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At least 19 recordsLinked to original sources

Functional hearing loss.

Functional hearing loss is a rather common entity, although it probably is overlooked more often than not. In most instances, the services of an experienced audiologist are necessary if one is to detect these cases. First, one must consider carefully the patient's behavior before and during the otologic and audiologic examination, and note the referral source, if any, since patients with certain backgrounds are more apt to exhibit functional hearing loss than others. Second, careful attention is given to certain aspects of the initial basic audiometric examination. Discrepancies here often stand out and point clearly toward functional loss. A so-called "modified approach" to conventional audiometry has enabled us to detect almost all cases of functional hearing loss without resort to the special audiometric tests designed for that purpose.

Adolescent↗

Functional hearing loss presenting as sudden hearing loss: a case report.

A case of functional hearing loss presenting as sudden sensorineural hearing loss in the only hearing ear of a musician is presented. Pure-tone audiometric evaluation showed good intratest and intertest consistency. The pitfalls of diagnosis, ultimately made by brain stem evoked response audiometry, are discussed in light of the literature on sudden and functional hearing loss. Psychiatric evaluation revealed features consistent with hysterical conversion. It is argued that it is important to establish the exact etiologic agent of functional hearing loss despite the difficulty of diagnosis so that the patient may receive appropriate treatment.

Adult↗

Personality and functional hearing loss in children.

Thirty children with functional hearing loss were seen for psychological assessment. The sample included twice as many girls as boys. Most had experienced middle-ear problems and scored outside normal limits on the Junior Eysenck Personality Inventory. Introversion alone or combined with neuroticism was the most important personality dimension, especially for girls. The relationship between introverted behaviour, hearing impairment and previous experience of hearing problems is discussed.

Audiometry, Pure-Tone↗

Psychological characteristics of children with functional hearing loss.

The terminology used to describe functional hearing loss (FHL) and some explanations of the phenomenon are discussed briefly. Previous studies of FHL in children are reviewed. Characteristics of 30 children seen for psychological assessment following diagnosis of FHL are described. There were twice as many girls as boys in the sample. A large proportion of the children had experienced middle ear problems. The mean IQ for the sample was below average, but the range of intellectual ability was wide. Nine children showed serious educational retardation. The children were assigned to one of three psychological problem groups depending on whether they had minor, school-based, or deeper, psychological problems. Those with deeper psychological problems tended to show greater hearing losses on pure tone audiometry. FHL seemed to be related to attentional factors in those with only minor or school-based problems but not for those with deeper psychological problems. These findings are discussed with reference to the need for psychological assessment of children with FHL.

Adolescent↗

Functional hearing loss and its relationship to resolved hearing levels.

The nature of functional hearing loss was retrospectively studied with respect to hearing sensitivity after resolution of the nonorganic components in 63 adults with bilateral exaggerated losses (126 ears). The configuration of the functional components (difference between the functional and resolved thresholds) was found to be related to that of the resolved hearing levels. The size of the functional overlay was essentially the same across the audiometric frequency range when the hearing was actually normal or if there was only mild loss. In cases of precipitously sloping high-frequency losses, the magnitude of the functional overlay became dramatically smaller for the impaired frequencies than for lower frequencies where hearing was normal or only mildly impaired. Moderate and severe losses represented a transitional situation, in which the functional components became gradually smaller with increasing frequency. Subjects with different resolved hearing in each ear (e.g., mild loss in one ear and a precipitous loss in the other) demonstrated nonorganic overlays that were consistent with the actual hearing levels for each respective ear. The findings suggest the use of an internalized, loudness level-based anchor by subjects with functional losses: the test signal must sound as loud as the anchor at each frequency in order for an exaggerated threshold response to be volunteered at that respective frequency. The pure-tone audiometric configuration and amount of functional loss at least in bilateral cases is thus consistently accounted for on the basis of known and explainable auditory factors.

Adult↗

Functional hearing loss in children.

This report reviewed 39 school-age children diagnosed as having a functional hearing loss utilizing auditory brainstem response (ABR) audiometry during the past 5 years at the Department of Otolaryngology, Kyushu University Hospital in Japan. Twenty-seven cases were females and 12 were males. Seven cases had a hearing loss unilaterally and 32 bilaterally. Although pure-tone audiometry revealed a variety of audiogram shapes, two-thirds of the cases had a flat or saucer-shaped audiogram with a mild to moderately severe hearing loss. ABR audiometry for the frequencies of 1, 2 and 4 kHz indicated a normal hearing threshold in 65 ears of 35 patients, and mild threshold elevations of at least one frequency in the remaining 6 ears of 4 patients. Three illustrative cases were demonstrated, and a discussion was held regarding the features in audiometric tests, and environmental factors surrounding the children with this condition. We emphasized that the physiological hearing measurement such as ABR audiometry should be performed when any discrepancy was noted between the patient's history and results of pure-tone audiometry, because of not infrequent occurrence of functional hearing loss.

Adolescent↗

Developmental and psychodynamic issues related to cases of childhood functional hearing loss.

The literature is scant regarding the details of the personality organizations of children exhibiting functional hearing losses. Projective data gleaned from five clinical cases of childhood functional hearing loss is presented. The core pathology involves a poorly consolidated image of the self. Threats to the continuity and cohesiveness of the self are avoided through a form of selective inattention.

Adolescent↗

Pure tone-spondee threshold relationships in functional hearing loss: a hypothesis.

A hypothesis is offered to account for the fact that in functional hearing loss, spondee threshold is frequently significantly lower than the pure-tone average. The hypothesis has three basic components: (1) that patients with functional hearing loss use a loudness criterion in making response decisions to suprathreshold stimuli; (2) that, at suprathreshold levels, pure tones and spondee words appear equally loud at equal sound pressure levels, and (3) that calibration values employed in pure-tone and speech audiometry contribute to the aberrant speech-pure tone relationship. Factors that may confound the speech-pure tone relationship are discussed as are the clinical and research implication of the hypothesis.

Audiometry↗

[Functional hearing loss in speech audiometry (author's transl)].

In a group of 238 patients assessed for medico-legal reasons, 26 subjects were found to have functional hearing problems. In detecting the presence of functional hearing loss, the reliability of speech audiometric patterns was shown. Each patient demonstrated at least one suspicious response. The evaluation revealed an irregular configuration of curves ("step-like", 56%) and a better understanding for monosyllabic testwords than for digits (28.8%) as the most important criteria. In the control group of 40 hard-of-hearing patients without functional hearing losses, testing-irregularities were found in only 2.5-3.7% of the patients. Furthermore, discrepancies between speech reception thresholds and pure tone averages (84.6%) as well as poor test-retest reliability in tone audiometry contributed to an identification of functional hearing loss. Békésy-audiometry Type V was obtained in 73% of those patients studied.

Adult↗

[Functional hearing loss in children].

The cases of children diagnosed with pseudohypacusis in the Department of Pediatric Otolaryngology were presented. Probable mechanism of its pathogenesis was described. The main stress was put on its correct diagnosis particularly in children with co-existing organic changes. Diagnosis of pseudohypacusis in children is not problematic provided that the occurence of this disease is taken into consideration during diagnostic procedures.

Adolescent↗

[Functional hearing loss in children who were not aware of their hearing loss].

We investigated one hundred and fourteen ears of 60 children (8 males, 52 females, aged from 6 to 13 years) with diagnoses of functional hearing loss (FHL), and were not aware of their own hearing loss. Forty nine (81.7%) of 60 cases examined were detected by school screening tests, 6 (10.0%) were referred to our hospital because their families noticed poor hearing responses, and 5 (8.3%) were enrolled because they complained of otalgia or discomfort in the ear. Forty (66.7%) showed only pure tone threshold loss without complications, and the remaining 20 associated nonorganic disorders. In addition, our investigation found 11 cases (18.3%) with nonorganic otalgia, 5 (8.3%) with functional visual disturbance, 1 (1.7%) with enuresis nocturna who refused to attend school, 1 with tinnitus, 1 with vertigo, and 1 with tic. Moreover, 11 (18.3%) of the 60 cases were suspected of being in conflict with school and/or home. The Type V Békésy pattern, which is frequently observed in FHL and it has clinical utility to distinguish FHL from other types of organic hearing loss, was detected in 44 ears (38.6%). Fifty two (45.6%) of 114 ears showed normal pure-tone thresholds during the clinical course. Sixteen (14.0%) ears needed more than 1 year for thresholds to normalize. These findings suggest that some FHL cases without awareness of their hearing loss resemble psychogenic hearing loss. In such cases, otolaryngologists should carefully check the patient's individual circumstances, and when appropriate, refer patients for psychiatric consultation.

Adolescent↗

Event-related potential correlates of functional hearing loss: reduced P3 amplitude with preserved N1 and N2 components in a unilateral case.

A female patient exhibiting functional hearing loss in her left ear demonstrated reduced amplitude of P3 component in event-related potentials (ERP) to left monaural stimulation, with preserved N1 and N2 components to stimulation of either ear. This result suggested that stimuli in the affected ear were conducted successfully up to the auditory cortex but that further processing in higher brain regions was 'repressed'. Event-related potential examination for such hysterical disorders could be useful in clarifying their brain mechanism and offer a useful diagnostic clue to its nature.

Adult↗