Functional Hearing Disorder in Children
Debra H Weisleder1, Pedro Weisleder2
1Delaware Speech and Hearing Center, Delaware, OH.
Insights
Functional hearing disorder (FHD) is a common cause of sudden hearing loss in children, affecting more girls than boys. Diagnosis involves audiological and neurological tests, with treatment focusing on cognitive-behavioral therapy.
Area of Science:
- Neurology
- Audiology
- Pediatrics
Background:
- Functional hearing disorder (FHD) is a type of Functional Neurological Disorder impacting hearing sensitivity.
- It is estimated to affect less than 2% of the general pediatric population, but up to 7% in children aged 6-17.
- FHD is considered a leading cause of sudden bilateral hearing loss in children, typically diagnosed around 11.3 years old and more prevalent in girls.
Purpose of the Study:
- To review the diagnosis of Functional Hearing Disorder.
- To discuss the treatment and management of Functional Hearing Disorder.
- To explore differential diagnoses and potential complications associated with Functional Hearing Disorder.
Main Methods:
- Diagnosis utilizes behavioral audiometry (pure-tone, speech) and physiological tests (imittance audiometry, otoacoustic emissions, auditory evoked potentials, functional neuroimaging).
- Review of existing literature on Functional Hearing Disorder diagnosis, treatment, and complications.
Main Results:
- Functional hearing disorder presents as a sudden, bilateral hearing loss across all frequencies, often linked to psychosocial conflict.
- Diagnostic criteria involve a discrepancy between subjective hearing loss and objective audiological findings.
- Treatment primarily involves cognitive-behavioral therapy, with psychiatric medications used as needed.
Conclusions:
- Functional hearing disorder is a distinct condition within Functional Neurological Disorders requiring specific diagnostic and therapeutic approaches.
- Early identification and intervention, particularly cognitive-behavioral therapy, are crucial for managing FHD in children.
- Further research into the underlying mechanisms and long-term outcomes of FHD is warranted.
Abstract:
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.
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