Functional hearing loss and developmental imbalances.

OBJECTIVE: Functional hearing loss (FHL) is a disorder in which there are abnormal values on a hearing test, despite the absence of organic abnormalities in the peripheral and central auditory pathways. Here, we examined the developmental characteristics of FHL and the importance of intervention by analyzing the clinical characteristics of children with this disorder. METHODS: We retrospectively examined 16 patients assessed under a diagnosis of FHL. After interventions such as psychological counseling by our pediatrics and psychiatry departments, we compared the clinical profiles of patients in which hearing was "improved/normalized" and "unimproved". RESULTS: Fourteen patients visited a pediatrician and two chose not to do so. A discrepancy between the maximum and minimum values of the four index scores was observed in all patients in which WISC-IV (the fourth version of the Wechsler Intelligence Scale for Children) was performed (n = 12). The discrepancy between the verbal comprehension index (VCI) and perceptual reasoning index (PRI) was significantly greater in "unimproved" patients than in "improved/normalized" patients. Hearing improved, or was normalized, after intervention in six of 16 patients. CONCLUSIONS: Developmental imbalances were suspected in all 12 children who visited a pediatrician and completed the WISC-IV. Cooperation with pediatricians, psychiatrists, and other health professionals is desirable in supporting patients diagnosed with FHL.

Functional Hearing Impairment, Psychological Resilience, and Social Well-Being Among Chinese Older Adults in Low-Income Households.

PURPOSE: Hearing loss (HL) is prevalent and relates to social health in old age. This study aims to examine the association between functional HL and social well-being (SWB) in older adults and to investigate whether psychological resilience mediates this association. METHOD: The analytical sample of 4,531 older adults aged ≥ 60 years was from the Sample Survey on Vulnerable Populations from Poor Families in Urban/Rural China (2018). SWB was measured by social networks and social engagement using the Lubben Social Network Scale and Index of Social Engagement Scale, respectively. Functional hearing impairment was defined by a dichotomized measure of self-perceived hearing difficulty. Psychological resilience was assessed by a 25-item Connor-Davidson Resilience Scale. Structural equation modeling was performed to determine associations of HL with SWB and the mediating roles of psychological resilience. RESULTS: Functional HL was associated with reduced SWB among older adults living in low-income households. Hearing-impaired individuals were more likely to be socially isolated and less socially engaged compared to those with normal hearing. The association persisted in gender subsamples and in non-low-income households but not in older adults aged ≥ 70 years. Psychological resilience partially mediated the association of hearing impairment with SWB, accounting for 50.9% of the variance in the change of SWB. CONCLUSIONS: Functional hearing impairment may be a modifiable risk factor for social restrictions and downstream older adults' health. Promotion of hearing health care and accessibility to coping resources including psychological support may improve social wellness among the older adults and benefit healthy aging. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22750736.

Late complications of cochlear implant: a case report of necrotizing meningoencephalitis similar to a CPA tumor.

OBJECTIVE: Report a case of localized necrotizing meningoencephalitis as the cause of functional hearing loss after cochlear implant (CI) surgery. CASE REPORT: A 12-year-old with bilateral CI presented to our quaternary center due to severe functional hearing loss after 11 years since left ear CI surgery. CT with contrast was conducted showing a CPA tumor-like mass. Pre-operative computed tomography (CT) scans and magnetic resonance imaging (MRI) performed at the age of 1 year showed no inner ear abnormalities and in particular no evidence of a tumor in the cerebellopontine angle (CPA). CONCLUSION: Following removal of the CI and the mass, histopathological, immunohistochemical and cultural examinations revealed a necrotizing meningoencephalitis, with the CI electrode as the focus.

[Recognition and complex diagnostics of functional hearing loss]. / A funkcionális halláscsökkenés felismerése és komplex diagnosztikája.

INTRODUCTION: Hearing loss is a sensory impairment that impairs speech understanding, communication and therefore the quality of life. Sometimes the patient's perceived loss of function is exaggerated; subjective and objective test results are inconsistent, the subjectively reported hearing loss is more significant, and in these cases functional hearing loss is considered. OBJECTIVE: Our aim was to collect and retrospectively analyze cases with the diagnosis of functional hearing loss, in order to draw conclusions about the characteristics of functional hearing loss, the signs and conditions that may be of attention and the consideration of appropriate rehabilitation. METHODS: Subjective tests were performed with pure-tone auditory threshold, speech understanding and communication tests, which were compared with the results obtained with objective impedance measurements, stapedial reflex tests, otoacoustic emission measurements, and brainstem evoked response recordings. Imaging studies, psychologist, psychiatrist, neurologist, neurologist and other co-specialists were involved as needed. We excluded cases of deception deliberately intended to obtain financial or other benefits. RESULTS: Between 2007 and 2022, 19 patients were diagnosed with functional hearing loss. The majority (17 cases) were female, the complaints were prevalent at a young age (10-41 years); the average age in the study population was 19.6 years, and the majority of patients (13 cases) were children aged 10-17 years. No organic cause was found in 11 cases, and in the remaining cases no detectable organic abnormality explained the extent of the hearing loss experienced by the patient. The degree of functional hearing loss varied (35-120 dB), with an average of 60,2 dB. CONCLUSION: Recognizing and diagnosing functional hearing loss is very difficult and requires a complex series of tests and professional cooperation. Without recognition, the patient may receive unjustified, even harmful and financially burdensome care, which may lead to the deterioration of his condition. Orv Hetil. 2023; 164(8): 283-292.

Hearing aid affordability in the United States.

PURPOSE: Substantial out-of-pocket costs for hearing aids constitute a barrier to hearing health care accessibility for older adults among whom prevalence of hearing loss is high. This study is the first to estimate the proportion of Americans with functional hearing loss for which out-of-pocket expenditures for hearing aids would be unaffordable at current average costs and determine how affordability varies by sociodemographic factors. MATERIALS AND METHODS: We utilized data from the 2016 American Community Survey to determine the proportion of adults with functional hearing loss for whom hearing aids would constitute ≥3% of annual income or have post-purchase income below a poverty standard. Chi-square tests were used to identify differences in affordability outcomes by sociodemographic characteristics. RESULTS: Results indicated that an average bundled cost of $2500 would constitute a catastrophic expense for 77% of Americans with functional hearing loss (N = 7,872,292) and would add an additional 4% of the population into poverty for the year (N = 423,548). Affordability outcomes varied significantly by age, race, sex, educational attainment and geographic location. CONCLUSIONS: Hearing aids were unaffordable for three-fourths of Americans with functional hearing loss, and their purchase would result in impoverishment for hundreds of thousands of individuals. Reductions in out-of-pocket hearing aid costs to $500 or $1000 would alleviate affordability issues for many Americans with hearing loss. Future federal and state policy should address poor rates of insurance coverage for hearing care, specifically among Medicare and Medicaid, to reduce out-of-pocket costs for hearing care particularly for older adults.Implications for rehabilitationAn average out-of-pocket hearing care cost of $2500 was unaffordable for over three quarters of Americans with functional hearing loss.Hearing care affordability varied significantly by demographic characteristics such as age, sex, gender, educational attainment and geographic region.Affordability constitutes a significant barrier to hearing care accessibility in the United States, where most costs of hearing aids and rehabilitation are statutorily excluded from insurance coverage, including the largest insurer of Americans, Medicare.

Loudness functions for patients with functional hearing loss.

OBJECTIVES: To compare the loudness functions (loudness ratings as a function of sound level) obtained from patients diagnosed as having functional hearing loss (FHL) with those for patients with sensorineural hearing loss (SNHL) and healthy volunteers. DESIGN: Loudness functions for a 1000 Hz tone for patients with FHL and SNHL were assessed based on the categorical loudness scaling method. The data were compared with control data obtained in our facilities. STUDY SAMPLE: 18 patients (33 ears) with FHL and 10 patients (19 ears) with SNHL. RESULTS: For patients with SNHL and healthy volunteers, loudness increased progressively with increasing sound level above the audiometric threshold, with no exceptions. However, for about 70% of the patients with FHL, a different type of loudness function was obtained; the thresholds determined from the loudness function, which were defined as the minimum sound levels at which loudness could be judged, were 10 dB or more lower than the audiometric threshold (>10 dB), and/or the loudness ratings were elevated for a sound at the audiometric threshold. CONCLUSIONS: The results support the hypothesis that patients with FHL often make threshold judgments based on a certain loudness.

Growth Hormone and the Auditory Pathway: Neuromodulation and Neuroregeneration.

Growth hormone (GH) plays an important role in auditory development during the embryonic stage. Exogenous agents such as sound, noise, drugs or trauma, can induce the release of this hormone to perform a protective function and stimulate other mediators that protect the auditory pathway. In addition, GH deficiency conditions hearing loss or central auditory processing disorders. There are promising animal studies that reflect a possible regenerative role when exogenous GH is used in hearing impairments, demonstrated in in vivo and in vitro studies, and also, even a few studies show beneficial effects in humans presented and substantiated in the main text, although they should not exaggerate the main conclusions.

Satisfaction With Quality of Health Care Among Medicare Beneficiaries With Functional Hearing Loss.

BACKGROUND/OBJECTIVES: Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing loss and dissatisfaction with quality of health care over the past year among Medicare beneficiaries. METHODS: Cross-sectional study of satisfaction with quality of health care among Medicare beneficiaries with self-reported trouble hearing from the 2015 Medicare Current Beneficiaries Survey. There were 11,441 Medicare beneficiaries representing a 48.6 million total weighted nationally representative sample. RESULTS: Forty-eight percent of Medicare beneficiaries reported a little or a lot of trouble hearing. Medicare beneficiaries with a little trouble hearing (odds ratio=1.496; 95% confidence interval, 1.079-2.073; P=0.016) and a lot of trouble hearing (odds ratio=1.769; 95% confidence interval, 1.175-2.664; P=0.007) had 49.6% and 76.9% higher odds of being dissatisfied with the quality of their health care over the previous year, respectively. CONCLUSIONS: Medicare beneficiaries with functional hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Given Medicare's reliance on patient satisfaction as a value-based measure for hospital reimbursement, interventions to address hearing loss in the health care system are needed.

Pérdida de audición no orgánica. A propósito de un caso / Non-organic hearing loss. Clinical case report

La sordera de origen no orgánico ha sido objeto de estudio por parte de otorrinolaringología con el fin de establecer un diagnóstico certero. Sin embargo, pocos artículos versan sobre la salud mental del sujeto que la sufre. Entre las causas subyacentes se diferencian el trastorno por conversión, trastorno facticio y la simulación. En el presente artículo se expone el caso de una mujer cuyo malestar emocional esbozará variopintos síntomas conversivos, destacando la pérdida de audición por su relativa infrecuencia. Se expondrán las dificultades encontradas en su diagnóstico clínico y manejo terapéutico. Se pondrá en evidencia la importancia de trabajar conjuntamente con el resto de especialistas y entorno más cercano de la paciente

Non-organic hearing loss has been the focus of study by otorrinolaringologists to get the correct differential diagnosis. Nevertheless, scarce literature is about mental health status from the subject who suffers it. The psychological causes beyond the deafness can be divided into conversion disorder, factitious or malingering. In this article we expound the case of a woman whose suffering will outline various conversive symptoms, as the rare hypoacusis. The difficulties found for the diagnosis and treatment will be discussed. It'll be evident that it is a must to work together with the other specialties and family environment

Author Response to Peck (2018), "Questionable Use of 'Nonorganic' in 'Estimating Nonorganic Hearing Thresholds'".

PURPOSE: The purpose of this letter is to respond to Dr. Peck's (2018) letter to the editor regarding the use of the term "nonorganic" to describe hearing loss, demonstrated by the pure tone audiogram that cannot be explained or is greater than what can be explained by a physiological auditory disorder. CONCLUSIONS: We prefer the term "nonorganic" rather than the term "false and exaggerated hearing loss." "Nonorganic," in our view, is a nonjudgmental term and, as stated by Austen and Lynch (2004), implies "as little as possible about its cause" (p. 450).

Questionable Use of "Nonorganic" in Norrix et al. (2017), "Estimating Nonorganic Hearing Thresholds".

PURPOSE: The author of this letter to the editor expresses concern about the use of the word "nonorganic" as a source of confusion in terminology. Specifically, this is in response to the December 2017 American Journal of Audiology article, "Estimating Nonorganic Hearing Thresholds Using Binaural Auditory Stimuli" (Norrix, Rubiano, & Mueller, 2017). "Nonorganic" is a source of confusion in terminology, because it can be used in two different ways. One way can mean to say there is no hearing loss. When used in this sense, it is illogical because it is qualifying a hearing loss believed not to exist. The second usage means there is a real disorder of function, but the organs themselves are not damaged and the basis is unknown. In the place of "nonorganic," I have proposed "false hearing loss." "Nonorganic" might carry a negative connotation that "false" might not. Many instances of false hearing loss stem from physical-mental health disturbances. Audiologists must stay alert to signs of psychosocial difficulty and refer for further evaluation accordingly. CONCLUSION: "False" hearing loss is a more appropriate term than "nonorganic" hearing loss.

Auditory processing and neuropsychological profiles of children with functional hearing loss.

OBJECTIVES: This paper compares structured history, auditory processing abilities and neuropsychological findings of children with functional hearing loss (FHL) to those with suspected auditory processing disorder without FHL (control). The main aim was to evaluate the value of a holistic assessment protocol for FHL used in a routine pediatric audiology clinic. The protocol incorporated a commercially available test battery for auditory processing disorder (APD), non-verbal intelligence (NVIQ) and tools to screen for common co-existing neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD), language impairment (LI) and developmental coordination disorder (DCD). The outcome of such holistic assessment was expected to help in understanding the nature of FHL and to provide individualized support to mitigate their difficulties. METHODS: This retrospective study compared two groups, 40 children (M = 17, F = 23) in each group between seven and sixteen years of age, one group with a history of FHL and the other with suspected APD without FHL (control). The groups were matched against age, gender, hand use, diagnosis of APD or non-APD (31 with APD and 9 without APD in each group) and non-verbal intelligence. All the children were healthy English speaking children attending mainstream schools with no middle or inner ear abnormalities. Structured history was obtained from parents regarding different nonacademic and academic concerns. The SCAN-3:C and SCAN-3:A test batteries were used to assess auditory processing abilities; Lucid Ability test for NVIQ; Children's Communication Checklist-2 (CCC-2) for language ability; Swanson Nolan and Pelham-IV Rating Scale (SNAP-IV) for ADHD; and the manual dexterity components of the Movement Assessment Battery for Children-2 (MABC-2) as a screening tool for DCD. RESULTS: About 60% of children in both the groups had concerns regarding listening in noisy background. In the history, poor attention was reported in 45% of children in the FHL group compared to 82.5% in the control group (p < 0.01). Hyperacusis was present in 35% of children in the FHL group and in 62% of children in the control group (p < 0.05). Concerns about overall academic abilities were present in 59% of children in the FHL group and 75% of the controls (p > 0.05). Only 15% of children in the FHL group had concerns with numeracy skills in contrast to 41% of the controls (p < 0.05). Significantly fewer (p < 0.01) children in the FHL group (41%) received additional support at school than the controls (75%). Fewer children performed poorly in Filtered Words (FW) test of the SCAN-3 batteries, 30% in the FHL group and 17.5% in the control group, in contrast to Auditory Figure Ground 0 (AFG0), 85% in FHL and 80% in the control group. The number of children performing poorly in AFG0 was significantly higher compared to all the other SCAN-3 tests in FHL (P < 0.05), in contrast to FW and Competing Sentences (CS) only in the control group (p < 0.05). The control group had higher prevalence of atypical ear advantage (AEA) in left directed Competing Words (CW) (32.5%) and Time Compressed Sentences (TCS) (32.5%) compared to FW (7.5%). In contrast, FHL group had higher prevalence of AEA in AFG0 (48.7%) compared to CS (21%). High proportions of children in both the groups had LI (80% in FHL and 82.5% in the control group), with significantly lower (p < 0.05) levels of ADHD symptoms in the FHL group (39.5%) compared to the control group (72.5%). Impaired manual dexterity was present in 30.7% of children in FHL group and 47.5% in the controls. CONCLUSIONS: The prevalences of APD and language impairment are high compared to ADHD symptoms in children with FHL, and holistic assessment is recommended. Despite some similarities in the auditory and neuropsychological profiles between children with FHL and those with suspected APD without FHL some differences were noted. The results suggest that children with FHL have genuine difficulties that need to be identified and addressed. Future research is required to identify the neural pathways which could explain the similarities and dissimilarities between the two groups.

[Pseudohypoacusis associated with Munchausen's syndrome]. / Psevdogipoakuziia pri sindrome Miunkhgauzena.

The authors describe a rare clinical case of psychogenic hearing loss in a female patient presenting Munchausen's syndrome with special reference to the objective and subjective methods designed to evaluate the hearing ability and used for diagnostics of this condition.

Estimating Nonorganic Hearing Thresholds Using Binaural Auditory Stimuli.

PURPOSE: Minimum contralateral interference levels (MCILs) are used to estimate true hearing thresholds in individuals with unilateral nonorganic hearing loss. In this study, we determined MCILs and examined the correspondence of MCILs to true hearing thresholds to quantify the accuracy of this procedure. METHOD: Sixteen adults with normal hearing participated. Subjects were asked to feign a unilateral hearing loss at 1.0, 2.0, and 4.0 kHz. MCILs were determined. Subjects also made lateralization judgments for simultaneously presented tones with varying interaural intensity differences. RESULTS: The 90% confidence intervals, calculated for the distributions, indicate that the MCIL in 90% of cases would be expected to be very close to threshold to approximately 17-19 dB poorer than the true hearing threshold. How close the MCIL is to true threshold appears to be based on the individual's response criterion. CONCLUSIONS: Response bias influences the MCIL and how close an MCIL is to true hearing threshold. The clinician can never know a client's response bias and therefore should use a 90% confidence interval to predict the range for the expected true threshold. On the basis of this approach, a clinician may assume that true threshold is at or as much as 19 dB better than MCIL.

Childhood psychogenic hearing loss: Identification and diagnosis.

Psychogenic hearing loss, formerly known as functional or non-organic hearing loss, is a classic cause of consultation in infantile audiology. Risk factors include female gender, and age 8 or 12 years. Onset is relatively sudden, without impact on schooling or voice quality. Audiometric signs comprise non-superimposable audiometric thresholds (variable audiometric results), bilaterality, flat mean audiometric curve, and discrepancy between pure-tone and speech audiometry. The child needs reassuring during audiometric examination: attention-diversion techniques may be effective. Objective audiometry allows positive diagnosis, followed by rehabilitation and psychological care.

Management of non-organic hearing loss in children - A case study.

A 10 year-old girl was admitted due to the claim of progressively developing hearing loss. The impedance audiometry showed no abnormalities but it was impossible to obtain reliable outcomes during pure tone audiometry assessment. The girl was additionally sent for speech audiometry, indicating a bilateral hearing loss and objective evaluations such as distortion product otoacoustic emissions and auditory brainstem responses, which results indicated a normal hearing. On the second day, repeated subjective audiometric tests showed also normal hearing, despite constantly reported hearing loss. After the psychological consultation and exclusion of neurologic pathology, the diagnosis of non-organic hearing loss was stated and the girl was scheduled for regular appointments with psychologist.

Pure-Tone-Spondee Threshold Relationships in Functional Hearing Loss: A Test of Loudness Contribution.

Purpose: The purpose of this article is to examine explanations for pure-tone average-spondee threshold differences in functional hearing loss. Method: Loudness magnitude estimation functions were obtained from 24 participants for pure tones (0.5 and 1.0 kHz), vowels, spondees, and speech-shaped noise as a function of level (20-90 dB SPL). Participants listened monaurally through earphones. Loudness predictions were obtained for the same stimuli by using a computational, dynamic loudness model. Results: When evaluated at the same SPL, speech-shaped noise was judged louder than vowels/spondees, which were judged louder than tones. Equal-loudness levels were inferred from fitted loudness functions for the group. For the clinical application, the 2.1-dB difference between spondees and tones at equal loudness became a 12.1-dB difference when the stimuli were converted from SPL to HL. Conclusions: Nearly all of the pure-tone average-spondee threshold differences in functional hearing loss are attributable to references for calibration for 0 dB HL for tones and speech, which are based on detection and recognition, respectively. The recognition threshold for spondees is roughly 9 dB higher than the speech detection threshold; persons feigning a loss, who base loss magnitude on loudness, do not consider this difference. Furthermore, the dynamic loudness model was more accurate than the static model.

Hearing loss and disability exit: Measurement issues and coping strategies.

Hearing loss is one of the most common conditions related to aging, and previous descriptive evidence links it to early exit from the labor market. These studies are usually based on self-reported hearing difficulties, which are potentially endogenous to labor supply. We use unique representative data collected in the spring of 2005 through in-home interviews. The data contains self-reported functional and clinically-measured hearing ability for a representative sample of the Danish population aged 50-64. We estimate the causal effect of hearing loss on early retirement via disability benefits, taking into account the endogeneity of functional hearing. Our identification strategy involves the simultaneous estimation of labor supply, functional hearing, and coping strategies (i.e. accessing assistive devices at work or informing one's employer about the problem). We use hearing aids as an instrument for functional hearing. Our main empirical findings are that endogeneity bias is more severe for men than women and that functional hearing problems significantly increase the likelihood of receiving disability benefits for both men and women. However, relative to the baseline the effect is larger for men (47% vs. 20%, respectively). Availability of assistive devices in the workplace decreases the likelihood of receiving disability benefits, whereas informing an employer about hearing problems increases this likelihood.

Inside implant criteria or not? - Detection of non-organic hearing loss during cochlear implant assessment.

OBJECTIVES: The diagnosis of non-organic hearing loss (NOHL) is a difficult but important issue during the assessment process for cochlear implantation (CI). We aim to identify the key factors in identifying patients with NOHL during CI assessment and present our local screening protocol for NOHL. METHODS: A retrospective review of patients referred to the Yorkshire Auditory Implant Service (YAIS) between 2003 and 2015 who were subsequently diagnosed with NOHL during the assessment. Patient demographic data, audiological and functional assessments were assessed. RESULTS: Thirty-two patients were included in the study. Mean age was 43 years (range 14-82 years). Male to female ratio was 1:1.7. Indicators of possible NOHL included a sudden deterioration in hearing (n = 21; 66%), mismatches in observed behaviour and either pure-tone audiogram (PTA) (n = 27; 84%) or functional testing (n = 20; 80%) and stapedial reflexes below reported audiological thresholds (n = 12; 46%). A mismatch in functional hearing and PTA was seen in 72% of patients. Patients with suspected NOHL were referred for further objective testing. All 23 patients who underwent objective testing had better hearing levels compared to reported hearing thresholds thus placing them outside of implant criteria. Five candidates were found to have normal hearing thresholds. DISCUSSION: NOHL can present a significant challenge to the implant team, particularly in the subgroup with a pre-existing organic hearing loss with non-organic overlay. We discuss the common features in this cohort of patients. CONCLUSIONS: To facilitate the identification of patients with NOHL, the YAIS has developed a screening protocol.

Assessment of the latest NGS enrichment capture methods in clinical context.

Enrichment capture methods for NGS are widely used, however, they evolve rapidly and it is necessary to periodically measure their strengths and weaknesses before transfer to diagnostic services. We assessed two recently released custom DNA solution-capture enrichment methods for NGS, namely Illumina NRCCE and Agilent SureSelect(QXT), against a reference method NimbleGen SeqCap EZ Choice on a similar gene panel, sharing 678 kb and 110 genes. Two Illumina MiSeq runs of 12 samples each have been performed, for each of the three methods, using the same 24 patients (affected with sensorineural disorders). Technical outcomes have been computed and compared, including depth and evenness of coverage, enrichment in targeted regions, performance in GC-rich regions and ability to generate consistent variant datasets. While we show that the three methods resulted in suitable datasets for standard DNA variant discovery, we describe significant differences between the results for the above parameters. NimbleGen offered the best depth of coverage and evenness, while NRCCE showed the highest on target levels but high duplicate rates. SureSelect(QXT) showed an overall quality close to that of NimbleGen. The new methods exhibit reduced preparation time but behave differently. These findings will guide laboratories in their choice of library enrichment approach.