Acute and Transient Psychotic Disorder with Catatonia in a Patient with Congenital Right Ear Absence and Left Microtia: A Rare Neuropsychiatric Interface

Acute and Transient Psychotic Disorder with Catatonia in a Patient with Congenital Right Ear Absence and Left Microtia: A Rare Neuropsychiatric Interface | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Acute and Transient Psychotic Disorder with Catatonia in a Patient with Congenital Right Ear Absence and Left Microtia: A Rare Neuropsychiatric Interface Pukar Gupta, Kamal Hamal, Roshni Thapa, Pradeep Adhikari, Progress Sharma, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7342313/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Acute and transient psychotic disorder (ATPD) is characterized by sudden onset of psychotic symptoms, often precipitated by stress, with remission typically within weeks. While auditory hallucinations are common in psychosis, their presence in individuals with congenital ear malformations is scarcely reported. This raises important questions about the neural basis of such perceptual phenomena. Case presentation We present the case of a 20-year-old woman diagnosed with acute and transient psychotic disorder (ATPD) with catatonia, who experienced persistent bilateral auditory hallucinations despite complete absence of the right external auditory canal and microtia of the left ear. Neuroimaging showed no intracranial abnormalities. After being treated with lorazepam and low-dose risperidone, her symptoms went away. Discussion This case illustrates that vivid audio hallucinations may manifest even in the absence of functional external auditory structures. The activation of the central auditory network, cortical remodeling, or hyperactivity within the limbic system may elucidate the phenomenon. These observations demonstrate the intricate connection between psychiatric symptoms and congenital sensory impairments. Conclusion Clinicians should remain aware that structural ear anomalies do not preclude centrally generated hallucinations. A multidisciplinary approach involving psychiatry, neurology, and otology is essential in similar presentations. acute and transient psychotic disorder catatonia auditory hallucinations microtia congenital auditory canal atresia Figures Figure 1 Highlights First documented case linking congenital bilateral external ear malformations with Acute and Transient Psychotic Disorder (ATPD) and catatonia. Auditory hallucinations occurred despite absent right auditory canal and left microtia, emphasizing central neural mechanisms. Rapid recovery achieved with combined benzodiazepine and low-dose antipsychotic therapy. Expands the understanding of sensory pathway anomalies in acute psychotic presentations. Introduction Auditory hallucinations, a hallmark of psychotic disorders, are generally attributed to abnormal activation within auditory cortices and interconnected neural network mechanisms that can operate independently of intact peripheral hearing pathways [ 1 , 2 ]. In cases of congenital ear abnormalities or severe hearing impairment, these hallucinations contest the conventional sensory input paradigm, indicating that intricate auditory phenomena may arise centrally [ 3 , 4 ]. Catatonia, although classically linked to schizophrenia, also occurs in mood disorders, medical conditions, and acute psychoses such as ATPD [ 5 ]. Recognizing catatonia quickly is important to avoid problems like autonomic instability and health problems associated to immobility. We present a rare case of ATPD with catatonia in a patient with bilateral external ear malformations, exploring diagnostic, neurobiological, and cultural aspects. This case report conforms to the CARE case report standards [ 6 ]. Case Presentation A 20-year-old woman, with no prior psychiatric or significant medical history, was brought to the hospital by her family after they observed a sudden and marked change in her behavior over the past several days. Before the start, she was doing well and was busy with housework, getting along with family members, and keeping up with her usual social life. The transformation happened after the family talked about her schooling and independence. After that, she grew aloof, stopped doing activities she did every day, and people saw her talking to herself. Her symptoms got worse over the next few days. She increasingly isolated herself spending over an hour alone in the bathroom at times and became reluctant to speak or interact. When approached, she occasionally responded with obscene language. She developed paranoid thoughts, convinced that others were conspiring against her, and described hearing voices in both ears (more prominent on the left). These voices, which she identified as belonging to familiar people, carried threatening and derogatory content. Her family also observed her speaking to unseen individuals and reacting to what seemed to be internal stimuli. Physical examination revealed congenital anomalies of the external ear complete absence of the right pinna and external auditory canal, and microtia of the left ear (shown in Fig. 1 ). Despite these malformations, she reported that the hallucinated voices were clear and distinct. Upon admission, she exhibited mutism, prolonged fixed staring, and diminished responsiveness, indicative of catatonia . There were no signs of illness or head injuries, and the neurological exam was otherwise normal. The lab tests, which included a full blood count, a metabolic panel, and a thyroid function test, all came back normal.The brain MRI did not show any problems inside the skull besides the known problems with the outer ear. A comprehensive psychiatric assessment led to a diagnosis of Acute and Transient Psychotic Disorder (ATPD) in accordance with ICD-10 criteria with catatonia . A lorazepam challenge resulted in a rapid amelioration of her motor symptoms, thereby validating the catatonic aspect of her disease. She was subsequently given a small amount of risperidone, which she handled well and helped her psychotic symptoms get better over time. She got much better over the course of ten days. Her speech resumed to its normal flow, her mood steadied, and her persecutory views disappeared. She resumed normal interaction with her family and regained her baseline social and cognitive functioning. Mental Status Examination On examination, she appeared minimally kempt and was lying in bed with limited eye contact. Establishing engagement proved difficult. She showed signs of catatonia, including mutism and negativism, interspersed with episodes of excessive, tangential speech focused on irrelevant topics. When she wasn't talking, her speech was short and monotone. When she did talk, it was sometimes jumbled. She said she felt "fine," but her mood was typically low but ranged from being low to being irritable, angry, and hard to predict. She was quite afraid of getting hurt and had a lot of paranoid thoughts and mixed feelings. She also said that loud, clear sounds coming from her left ear scared her. Because her health was so bad, formal cognitive testing was put off until after the acute phase. Her ability to think clearly and exercise sound judgment was significantly impaired during this time. Physical Examination Right ear : Complete absence of external auditory canal and pinna. Left ear : Microtia with partially formed auricle. No other dysmorphic features or neurological deficits. Waldrop Physical Anomaly Scale Assessment : On the Waldrop scale, the patient scored 2 (depicted in Table 1 ), attributable to bilateral external ear malformations complete absence of the right pinna and external auditory canal, and microtia of the left ear. No other minor physical anomalies were identified [ 14 ]. Table 1 Waldrop Physical Anomaly Scale Assessment for the Patient (Adapted from Waldrop et al., 1968) Region Item (Minor Physical Anomaly) Score (0/1) Patient Finding Head Head circumference 90th percentile 0 Normal Fine electric hair 0 Absent Epicanthal folds 0 Absent Hypertelorism (wide intercanthal distance) 0 Absent Eyes Strabismus 0 Absent Ptosis 0 Absent Ears Low-set ears 0 Not observed Adherent ear lobes 0 Absent Malformed ears 2 Right anotia & left microtia Mouth High-arched palate 0 Absent Furrowed tongue 0 Absent Tongue with smooth/short frenulum 0 Absent Hands Clinodactyly (curvature of 5th finger) 0 Absent Single transverse palmar crease 0 Absent Hyperconvex nails 0 Absent Feet Partial syndactyly (2nd & 3rd toes) 0 Absent Wide gap between 1st & 2nd toes 0 Absent Total Score — 2 — “Interpretation The patient’s score of 2 , resulting solely from congenital ear malformations, indicates a region-specific minor anomaly. No other physical anomalies were identified”. Final Diagnosis ● Acute and Transient Psychotic Disorder (ICD-10) with catatonia ● Congenital absence of the right external auditory canal ● Left-sided microtia Management & Outcome Management & Outcome The patient was given a mix of benzodiazepines to treat catatonia and low-dose antipsychotic treatment. During her time in the hospital, she had supportive care. By the end of her hospital stay, she had completely recovered her ability to speak clearly, act appropriately in social situations, and control her emotions. All of her psychotic and catatonic symptoms had also gone away. Discussion This example illustrates the intricate neuropsychiatric relationship between prenatal auditory system anomalies and the emergence of psychosis. The occurrence of distinct, bilateral auditory hallucinations in a patient with an absent right external auditory canal and microtia on the left supports the notion that these perceptual phenomena predominantly originate from central brain mechanisms rather than peripheral sensory input. Functional neuroimaging studies have shown that auditory hallucinations are linked to unusual activity in areas such as the superior temporal gyrus, Broca's area, and other language-related networks, even in individuals with significant hearing loss (Shergill et al., 2000; Allen et al., 2008) [ 7 , 8 ]. Moreover, sensory deprivation, as investigated by Merabet and Pascual-Leone (2010) [ 9 ], can stimulate the brain's remarkable capacity for remodeling through cross-modal plasticity, hence increasing the likelihood of internally generated percepts, such as hallucinations. In cases of congenital ear abnormalities, this cerebral reconfiguration may clarify the occurrence of severe auditory hallucinations in individuals, such as ours, in the absence of external auditory pathways. This behavior resembles "phantom auditory perception," which Griffiths (2000) associated with phantom limb pain [ 10 ]. In this case, the brain creates sensory experiences to make up for missing or not enough information. Acute and Transient Psychotic Disorder (ATPD) is clinically defined by the abrupt emergence of psychotic symptoms that often persist for under one month, with a significant percentage of patients attaining complete remission (Susser & Wanderling, 1994) [ 11 ]. Although catatonia is infrequently seen in Acute and Transient Psychotic Disorder (ATPD), it has been documented in several case series and is believed to include dysregulations in GABAergic and glutamatergic neurotransmission (Fink and Taylor, 2003) [ 5 ]. Our patient asserts that initiating treatment with benzodiazepines and antipsychotics at an early stage typically results in favorable clinical outcomes (Sienaert, 2014) [ 12 ]. Cultural variables significantly influence individuals' perceptions and responses to disease. In South Asia, hallucinations are frequently viewed through supernatural or moral frameworks, hindering access to psychiatric therapy (Chase et al., 2018) [ 13 ]. The patient thought the voices were coming from people who wanted to hurt them, not from outside sources. This made it easy for them to receive medical treatment right away. This case supports the hypothesis that brain auditory networks can create strong hallucinations even when the hearing systems on the outside aren't working well. It also shows how important it is to do a full psychiatric evaluation and give people with sensory impairments who are showing psychotic symptoms medication as soon as possible. Patient Perspective “At first, I thought people around me were talking about me, even when I could not see them. The voices became clearer in one ear than the other. I recognized them as voices of people I knew. It was frightening because I felt they were plotting against me.The voices got quieter once I started treatment, and I could talk to my family again. I still remember how bizarre it was to hear them when I realized my ears were different from other people's. Conclusion This case illustrates that auditory hallucinations can occur without functional external auditory structures, underscoring their fundamental basis. In ATPD, the concurrent occurrence of catatonia complicates management and underscores the disorder's diverse presentations. A comprehensive assessment incorporating both psychological and otological perspectives is essential. Learning Points Hallucinations can arise centrally even without external auditory canal function. ATPD may present with catatonia; rapid recognition prevents complications. Congenital ear anomalies should not delay psychiatric assessment for perceptual disturbances. Cultural interpretations shape help-seeking behaviors. Cross-modal cortical plasticity may enable vivid hallucinations despite sensory deficits. Abbreviations ATPD: Acute Transient Psychotic Disorder ICD-10: International Classification of Diseases Declarations Acknowledgment: None to acknowledge. Clinical trial number: not applicable, this is a single clinical case report Funding sources: No funding was obtained for this study. Availability of data and materials: The datasets supporting the conclusions of this article are included within the article. Competing interests: The authors declare that they have no competing interests. Consent for publication: Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent form is available for review by the editor-in-chief of this journal upon request. Ethics approval: Since this is a case report, ethical clearance was not necessary. Registration of research studies: This is a case report, so registration was not required. Provenance and peer review: Not commissioned or externally peer-reviewed. References World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines . WHO; 1992. Hugdahl K. Auditory hallucinations: A review of the ERC "VOICE" project. World J Psychiatry. 2015 Jun 22;5(2):193-209. doi: 10.5498/wjp.v5.i2.193. PMID: 26110121; PMCID: PMC4473491. Bamiou, D. E., Campbell, N., & Sirimanna, T. (2006). Management of auditory processing disorders. Audiological Medicine , 4 (1), 46–56. https://doi.org/10.1080/16513860600630498 Vanneste S, Song JJ, De Ridder D. Tinnitus and musical hallucinosis: the same but more. Neuroimage. 2013 Nov 15;82:373-83. doi: 10.1016/j.neuroimage.2013.05.107. Epub 2013 Jun 1. PMID: 23732881. Rogers D. Catatonia: A Clinician’s Guide to Diagnosis and Treatment By Max Fink & Michael Alan Taylor, Cambridge: Cambridge University Press. 2003. 256 pp. $50 (hb). ISBN 0 521 82226 2. British Journal of Psychiatry . 2004;184(6):550-550. doi:10.1192/bjp.184.6.550-a Gagnier JJ, Kienle G, Altman DG, et al. CARE Group*. The CARE guidelines: consensus-based clinical case reporting guideline development. Glob Adv Health Med. 2013;2:38–43. Shergill SS, Brammer MJ, Williams SC, Murray RM, McGuire PK. Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging. Arch Gen Psychiatry. 2000 Nov;57(11):1033-8. doi: 10.1001/archpsyc.57.11.1033. PMID: 11074868. Allen P, Larøi F, McGuire PK, Aleman A. The hallucinating brain: a review of structural and functional neuroimaging studies of hallucinations. Neurosci Biobehav Rev. 2008;32(1):175-91. doi: 10.1016/j.neubiorev.2007.07.012. Epub 2007 Aug 15. PMID: 17884165. Merabet LB, Pascual-Leone A. Neural reorganization following sensory loss: the opportunity of change. Nat Rev Neurosci. 2010 Jan;11(1):44-52. doi: 10.1038/nrn2758. Epub 2009 Nov 25. PMID: 19935836; PMCID: PMC3898172. Griffiths TD. Musical hallucinosis in acquired deafness. Phenomenology and brain substrate. Brain. 2000 Oct;123 ( Pt 10):2065-76. doi: 10.1093/brain/123.10.2065. PMID: 11004124. Susser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Arch Gen Psychiatry. 1994 Apr;51(4):294-301. doi: 10.1001/archpsyc.1994.03950040038005. PMID: 8161289. Sienaert, Pascal & Dhossche, Dirk & Gazdag, Gábor. (2013). Adult catatonia: Etiopathogenesis, diagnosis and treatment. Neuropsychiatary. 41. 391-399. 10.2217/NPY.13.41. Chase LE, Sapkota RP, Crafa D, Kirmayer LJ. Culture and mental health in Nepal: an interdisciplinary scoping review. Glob Ment Health (Camb). 2018 Nov 5;5:e36. doi: 10.1017/gmh.2018.27. PMID: 30455971; PMCID: PMC6236213. Waldrop MF, Pedersen FA, Bell RQ. Minor physical anomalies and behavior in preschool children. Child Dev. 1968 Jun;39(2):391-400. PMID: 4172079. Additional Declarations No competing interests reported. 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17:56:48","extension":"html","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79346,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7342313/v1/16f913052f54d0bb4ca42d22.html"},{"id":92021018,"identity":"1f6289d7-e7b6-4195-bcde-ea28a92c8ff9","added_by":"auto","created_at":"2025-09-23 17:40:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":216544,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCongenital External Ear Anomalies: Right-Sided Anotia and Left-Sided Microtia (Red Arrows)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7342313/v1/8b22a69023b7c88862746e8b.png"},{"id":92021845,"identity":"cbfb4ad3-4f28-421d-a6a4-8e61703d7873","added_by":"auto","created_at":"2025-09-23 17:56:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1033181,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7342313/v1/c98361d1-b28b-41ec-bb50-9413357a789d.pdf"},{"id":92022259,"identity":"e45b00a4-590e-4b2c-a406-36d2953ee978","added_by":"auto","created_at":"2025-09-23 18:04:48","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":312576,"visible":true,"origin":"","legend":"","description":"","filename":"AHCAREChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7342313/v1/04a7ebace8573ba305cf1394.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Acute and Transient Psychotic Disorder with Catatonia in a Patient with Congenital Right Ear Absence and Left Microtia: A Rare Neuropsychiatric Interface","fulltext":[{"header":"Highlights","content":"\u003cul\u003e\n \u003cli\u003eFirst documented case linking congenital bilateral external ear malformations with Acute and Transient Psychotic Disorder (ATPD) and catatonia. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAuditory hallucinations occurred despite absent right auditory canal and left microtia, emphasizing central neural mechanisms. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRapid recovery achieved with combined benzodiazepine and low-dose antipsychotic therapy.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eExpands the understanding of sensory pathway anomalies in acute psychotic presentations.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eAuditory hallucinations, a hallmark of psychotic disorders, are generally attributed to abnormal activation within auditory cortices and interconnected neural network mechanisms that can operate independently of intact peripheral hearing pathways [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In cases of congenital ear abnormalities or severe hearing impairment, these hallucinations contest the conventional sensory input paradigm, indicating that intricate auditory phenomena may arise centrally [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCatatonia, although classically linked to schizophrenia, also occurs in mood disorders, medical conditions, and acute psychoses such as ATPD [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recognizing catatonia quickly is important to avoid problems like autonomic instability and health problems associated to immobility.\u003c/p\u003e\u003cp\u003eWe present a rare case of ATPD with catatonia in a patient with bilateral external ear malformations, exploring diagnostic, neurobiological, and cultural aspects. This case report conforms to the \u003cb\u003eCARE case report standards\u003c/b\u003e [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 20-year-old woman, with no prior psychiatric or significant medical history, was brought to the hospital by her family after they observed a sudden and marked change in her behavior over the past several days. Before the start, she was doing well and was busy with housework, getting along with family members, and keeping up with her usual social life.\u003c/p\u003e\u003cp\u003eThe transformation happened after the family talked about her schooling and independence. After that, she grew aloof, stopped doing activities she did every day, and people saw her talking to herself. Her symptoms got worse over the next few days. She increasingly isolated herself spending over an hour alone in the bathroom at times and became reluctant to speak or interact. When approached, she occasionally responded with obscene language. She developed paranoid thoughts, convinced that others were conspiring against her, and described hearing voices in both ears (more prominent on the left). These voices, which she identified as belonging to familiar people, carried threatening and derogatory content.\u003c/p\u003e\u003cp\u003eHer family also observed her speaking to unseen individuals and reacting to what seemed to be internal stimuli. Physical examination revealed congenital anomalies of the external ear complete absence of the right pinna and external auditory canal, and microtia of the left ear (shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Despite these malformations, she reported that the hallucinated voices were clear and distinct.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUpon admission, she exhibited mutism, prolonged fixed staring, and diminished responsiveness, indicative of \u003cb\u003ecatatonia\u003c/b\u003e. There were no signs of illness or head injuries, and the neurological exam was otherwise normal. The lab tests, which included a full blood count, a metabolic panel, and a thyroid function test, all came back normal.The brain MRI did not show any problems inside the skull besides the known problems with the outer ear.\u003c/p\u003e\u003cp\u003eA comprehensive psychiatric assessment led to a diagnosis of \u003cb\u003eAcute and Transient Psychotic Disorder (ATPD)\u003c/b\u003e in accordance with ICD-10 criteria \u003cb\u003ewith catatonia\u003c/b\u003e. A lorazepam challenge resulted in a rapid amelioration of her motor symptoms, thereby validating the catatonic aspect of her disease. She was subsequently given a small amount of risperidone, which she handled well and helped her psychotic symptoms get better over time.\u003c/p\u003e\u003cp\u003eShe got much better over the course of ten days. Her speech resumed to its normal flow, her mood steadied, and her persecutory views disappeared. She resumed normal interaction with her family and regained her baseline social and cognitive functioning.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eMental Status Examination\u003c/h2\u003e\u003cp\u003eOn examination, she appeared minimally kempt and was lying in bed with limited eye contact. Establishing engagement proved difficult. She showed signs of catatonia, including mutism and negativism, interspersed with episodes of excessive, tangential speech focused on irrelevant topics. When she wasn't talking, her speech was short and monotone. When she did talk, it was sometimes jumbled. She said she felt \"fine,\" but her mood was typically low but ranged from being low to being irritable, angry, and hard to predict. She was quite afraid of getting hurt and had a lot of paranoid thoughts and mixed feelings.\u003c/p\u003e\u003cp\u003eShe also said that loud, clear sounds coming from her left ear scared her. Because her health was so bad, formal cognitive testing was put off until after the acute phase. Her ability to think clearly and exercise sound judgment was significantly impaired during this time.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePhysical Examination\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRight ear\u003c/b\u003e: Complete absence of external auditory canal and pinna.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eLeft ear\u003c/b\u003e: Microtia with partially formed auricle.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNo other dysmorphic features or neurological deficits.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eWaldrop Physical Anomaly Scale Assessment\u003c/b\u003e: On the Waldrop scale, the patient scored \u003cb\u003e2\u003c/b\u003e (depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), attributable to bilateral external ear malformations complete absence of the right pinna and external auditory canal, and microtia of the left ear. No other minor physical anomalies were identified [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eWaldrop Physical Anomaly Scale Assessment for the Patient\u003c/b\u003e\u003c/p\u003e \u003cdiv class=\"Credit\"\u003e\u003cp\u003e\u003cem\u003e(Adapted from Waldrop et al., 1968)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem (Minor Physical Anomaly)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScore (0/1)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePatient Finding\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHead\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead circumference\u0026thinsp;\u0026lt;\u0026thinsp;10th or \u0026gt;\u0026thinsp;90th percentile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFine electric hair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEpicanthal folds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertelorism (wide intercanthal distance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEyes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrabismus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePtosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEars\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow-set ears\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot observed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdherent ear lobes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMalformed ears\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRight anotia \u0026amp; left microtia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMouth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh-arched palate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFurrowed tongue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTongue with smooth/short frenulum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHands\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinodactyly (curvature of 5th finger)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle transverse palmar crease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHyperconvex nails\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFeet\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartial syndactyly (2nd \u0026amp; 3rd toes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWide gap between 1st \u0026amp; 2nd toes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u0026ldquo;Interpretation\u003c/strong\u003e\u003cp\u003e\u003cem\u003eThe patient\u0026rsquo;s score of\u003c/em\u003e \u003cb\u003e2\u003c/b\u003e, \u003cem\u003eresulting solely from congenital ear malformations, indicates a region-specific minor anomaly. No other physical anomalies were identified\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eFinal Diagnosis\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e● Acute and Transient Psychotic Disorder (ICD-10) with catatonia\u003c/p\u003e\u003cp\u003e● Congenital absence of the right external auditory canal\u003c/p\u003e\u003cp\u003e● Left-sided microtia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eManagement \u0026 Outcome\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eManagement \u0026amp; Outcome\u003c/div\u003e\u003cp\u003eThe patient was given a mix of benzodiazepines to treat catatonia and low-dose antipsychotic treatment. During her time in the hospital, she had supportive care. By the end of her hospital stay, she had completely recovered her ability to speak clearly, act appropriately in social situations, and control her emotions. All of her psychotic and catatonic symptoms had also gone away.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis example illustrates the intricate neuropsychiatric relationship between prenatal auditory system anomalies and the emergence of psychosis. The occurrence of distinct, bilateral auditory hallucinations in a patient with an absent right external auditory canal and microtia on the left supports the notion that these perceptual phenomena predominantly originate from central brain mechanisms rather than peripheral sensory input.\u003c/p\u003e\u003cp\u003eFunctional neuroimaging studies have shown that auditory hallucinations are linked to unusual activity in areas such as the superior temporal gyrus, Broca's area, and other language-related networks, even in individuals with significant hearing loss \u003cb\u003e(Shergill et al., 2000; Allen et al., 2008)\u003c/b\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, sensory deprivation, as investigated by \u003cb\u003eMerabet and Pascual-Leone (2010)\u003c/b\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], can stimulate the brain's remarkable capacity for remodeling through cross-modal plasticity, hence increasing the likelihood of internally generated percepts, such as hallucinations. In cases of congenital ear abnormalities, this cerebral reconfiguration may clarify the occurrence of severe auditory hallucinations in individuals, such as ours, in the absence of external auditory pathways.\u003c/p\u003e\u003cp\u003eThis behavior resembles \"phantom auditory perception,\" which \u003cb\u003eGriffiths (2000)\u003c/b\u003e associated with phantom limb pain [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this case, the brain creates sensory experiences to make up for missing or not enough information.\u003c/p\u003e\u003cp\u003eAcute and Transient Psychotic Disorder (ATPD) is clinically defined by the abrupt emergence of psychotic symptoms that often persist for under one month, with a significant percentage of patients attaining complete remission \u003cb\u003e(Susser \u0026amp; Wanderling, 1994)\u003c/b\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although catatonia is infrequently seen in Acute and Transient Psychotic Disorder (ATPD), it has been documented in several case series and is believed to include dysregulations in GABAergic and glutamatergic neurotransmission \u003cb\u003e(Fink and Taylor, 2003)\u003c/b\u003e [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Our patient asserts that initiating treatment with benzodiazepines and antipsychotics at an early stage typically results in favorable clinical outcomes \u003cb\u003e(Sienaert, 2014)\u003c/b\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCultural variables significantly influence individuals' perceptions and responses to disease. In South Asia, hallucinations are frequently viewed through supernatural or moral frameworks, hindering access to psychiatric therapy \u003cb\u003e(Chase et al., 2018)\u003c/b\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The patient thought the voices were coming from people who wanted to hurt them, not from outside sources. This made it easy for them to receive medical treatment right away.\u003c/p\u003e\u003cp\u003eThis case supports the hypothesis that brain auditory networks can create strong hallucinations even when the hearing systems on the outside aren't working well. It also shows how important it is to do a full psychiatric evaluation and give people with sensory impairments who are showing psychotic symptoms medication as soon as possible.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003ePatient Perspective\u003c/h3\u003e\n\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e“At first, I thought people around me were talking about me, even when I could not see them. The voices became clearer in one ear than the other. I recognized them as voices of people I knew. It was frightening because I felt they were plotting against me.The voices got quieter once I started treatment, and I could talk to my family again. I still remember how bizarre it was to hear them when I realized my ears were different from other people's.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case illustrates that auditory hallucinations can occur without functional external auditory structures, underscoring their fundamental basis. In ATPD, the concurrent occurrence of catatonia complicates management and underscores the disorder's diverse presentations. A comprehensive assessment incorporating both psychological and otological perspectives is essential.\u003c/p\u003e\u003ch3\u003eLearning Points\u003c/h3\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHallucinations can arise centrally even without external auditory canal function.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eATPD may present with catatonia; rapid recognition prevents complications.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCongenital ear anomalies should not delay psychiatric assessment for perceptual disturbances.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCultural interpretations shape help-seeking behaviors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCross-modal cortical plasticity may enable vivid hallucinations despite sensory deficits.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eATPD:\u0026nbsp;\u003c/strong\u003eAcute Transient Psychotic Disorder\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICD-10:\u0026nbsp;\u003c/strong\u003eInternational Classification of Diseases\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e None to acknowledge.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethis is a single clinical case report\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources:\u003c/strong\u003e No funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets supporting the conclusions of this article are included within the article.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent form is available for review by the editor-in-chief of this journal upon request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u0026nbsp; Since this is a case report, ethical clearance was not necessary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eRegistration of research studies:\u003c/strong\u003e This is a case report, so registration was not required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eProvenance and peer review:\u003c/strong\u003e Not commissioned or externally peer-reviewed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eThe ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines\u003c/em\u003e. WHO; 1992.\u003c/li\u003e\n\u003cli\u003eHugdahl K. Auditory hallucinations: A review of the ERC \u0026quot;VOICE\u0026quot; project. World J Psychiatry. 2015 Jun 22;5(2):193-209. doi: 10.5498/wjp.v5.i2.193. PMID: 26110121; PMCID: PMC4473491.\u003c/li\u003e\n\u003cli\u003eBamiou, D. E., Campbell, N., \u0026amp; Sirimanna, T. (2006). Management of auditory processing disorders. \u003cem\u003eAudiological Medicine\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(1), 46\u0026ndash;56. https://doi.org/10.1080/16513860600630498\u003c/li\u003e\n\u003cli\u003eVanneste S, Song JJ, De Ridder D. Tinnitus and musical hallucinosis: the same but more. Neuroimage. 2013 Nov 15;82:373-83. doi: 10.1016/j.neuroimage.2013.05.107. Epub 2013 Jun 1. PMID: 23732881.\u003c/li\u003e\n\u003cli\u003eRogers D. Catatonia: A Clinician\u0026rsquo;s Guide to Diagnosis and Treatment By Max Fink \u0026amp;amp; Michael Alan Taylor, Cambridge: Cambridge University Press. 2003. 256 pp. $50 (hb). ISBN 0 521 82226 2. \u003cem\u003eBritish Journal of Psychiatry\u003c/em\u003e. 2004;184(6):550-550. doi:10.1192/bjp.184.6.550-a\u003c/li\u003e\n\u003cli\u003eGagnier JJ, Kienle G, Altman DG, et al. CARE Group*. The CARE guidelines: consensus-based clinical case reporting guideline development. Glob Adv Health Med. 2013;2:38\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003eShergill SS, Brammer MJ, Williams SC, Murray RM, McGuire PK. Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging. Arch Gen Psychiatry. 2000 Nov;57(11):1033-8. doi: 10.1001/archpsyc.57.11.1033. PMID: 11074868.\u003c/li\u003e\n\u003cli\u003eAllen P, Lar\u0026oslash;i F, McGuire PK, Aleman A. The hallucinating brain: a review of structural and functional neuroimaging studies of hallucinations. Neurosci Biobehav Rev. 2008;32(1):175-91. doi: 10.1016/j.neubiorev.2007.07.012. Epub 2007 Aug 15. PMID: 17884165.\u003c/li\u003e\n\u003cli\u003eMerabet LB, Pascual-Leone A. Neural reorganization following sensory loss: the opportunity of change. Nat Rev Neurosci. 2010 Jan;11(1):44-52. doi: 10.1038/nrn2758. Epub 2009 Nov 25. PMID: 19935836; PMCID: PMC3898172.\u003c/li\u003e\n\u003cli\u003eGriffiths TD. Musical hallucinosis in acquired deafness. Phenomenology and brain substrate. Brain. 2000 Oct;123 ( Pt 10):2065-76. doi: 10.1093/brain/123.10.2065. PMID: 11004124.\u003c/li\u003e\n\u003cli\u003eSusser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Arch Gen Psychiatry. 1994 Apr;51(4):294-301. doi: 10.1001/archpsyc.1994.03950040038005. PMID: 8161289.\u003c/li\u003e\n\u003cli\u003eSienaert, Pascal \u0026amp; Dhossche, Dirk \u0026amp; Gazdag, G\u0026aacute;bor. (2013). Adult catatonia: Etiopathogenesis, diagnosis and treatment. Neuropsychiatary. 41. 391-399. 10.2217/NPY.13.41. \u003c/li\u003e\n\u003cli\u003eChase LE, Sapkota RP, Crafa D, Kirmayer LJ. Culture and mental health in Nepal: an interdisciplinary scoping review. Glob Ment Health (Camb). 2018 Nov 5;5:e36. doi: 10.1017/gmh.2018.27. PMID: 30455971; PMCID: PMC6236213.\u003c/li\u003e\n\u003cli\u003eWaldrop MF, Pedersen FA, Bell RQ. Minor physical anomalies and behavior in preschool children. Child Dev. 1968 Jun;39(2):391-400. PMID: 4172079.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"acute and transient psychotic disorder, catatonia, auditory hallucinations, microtia, congenital auditory canal atresia","lastPublishedDoi":"10.21203/rs.3.rs-7342313/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7342313/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute and transient psychotic disorder (ATPD) is characterized by sudden onset of psychotic symptoms, often precipitated by stress, with remission typically within weeks. While auditory hallucinations are common in psychosis, their presence in individuals with congenital ear malformations is scarcely reported. This raises important questions about the neural basis of such perceptual phenomena.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe present the case of a 20-year-old woman diagnosed with acute and transient psychotic disorder (ATPD) with catatonia, who experienced persistent bilateral auditory hallucinations despite complete absence of the right external auditory canal and microtia of the left ear. Neuroimaging showed no intracranial abnormalities. After being treated with lorazepam and low-dose risperidone, her symptoms went away.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case illustrates that vivid audio hallucinations may manifest even in the absence of functional external auditory structures. The activation of the central auditory network, cortical remodeling, or hyperactivity within the limbic system may elucidate the phenomenon. These observations demonstrate the intricate connection between psychiatric symptoms and congenital sensory impairments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinicians should remain aware that structural ear anomalies do not preclude centrally generated hallucinations. A multidisciplinary approach involving psychiatry, neurology, and otology is essential in similar presentations.\u003c/p\u003e","manuscriptTitle":"Acute and Transient Psychotic Disorder with Catatonia in a Patient with Congenital Right Ear Absence and Left Microtia: A Rare Neuropsychiatric Interface","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 17:40:43","doi":"10.21203/rs.3.rs-7342313/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"87333054079668340358698806218075897686","date":"2025-09-24T13:13:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237278309889288811205243463272652766721","date":"2025-09-23T13:32:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T11:46:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96011029194531647201900133630170993176","date":"2025-09-12T09:52:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229607537826363690355399330381658713385","date":"2025-09-11T12:08:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-11T11:00:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T16:23:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-18T06:38:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-15T02:59:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-08-15T02:56:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e3ae1e76-548b-4f7c-add5-b2fe27120bf4","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T17:40:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 17:40:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7342313","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7342313","identity":"rs-7342313","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}