Funtabulously Frivolous Friday Five 097

A recent study in the Australasian Emergency Nursing Journal found that noise levels in Australian EDs exceed those in the chimpanzee enclosure in Whipsnade Zoo.

Noise, it seems, is all around us, all but drowning out the borborygmi and leathery rubs to which the well-trained physician’s ears are normally attuned. So what chance have we got of detecting a tell-tale palatal click, or the characteristic hum of a pulsatile cervix? I SAID – WHAT CHANCE HAVE WE GOT – oh forget it. Let’s get on with the bloody quiz. It’s about noises, right?

Question 1

What sound is associated with Exploding Head Syndrome?

  • Bang.
  • The Exploding Head Syndrome is an example of a hypnagogic auditory hallucination, characterised by the sensation of an explosion in the head, which wakes the sufferer from sleep.
  • The first report in the literature, from Hull Royal Infirmary in 1989, gathered an astonishing 50 cases.

Clinical features of the exploding head syndrome.
Pearce JM.
J Neurol Neurosurg Psychiatry. 1989 Jul;52(7):907-10.

Question 2

Which famous rock bands have exceeded the auditory threshold for pain?

  • The auditory threshold for pain is generally considered to be about 125 decibels.
  • Led Zeppelin, The Who, and Motörhead are reputed to have exceeded this value in live performances. The current 130 dB record is held by ghastly metallists Manowar.
  • Legendary heavy metal band Spinal Tap are known to have used the loudest guitar amps ever made.

Question 3

Which vomit-related syndrome generates the crackly-sounding Hamman’s sign?

  • Boerhaave’s Syndrome (‘spontaneous’ oesophageal rupture)
  • Hamman’s sign (otherwise known as precordial crunch) is an auscultatory crackle which coincides with normal heart sounds. It is produced by gas in the mediastinum or pericardium.
  • The first described case of Boerhaave’s Syndrome, in 1723, was Grand Admiral of the Dutch Fleet, Baron Jan Gerrit van Wassenaer. The Admiral had an uncomfortably heavy meal, followed by eight cups of olive oil as an emetic. The diagnosis of a ruptured oesophagus was made at autopsy, when Boerhaave found morsels of duck meat in the pleural cavity.
  • Vomition of honeycomb-centred confectionary produces a variant of Hamman’s sign, termed “precordial Crunchie”.
  • Learn more about Boerhaave’s syndrome in Roast Duck and Juniper Beer.

Question 4

Which maddening conditions produce objective tinnitus?

  1. AV malformations in head and neck.
  2. Palatal and stapedius myoclonus syndromes.

Unlike its subjective counterpart, objective tinnitus can be discerned by the examiner e.g. by placing the stethoscope over the patient’s ear. AV malformations generally produce a machinery murmur whereas the myoclonus syndromes generate clicks.

Question 5

What sound is made by an earworm?

  • The sound of a familiar piece of music.
  • Earworms are pieces of music that stick in your mind. They experienced by 98% of people, usually have lyrics and are generally irritating in quality.
  • The pathological variant is termed a musical hallucination: in this temporal lobe phenomenon, the music is often incessant, very loud, and distressing. Musical hallucinations are associated with advanced age, female gender, deafness, and previous exposure to Come On Eileen by Dexy’s Midnight Runners.

Mrs O’C was somewhat deaf, but otherwise in good health. She lived in an old people’s home. One night, in January 1979, she dreamt vividly, nostalgically, of her childhood in Ireland, and especially of the songs they danced to and sang. When she woke up, the music was still going, very loud and clear. She got up, roused and puzzled. It was the middle of the night. Someone, she assumed, must have left a radio playing. But why was she the only person to be disturbed by it? She checked every radio she could find – they were all turned off.

Oliver Sacks. The Man Who Mistook His Wife for a Hat. Picador, 1986.


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