Autophony

What is Autophony?

Autophony is a condition where a person hears their own internal sounds much louder than normal. These sounds can include:

• Your own voice
• Your breathing
• Your heartbeat
• Chewing or swallowing noises
• Eye movements or blinking
• Footsteps
• Creaking joints

Imagine feeling like you're speaking through a megaphone, but only you can hear it. That's what autophony can feel like for many people.

What Causes Autophony?

There are several potential causes of autophony. Here are the most common:

1. Patulous Eustachian Tube: This is when the Eustachian tube, which normally opens and closes to equalize pressure, remains abnormally open. This creates a passage for the inner body sounds to travel to the ear and to be heard. You can explore this condition in more detail in this article.
   
   
2. Superior Canal Dehiscence Syndrome (SCDS): This rare condition involves a small opening in the bone covering the inner ear. That opening lets the body sounds through to the ear. Learn more about this condition here.
   
   
3. Middle Ear Conditions and Eustachian Tube Dysfonction: Issues like fluid buildup or infections can alter sound perception. This is usually short-lived and resolves in a few weeks or months. 
   
   
4. Eardrum Occlusion: Sometimes, blockages in the ear canal can cause autophony. Place your finger in your ear and hum; you'll notice the humming is amplified in the ear that's plugged!

When Should You See a Doctor?

While occasional autophony can be normal, you should consult an ENT specialist if:

• Symptoms persist for more than a few days
• Autophony is affecting your quality of life
• You experience additional symptoms like dizziness or hearing loss.

Remember, autophony can sometimes be a symptom of a more serious underlying condition, so it's always better to get checked out.

What is The Work-up For Autophony?

When you visit an ENT for autophony, they will first conduct a thorough medical history to understand your symptoms and associated conditions. It is important to mention which sounds you hear (your voice, your breath, your eyes, and so on), and also if there is a triggering event. For example, it is common to see rapid weight loss as a trigger for patulous Eustachian tube. They will ask about ear pressure, vertigo, tinnitus among other questions. 

They will then perform physical examination. This includes looking at your ear canal and eardrum. Specifically, looking for obstructions, or sometimes for movement of the eardrum with nasal breathing (seen in patulous Eustachian tube). The examination will also include a neuro-vestibular assessment (this can help diagnose SCDS) and a nasopharyngeal endoscopy (called a "scope") to examine the Eustachian tube opening.

The work-up for autophony usually includes some of the following tests: 

1. Audiogram. This test measures your ability to hear. An audiogram is the first step as it can objectively evaluate whether you can truly hear sounds through your body (using bone conduction, we can determine if there is hyper-conductivity). This article explains how to interpret the audiogram. 
   
   
2. Tympanometry: This test measures how your eardrum responds to pressure. Helps diagnose conditions like Eustachian tube dysfunction and patulous Eustachian tube. Read more on tympanometry here.
   
   
3. CT Scan: In some cases, imaging may be needed to rule out conditions like SCDS, where the missing bone can be seen as an opening in the inner ear. 
   
   
4. Vestibular Evoked Myogenic Potential (VEMP) Test: This can help diagnose SCDS. Find out more here.

Treatment Options for Autophony

Treatment depends on the underlying cause. I recommend exploring the specific articles for each disorder to gain more in-depth information. Here is a overview of the approach we usually employ:

1. Conservative Measures: For mild cases, staying hydrated (helps a patulous Eustachian tube) or performing the Valsalva maneuver (gently blowing out while pinching your nose) may help.
   
   
2. Medication: In some cases, medications to reduce inflammation in the middle ear or fluid buildup may be prescribed. This usually involves decongestants and nasal steroid sprays. For patulous Eustachian tube, we usually recommend hypertonic saline (higher concentration of salt) nasal drops or PatulEnd (a form of liquid vitamin C designed as a nasal spray). There is no medical treatment for SCDS.
   
   
3. Surgery: For severe cases or those caused by SCDS, surgical intervention might be necessary. This could involve plugging the Eustachian tube (rarely done, for patulous Eustachian tube), placing tubes in the eardrum (for middle ear fluid or some forms of patulous Eustachian tube), or repairing the dehiscence in SCDS. You can read more about the surgical treatments of SCDS here.

Remember, autophony is often treatable, so don't hesitate to seek help if you're experiencing persistent symptoms. Your quality of life is important, and addressing autophony can make a significant difference in your daily comfort and well-being.