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

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.