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PubMed1990

A descending LOT-Bekesy screening test for functional hearing loss.

This study investigated the screening efficiency of a descending version of Hattler's Lengthened Off-time (LOT) Bekesy test. The Descending LOT (DELOT) test was administered to 24 subjects who presented unequivocal audiometric evidence of functional hearing loss during clinical examinations and 30 subjects with no audiometric evidence of functional loss. The DELOT format substantially increased screening sensitivity: 29.2% more functional group subjects and 42.2% more functional group ears were identified correctly relative to LOT test identifications. There was one marginally positive DELOT outcome involving one ear in the nonfunctional group. The high sensitivity of the DELOT test was clearly a function of significantly larger intertrace gaps caused by the DELOT trace. The mean intertrace gap for the DELOT test was more than 10 dB greater than the gap for the LOT test.

Adult↗
PubMed1975

[SISI-Test and functional hearing loss (author's transl)].

The original SISI test (Jerger, Shedd and Harford) is described in German language. Modifications of various authors are cited. The results of SISI test with 16 persons demanding monetary compensation for hearing loss are tabulated. 18 ears seemed free from non-organic overlay. 12 of those ears gave SISI scores more than 70%. Functional discrepancies wer observed in 13 ears. Only in one of them a maximum SISI score of 25% was presented. All other non-organic ears gave lower ratings, 0% in most cases. Increments of 5 dB were not responded with 5 ears. In one case of unilateral non-organic loss SISI scores were high in the normal and low in the aggravating ear. It is suggested therefore, that low SISI ratings should arise suspicion of non-organic problems, besides of retrocochlear site.

Adult↗
PubMed1976

[Aggravation of hearing loss (author's transl)].

Functional hearing loss is defined as a syndrome in which audiologic responses are found lacking. Such phenomena are related to capacities of the auditory system which are not fully understood (and include constant functional threshold levels as well as decreasing functional overlay with steeper discrimination scores). Examples are given for symptoms which characterize functional hearing losses, and variable timing for degrees of functional hearing loss described. In addition, etiologic factors are tabulated from a literature survey.

Audiometry↗
PubMed1991

[Tube function in sudden hearing loss].

The function of the Eustachian tube was assessed in 50 patients suffering from sudden hearing loss, using the pressure chamber impedance method. We investigated the existence of a relationship between sudden hearing loss and the occurrence of a patulous tube. We could not observe more patulous tubes in patients with sudden hearing loss compared to a control group with healthy ears. We registered the parameters "tissue resistance pressure" and "tubal opening pressure", both characterising the passive qualities of the Eustachian tube. There was no indication of a facilitated passive tubal opening nor a tendency to a patulous tube among our patients. Statistical evaluation of these parameters showed no significantly different tubal function on comparing the right and the left ear, as well as the ear affected by sudden hearing loss and the healthy ear. We conclude that there is no relationship between sudden hearing loss and patulous tube.

Adolescent↗
PubMed2006

Nonorganic hearing loss.

Nonorganic hearing loss is a decrease in hearing that is unexplained by anatomic or physiologic abnormalities, or both. The term is synonymous with functional hearing loss and pseudohypacusis. The demographics and potential etiologies of nonorganic hearing loss are described. History and physical findings that indicate a functional hearing loss are also discussed. A review of the anatomy and physiology of the auditory system is provided as a background for the discussed objective tests of hearing thresholds. Finally, conditions that may mimic functional hearing loss are described in detail.

Hearing Loss, Functional↗
PubMed1990

Time-intensity relations in Békésy audiometry.

Threshold and amplitude measurements were made for fixed frequency Bekesy pure tones on subjects with normal hearing, sensorineural hearing impairment, and functional hearing loss. Following conventional Bekesy audiometry (intensity change 4 dB/sec), -20 dB was added to a signal at the threshold of audibility (bottom of the spike). When sensation was lost at the threshold of inaudibility (top of the spike), +20 dB was added. Adding +/- 20 dB in subjects with normal hearing reduced the amplitude of the spike about 4 dB, corresponding to 1 second, for both pulsed and continuous tones. Adding +/- 40 dB produced essentially similar findings. Adding +/- 20 dB in subjects with sensorineural loss with reduced amplitude of continuous tone tracings also reduced the amplitude approximately 4 dB for pulsed tones, but 3 dB, corresponding to 0.75 seconds, for continuous tones. Abnormal rapid adaptation may account for this reduced amplitude of the spikes. A subject with multiple sclerosis producing excessive abnormal adaptation showed spectacular increased amplitude for continuous tone only when -20 dB was added at bottoms and +20 dB at tops of spikes. An explanation based on slow adaptation is offered. Subjects with functional hearing loss may emphasize either time or intensity in their inappropriate responses when +/- 20 dB is added at tops and/or bottoms of spikes.

Audiometry, Pure-Tone↗
PubMed1995

Two new otolaryngologic findings in child abuse.

We reviewed cases of early childhood hoarseness caused by vocal nodules and functional hearing loss as being possible manifestations of child abuse. This is a retrospective review set in two urban referral centers. The patients consisted of four children with vocal nodules and known histories of abuse, and four children with functional hearing loss and histories suggestive of abuse. Vocal nodules or functional hearing loss may be indicators of an abusive situation. Child abuse should be considered in the differential diagnosis of these problems.

Adolescent↗
PubMed1984

[Nonorganic (functional) hearing disorders in childhood].

Within a period of two years, we were able to observe five cases in which non-organic (functional) hearing defects occurred during infancy. The careful assessment of the case history and close observation, but also a differential-diagnostic audiological procedure in case of unstable hearing defects of unknown origin may disclose non-organic auditory communication disturbances. Based on our experience, the easily appreciated clinical picture is described. A pointer is supplied by the unstable auditory threshold in the tone audiogram. Integration of impedance audiometry and of acoustically evoked potentials (brain stem audiometry) into the individual audiometric experimental pattern is indispensable. In differential diagnosis it is essential to take into account fluctuating diseases of the internal ear, as well as high-grade auditory inattention as an expression of a partial conduction impairment.

Audiometry, Pure-Tone↗
PubMed1996

Childhood pseudohypacusis.

Pseudohypacusis is a condition in which a hearing loss is exhibited in the absence of any organic disease. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to produce consistently erroneous results on repeated testing. In spite of this, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. We present the findings in ten children seen in the past year. Initially they had average pure tone thresholds of 51.3 db in the right ear and 51.4 db in the left ear. All of the children underwent repeat pure tone audiometry and speech audiometry. In nine cases the speech audiograms confirmed the diagnosis. In one child the speech audiogram was consistent with a mild hearing loss subsequently confirmed as a 30-40 db low frequency sensorineural hearing loss. Following a programme of close follow up and support, the pure tone thresholds returned to within normal limits in nine children and to a level consistent with the clinical impression in the child with a sensorineural loss. None of the children required brain stem evoked response audiograms to confirm the diagnosis.

Age Factors↗
PubMed2005

Conversion disorder in a child presenting as sudden sensorineural hearing loss.

Pseudohypoacacusis is a form of conversion disorder in which a hearing loss is found in the absence of organic disease. A case of an 11-year-old boy with auditory conversion disorder after mild head trauma is reported. The child presented with unilateral hearing loss, with no accompanying vestibular symptoms and no history of otologic disease. Auditory testing revealed severe right-sided sensorineural hearing loss, however, CT scan was normal. There was a family history of conversion disorder and the child was undergoing an emotionally stressful period. It was decided to treat the child conservatively with close monitoring and a repeat audiogram 2 weeks later. One week after presentation, the child's hearing suddenly returned to normal after a second very minor head injury. It is important to consider pseudohypoacusis or conversion disorder even in cases such as trauma, when the clinical history supports a diagnosis of hearing loss.

Audiometry, Pure-Tone↗
PubMed2005

Diagnostic tools in pseudohypacusis in children.

Pseudohypacusis is the term used for a non-organic or functional hearing loss. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to reproduce consistently erroneous results on repeated testing. Nevertheless, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. In a previous study from our department, we highlighted the usefulness of speech audiometry in establishing the diagnosis. However, with the advent of otoacoustic emissions testing, we have changed the emphasis of our testing protocol. Using otoacoustic emissions, the diagnosis of pseudohypacusis can be established quickly and easily.

Adolescent↗
PubMed2006

A clinical analysis of psychogenic sudden deafness.

OBJECTIVE: Sudden deafness, in most cases, has no apparent cause. In some cases viral infection, vascular occlusion, or a cochlear membrane rupture may be responsible for the sudden loss of hearing. In this study, we analyzed etiology, audiologic, psychiatric, and clinical aspects of psychogenic sudden deafness through a retrospective chart review. Patients included were thought to have sudden deafness as a result of psychogenic causes and/or stresses. STUDY DESIGN AND SETTING: We reviewed the records of 277 patients who had been admitted to the Department of Otolaryngology, Kangbuk Samsung Hospital, from January 1997 to July 2003, with the initial diagnosis of idiopathic sudden hearing loss. RESULTS: In the medical history of 9 patients, there was an association between sudden onset of hearing loss and psychogenic events. There were 4 patients who had a preexisting mental health condition. A psychiatrist provided the classification of psychogenic sudden deafness for 7 patients (2.5%) who had organic causes ruled out. These patients showed discrepancy between pure tone audiometry and ABR. There were 2 males and 5 females; 4 patients were in their 10's, 1 in his 20's, and 2 in their 40's. Three patients had bilateral hearing loss and 4 had unilateral loss. The hearing test scores revealed: 4 patients with severe to profound hearing loss at 71 dB or higher, 2 patients with moderately severe hearing loss ranging from 56 to 70 dB, and 1 patient with moderate hearing loss from 41 to 56 dB. Hearing was restored in all patients, partially or completely, by treatment with steroid injections and psychotherapy. CONCLUSIONS: A total of 2.5% of sudden onset hearing loss cases in our study were a result of psychogenic causes. We observed distinctive features for audiologic measures, psychiatric findings, and clinical characteristics. The recovery rate and prognosis were better in patients who had accurate audiometry and were under the care of a psychiatrist. EBM RATING: C-4.

Adolescent↗