2018 Volume 59 Issue 2 Pages 199-207
We report on the course of treatment of an 18-year-old girl with autism spectrum disorder (ASD) who presented with severe hyperacusis. The patient first visited our hospital at 13 years of age for school nonattendance, and was diagnosed with pervasive developmental disorder not otherwise specified. By 18, she had become hypersensitive to almost all sounds in daily life, appearing fearful and easily startled. Earplugs and earmuffs could not control her symptoms; therefore, the patient was re-examined. Examination by the Department of Otolaryngology revealed no abnormal findings following medical tests, brain magnetic resonance imaging, and electroencephalographic examination. As such, she was diagnosed with ASD-associated hyperacusis. Pharmacotherapy was attempted following provision of information regarding her condition with consent to off-label drug use. Dose-dependent remission of hyperacusis was noted with gradual increase of aripiprazole (ARP) dose up to 18mg/day, but administration was suspended due to side effects. Symptom relief was observed with 3 mg ARP/day, but the effect being inadequate, combination treatment was attempted with sound exposure starting 3 months after resumption of ARP. Sound exposure consisted of a task in which the patient used headphones over earplugs to listen to music of her own selection at a tolerable volume once each day for 15 min with gradual increments in volume. As a result, habituation and generalization to acoustic stimuli occurred, resulting in significant reduction of hearing hypersensitivity. Five months after ARP resumption, ARP treatment was terminated due to side effects, while sound exposure alone was continued for 3 months, during which symptomatic improvement continued. The course of treatment of this patient suggested efficacy of low dose ARP combined with sound exposure as a treatment modality for treating ASD-associated hyperacusis. Recent findings, including auditory characteristics of ASD and side effects of ARP in ASD treatment, the treatment of hyperacusis, and future prospects were discussed.