneste & De Ridder, 2012). Furthermore, the constellation—sudden+2025a; Vanneste & De Ridder, 2012). 
 + 
 +Furthermore, the constellation—sudden
 audio-vestibular onset, unilateral hearing loss as a red flag, cognitive fog, balance issues, audio-vestibular onset, unilateral hearing loss as a red flag, cognitive fog, balance issues,
 and paresthesias—meets DHA criteria for AHI classification, warranting standardized and paresthesias—meets DHA criteria for AHI classification, warranting standardized
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 50 dB HL bilaterally), but the noted 8 kHz pure-tone tinnitus matching 60 dB HL intensity 50 dB HL bilaterally), but the noted 8 kHz pure-tone tinnitus matching 60 dB HL intensity
 suggests hyperacusis overlap, where amplified edge-frequency activity drives distress suggests hyperacusis overlap, where amplified edge-frequency activity drives distress
-(Schaette & McAlpine, 2011). This post-onset progression aligns with deafferentation+(Schaette & McAlpine, 2011). 
 + 
 +This post-onset progression aligns with deafferentation
 hyperactivity models, wherein acute tinnitus/AVH onset precedes and precipitates hearing hyperactivity models, wherein acute tinnitus/AVH onset precedes and precipitates hearing
 threshold shifts via excitotoxic damage to spiral ganglion neurons, a pattern observed in threshold shifts via excitotoxic damage to spiral ganglion neurons, a pattern observed in
 16-24% of severe hearing loss cases evolving to musical/verbal hallucinations (Teunisse et 16-24% of severe hearing loss cases evolving to musical/verbal hallucinations (Teunisse et
-al., 1996; Isham et al., 2021). Under DHA AHI guidelines, this qualifies as a reportable+al., 1996; Isham et al., 2021). 
 + 
 +Under DHA AHI guidelines, this qualifies as a reportable
 sensory event: acute unexplained otologic (tinnitus, unilateral hearing loss) and vestibular sensory event: acute unexplained otologic (tinnitus, unilateral hearing loss) and vestibular
 symptoms, with red flags (sudden unilateral loss) mandating urgent neuroimaging and symptoms, with red flags (sudden unilateral loss) mandating urgent neuroimaging and
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 & Larøi, 2008). Neurologically, they arise in temporal lobe epilepsy, migraines, brain tumors, & Larøi, 2008). Neurologically, they arise in temporal lobe epilepsy, migraines, brain tumors,
 encephalitis, and auditory pathway lesions, often with focal epileptiform activity (Nahum et encephalitis, and auditory pathway lesions, often with focal epileptiform activity (Nahum et
-al., 2011). Substance effects, including prior stimulant use (discontinued months earlier) or+al., 2011). 
 + 
 +Substance effects, including prior stimulant use (discontinued months earlier) or
 benzodiazepine withdrawal, can induce AVH, though the temporal disconnect here reduces benzodiazepine withdrawal, can induce AVH, though the temporal disconnect here reduces
 likelihood, as withdrawal peaks within days (Coyle et al., 2021). Deafferentation from tinnitus likelihood, as withdrawal peaks within days (Coyle et al., 2021). Deafferentation from tinnitus
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 De Ridder, 2012). High-frequency or ultrasonic exposures can induce non-vestibular De Ridder, 2012). High-frequency or ultrasonic exposures can induce non-vestibular
 dizziness and tingling, though typically non-linguistic, as seen in acoustic trauma models dizziness and tingling, though typically non-linguistic, as seen in acoustic trauma models
-(O'Beirne & Martin, 2024; Abouzari et al., 2020). The microwave auditory effect (Frey effect)+(O'Beirne & Martin, 2024; Abouzari et al., 2020). 
 + 
 +The microwave auditory effect (Frey effect)
 entails pulsed microwaves generating intra-cranial clicks or buzzes via thermoelastic entails pulsed microwaves generating intra-cranial clicks or buzzes via thermoelastic
 expansion, but theoretical extensions using multi-beam interference at VHF frequencies expansion, but theoretical extensions using multi-beam interference at VHF frequencies
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 changes) incompatible with psychosis (Azulay, 2025a; NVvP, 2023; Vanneste et al., changes) incompatible with psychosis (Azulay, 2025a; NVvP, 2023; Vanneste et al.,
 2018)—diverging from standards for neurological flags, including AHI-mandated DWI-MRI 2018)—diverging from standards for neurological flags, including AHI-mandated DWI-MRI
-and audiograms (NVvP, 2023; DHA, 2025). The qEEG, collected prior to hospitalization,+and audiograms (NVvP, 2023; DHA, 2025). 
 + 
 +The qEEG, collected prior to hospitalization,
 represented pre-existing patient-initiated data that could have informed differential diagnosis represented pre-existing patient-initiated data that could have informed differential diagnosis
 but was disregarded, contravening guidelines emphasizing integration of all available but was disregarded, contravening guidelines emphasizing integration of all available
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 for tinnitus (performed belatedly, revealing progression), neurology for vestibular/sensory for tinnitus (performed belatedly, revealing progression), neurology for vestibular/sensory
 testing, and autoimmune screens (e.g., anti-NMDA) given acute neurological signs and AHI testing, and autoimmune screens (e.g., anti-NMDA) given acute neurological signs and AHI
-red flags like unilateral loss (Rijksen & Crul, 2006; Connolly et al., 2024). Persistent+red flags like unilateral loss (Rijksen & Crul, 2006; Connolly et al., 2024). 
 + 
 +Persistent
 symptoms unresponsive to antipsychotics should prompt reevaluation and subspecialty input symptoms unresponsive to antipsychotics should prompt reevaluation and subspecialty input
 (NICE, 2014). This case evidences incomplete multidisciplinary scrutiny, risking organic (NICE, 2014). This case evidences incomplete multidisciplinary scrutiny, risking organic
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 from misdirected psychiatric treatment, aligning with malpractice precedents where failure to from misdirected psychiatric treatment, aligning with malpractice precedents where failure to
 interpret available tests leads to prolonged suffering and erroneous labeling (Stone, 2019). interpret available tests leads to prolonged suffering and erroneous labeling (Stone, 2019).
 +
 Compounding this, blocking the patient's appointment with a leading brain research Compounding this, blocking the patient's appointment with a leading brain research
 center—such as a specialized neuroimaging facility—represents negligent referral, a center—such as a specialized neuroimaging facility—represents negligent referral, a
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 psychosis, where somatic consultation guidelines explicitly recommend neurology referral for psychosis, where somatic consultation guidelines explicitly recommend neurology referral for
 atypical features like vertigo and paresthesia (NVvP, 2023; van der Gaag et al., 2013). atypical features like vertigo and paresthesia (NVvP, 2023; van der Gaag et al., 2013).
 +
 Furthermore, conditioning discharge on medication adherence without performing any Furthermore, conditioning discharge on medication adherence without performing any
 neurological examination exemplifies coercive practice, contravening the Dutch Compulsory neurological examination exemplifies coercive practice, contravening the Dutch Compulsory
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 comprehensive physical/neurological assessment in acute psychosis to rule out mimics, comprehensive physical/neurological assessment in acute psychosis to rule out mimics,
 potentially constituting negligence per Dutch tuchtrecht precedents where failure to examine potentially constituting negligence per Dutch tuchtrecht precedents where failure to examine
-somatically leads to disciplinary action (Hengeveld, 2006; Rijksen & Crul, 2006). Collectively,+somatically leads to disciplinary action (Hengeveld, 2006; Rijksen & Crul, 2006). 
 + 
 +Collectively,
 these actions not only perpetuate misdiagnosis but also erode trust, exacerbate side effects these actions not only perpetuate misdiagnosis but also erode trust, exacerbate side effects
 like the observed cognitive/job loss, and hinder recovery, underscoring systemic gaps in like the observed cognitive/job loss, and hinder recovery, underscoring systemic gaps in
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 AHI investigations show no reproducible signals, with symptoms often functional (Azulay, AHI investigations show no reproducible signals, with symptoms often functional (Azulay,
 2025c; Lin, 2021; Pierpaoli et al., 2024; Chan et al., 2024). Low-level RF poses no verified 2025c; Lin, 2021; Pierpaoli et al., 2024; Chan et al., 2024). Low-level RF poses no verified
-risks (WHO, 2016). Patient signals require calibrated, blinded validation to exclude artifacts.+risks (WHO, 2016). 
 + 
 +Patient signals require calibrated, blinded validation to exclude artifacts.
 The patient's digital trends analysis further contextualizes symptoms within broader The patient's digital trends analysis further contextualizes symptoms within broader
 2016-onset surges in AVH/tinnitus searches, suggesting exogenous factors beyond 2016-onset surges in AVH/tinnitus searches, suggesting exogenous factors beyond
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   - World Health Organization. (2016). Questions and answers: Electromagnetic fields. https://www.who.int/news-room/questions-and-answers/item/radiation-electromagnetic-fields   - World Health Organization. (2016). Questions and answers: Electromagnetic fields. https://www.who.int/news-room/questions-and-answers/item/radiation-electromagnetic-fields
   - Wu, J., Shi, M., & Wang, C. (2025). Association between tinnitus and cognitive impairment: Analysis of NHANES data. Frontiers in Neurology, 16, Article 1533821. https://doi.org/10.3389/fneur.2025.1533821   - Wu, J., Shi, M., & Wang, C. (2025). Association between tinnitus and cognitive impairment: Analysis of NHANES data. Frontiers in Neurology, 16, Article 1533821. https://doi.org/10.3389/fneur.2025.1533821
 +
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