Childhood psychogenic hearing loss: Identification and diagnosis

Importance of early objective auditory testing in the presentation of sudden sensorineural hearing loss in children

BACKGROUND

Functional hearing loss can be due to an auditory manifestation of functional neurological disorder, previously known as conversion disorder.

METHODS

This is a case series of 3 pediatric patients with a diagnosis of idiopathic SSNHL who ultimately were found to have functional neurological disorder.

RESULTS

Average age was 12.7 years at presentation (range 10-14 years). All three patients underwent invasive interventions prior to their initial clinic visit. All patients demonstrated profound SNHL on behavioural audiogram, but normal otoacoustic emissions (OAE) and auditory brainstem response testing. With counselling, both patients demonstrated significant hearing improvement.

CONCLUSIONS

Early use of OAE's in the workup of SSNHL can avoid unnecessary and potentially harmful therapies and expedite access to counselling services which may help lead to symptom resolution.

Functional Hearing Disorder in Children

Functional hearing disorder (FHD) is one of the conditions that fall under the umbrella of Functional Neurological Disorders. FHD is characterized by a decrease in hearing sensitivity without correlation in standard audiological testing. In the general pediatric population, the prevalence of FHD is estimated at less than 2%. The prevalence is about 7% in children 6-17 years of age. Some authors, however, consider FHD the most common etiology of sudden onset bilateral hearing loss in children. The mean age at diagnosis of FHD is 11.3 years - the condition is rare below 7 years of age. FHD affects twice as many girls as boys. The loss tends to be of sudden onset, bilateral, impacts all frequencies to a similar degree, and can be associated with an identifiable psychosocial conflict. FHD can be diagnosed using two sets of tests: (1) behavioral tests: pure-tone and speech audiometry; and (2) physiological tests: immittance audiometry, otoacoustic emissions, auditory evoked potentials, and functional neuroimaging. The backbone of the treatment of FHD includes cognitive-behavioral therapy and as needed, psychiatric medications. In this paper, we review the diagnosis, treatment, differential diagnosis, and complications of FHD.

Clinical features and prognostic factors of pediatric idiopathic sudden hearing loss from moderate to profound degree

BACKGROUND

The pediatric idiopathic sudden sensorineural hearing loss (PISSNHL) is not rare in the clinics, however, the prognostic factors of PISSNHL are still unclear.

OBJECTIVES

To investigate the clinical and audiologic characteristics associated with prognosis in PISSNHL.

MATERIAL AND METHODS

Clinical and audiological characteristics and possible prognostic factors were retrospectively evaluated in 76 PISSNHL patients aged less than 19 years.

RESULTS

Hearing loss was moderate in nine patients, severe in 21 patients, profound in 46 patients. Among five types of audiogram, 3.9% were classified as ascending, 11.8% as descending, 25.0% as flat, 55.3% as profound, and 3.9% as concave. The recovery rate according to Siegel's criteria was 55.3%. There was no significant difference between the recovery group and the poor recovery group in terms of age, sex, laterality of hearing loss, the onset of treatment, and accompanying symptoms (p > 0.05). The initial hearing levels and the audiogram type were significantly different in the two groups (p < 0.001) according to univariate analysis, while only the initial hearing level was significantly different (p = 0.046) according to multivariate analysis.

CONCLUSIONS AND SIGNIFICANCE

Prognosis of PISSNHL was mainly related to initial hearing at onset. An initial hearing level greater than 80 dB was a poor prognostic factor.

Prognostic factors in non-organic hearing loss in children

OBJECTIVE

Exploring factors that predict a favourable clinical outcome in non-organic hearing loss (NOHL) in children. NOHL is defined as a subjective hearing loss without correlation in objective measures.

DESIGN

Retrospective analysis of all childrens' data with the diagnosis NOHL seen between 2005 and 2017 at a tertiary referral centre.

STUDY SAMPLE

Sixty-seven children (44 female, 23 male; mean age 11.26 years) were included. Statistical analyses included descriptive statistics, logistic regression, correlations, and Mann-Whitney U tests.

RESULTS

A quarter of the children (17/67) had been provided previously with hearing aids without objective sensorineural hearing loss. Having been provided with hearing aids before the first visit to our clinic lowered the chance of normal hearing at the final visit by 76%. The prescription of hearing aids was significantly more likely in girls. Children provided with hearing aids were significantly older than those without and the time span between the first occurrence of the NOHL and first presentation at our department was longer than in children not provided with hearing aids.

CONCLUSIONS

In cases of NOHL, hearing aid prescription is not indicated and significantly lowers a child's chance of full recovery and, thus, should not be prescribed unless NOHL is ruled out.