Pseudohypacusis in children: circumstances and diagnostic strategy
M Drouillard1, N Petroff1, J Majer1
1APHP Groupe hospitalier Robert Debré, Pediatric Otorhinolaryngology Department, 75019 Paris, France; Université Paris 7, Denis Diderot, 5 rue Thomas Mann, 75013 Paris, France.
Insights
Diagnosing pseudohypacusis in children requires careful evaluation of hearing thresholds. Complementary tests are crucial before considering invasive treatments for simulated hearing loss.
Area of Science:
- Pediatric Audiology
- Child Psychology
- Otolaryngology
Background:
- Pseudohypacusis, or simulated hearing loss, in children presents diagnostic challenges.
- Understanding the circumstances and contributing factors is essential for accurate diagnosis and management.
Purpose of the Study:
- To define the conditions warranting attention for childhood pseudohypacusis.
- To evaluate diagnostic methods for hearing thresholds in unilateral or bilateral cases.
- To discuss the prognosis for children with pseudohypacusis.
Main Methods:
- Retrospective and prospective study of 54 children (ages 3-16) diagnosed with pseudohypacusis.
- Standard pure tone and speech audiometry, supplemented by transient evoked otoacoustic emissions (TEOEs) and auditory brainstem responses (ABR).
- Family contact for results and follow-up proposals.
Main Results:
- Pseudohypacusis was more common in girls (35) than boys (19), with an average age of 10.
- Commonly associated with family history (15 cases) or significant life events (27 cases).
- Diagnosis often relied on discrepancies in audiological tests, confirmed by ABR or TEOEs.
Conclusions:
- Thorough audiological examinations are vital to exclude pseudohypacusis.
- Avoid invasive or costly treatments like surgery or hearing aids before a definitive diagnosis.
- Propose audiological and psychological follow-up for affected children.
Objectives:
The study attempts to specify the circumstances under which we should pay attention to children's pseudohypacusis. It evaluates the methods used to detect such cases and to determine hearing thresholds, according to the uni-or bilateralism of hearing loss. The study finally deals with the future of children diagnosed with pseudohypacusis.
Methods:
The study was retrospective from January 1993 to November 2011 and prospective from December 2011 to April 2012. We included all the children between 3 and 16 years who were diagnosed with pseudohypacusis. We observed the reasons for them to consult, whether they had already been tested or had treatment, and what kind of hearing loss they displayed. All children were tested using standard pure tone audiometry and speech audiometry. Depending on the first results, other tests were conducted. They included transient evoked otoacoustic emissions (TEOEs), auditory brainstem responses (ABR) and auditory steady state responses. Families were finally contacted by phone over April 2012 in order to let them know about their child's results.
Results:
Fifty-four children were included: 19 boys and 35 girls, with an average age of 10 year-old (±3). The simulated hearing loss (HL) was bilateral (36), unilateral (18), of perception (37), moderate HL (33), cophosis (5). Fifteen cases were linked to a family or personal history of hearing loss, while 27 cases were due to important events like adoption, abuse, verbal aggression, school problems. Before diagnosing a pseudohypacusis, 13 children had had imaging studies, 3 had been treated with corticosteroids, and 5 had hearing aids. Most of the time the presence of pseudohypacusis was suspected a discrepancy between speech reception and air-conduction pure tone thresholds, as shown by the medical test (answer on whispered voice). The diagnosis was confirmed by ABR or TEOEs, except in cases where clinic was obvious. Then family's patient and patient were reassured and informed. An audiological follow-up during either 6 months or 1 year was proposed, as well as a psychological consultation.
Conclusion:
Complementary examinations have to be performed to rule out a pseudohypacusis case before suggesting an invasive or expensive treatment (surgery or hearing aids) of children.
