Auditory complications after electroconvulsive therapy – Tips for life after ECT treatment

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Do you have problems with noise or sound after ECT? I sure do! 

I learned something interesting about ECT and sound. The 2019 edition of the Thymatron ECT device manual lists “auditory complications” as a serious adverse event.

How does ECT cause Auditory Complications? 

Evidently, the electrode is placed directly over the trigeminal nerve. In the most common placement… even when it’s not placed directly over the trigeminal nerve, there’s so much current that it diffuses into all the cranial nerves. Pulsing nearly an ampere current through nerves that function on 0.002-0.004 amps can have consequences. The body’s defense mechanism diffuses the current through the Trigeminal nerve (CN V), Facial nerve (CN VII) and diffuses into the brainstem, other cranial nerves, and the spinal cord. 

Injury to the Trigeminal nerve (CN V) and Facial nerve (CN VII) can affect how we process sound. It can change our nervous system and brain’s ability to “dampen sound” by altering how the nerve to the tensor tympani (which originates from the mandibular division of the trigeminal nerve) as well as changing our motor function of the smallest skeletal nerve in the human body: stapedius. 

What “Auditory Complications” are caused by ECT? 

When either the CN V or CN VII (or both) are injured, we hear sound louder than others hear sound. It causes something called hyperacusis. 

Something that’s helped me with my hyperacusis after ECT is using Mack’s silicone (swimmer’s ear) plugs. After using them for a decade, I finally got some musician’s ear filters made by Westone. They had to be prescribed by my audiologist because they are made specifically for my ear. They CA reduce sound by either 15 or 25 dB. I always use the 25dB filters. I’m amazed at how easier it is to concentrate when the noise around me is reduced. 

I’m also amazed at how having less sound in my life reduces my stress levels, which in turn reduces the overwhelming rage that seemed to spring from nowhere when I was around another noise–even fun noise from good music, family, and friends. 

Central Auditory Processing Disorder

When I first finished with ECT, I thought I’d lost some of my hearing because although I could hear noise around me, I couldn’t understand what I was hearing. It took longer and more concentration to process what I was hearing. I began having to use closed captioning on videos and television. I had a hearing test by an audiologist, which showed I heard great, but my processing was bizarrely slow. After struggling to understand the world around me for over a decade, I finally learned that listening is more than hearing. I learned about an assessment that tests both your hearing and your listening: a Central auditory processing assessment. 

It’s like a hearing test, but more than hearing, it also tests whether you understand what you are hearing when surrounded by other noise and whether it takes longer to process information.

It turns out I hear great! In quiet, one on one situations, I understand great. But add more noise, and I went from the 98th percentile to below the 25th percentile. That means 75% of humans on the earth who are my age understand the noise around them better than I do.  

How do sound and noise affect mood after ECT?

My family and I discovered that noise, even fun noise, can be completely overwhelming for me. Concentrating so hard to understand everyone when every noise is already louder to me than people who haven’t had ECT… well, let’s just say that at times, daily life feels like those movie scenes where enemies torture their prisoners with loud noise to “break them.” I quickly snapped in anger and frustration before learning how to protect my hearing and reduce sensory input. I was wearing myself out trying to concentrate on understanding/processing all the noise around me–it was exhausting and frustrating all rolled into one–making ingredients my emotional fuse as short as a broken firework. 

Gratefully, to the relief of me, my family, and my friends, ear filters and ear plugs work really well. 

I’ve also learned to pace myself. Set boundaries like time limits in noisy places. I know when I need to leave, and gratefully, now my family and friends understand why and no longer beg me to stay in painfully noisy situations. 

I hope that helps!

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Sarah P. Hancock

Sarah Price Hancock, MS, CRC, lived for nearly two decades misdiagnosed with severe "treatment resistant" mental illness. She was given 116 bilateral ECT treatments and now lives with Delayed Electrical Injury's Myoneuroal Disorder. Sarah holds a Master’s in Rehabilitation Counseling and taught for four years in San Diego State University’s Rehabilitation Counseling program. She is the Co-Founder and Trustee of the Ionic Injury Foundation. She also hosts The Emotional Self-Reliance Podcast and guest lectures on psychiatric recovery.