[A case of hysterical deafness]

Area of Science:

• Neuroscience
• Psychiatry
• Otolaryngology

Background:

• A 40-year-old woman presented with bilateral hearing loss after surgery for an anterior communicating artery aneurysm.
• Post-operative complications included left hemiparesis and right middle cerebral artery spasm, necessitating a ventricular-peritoneal shunt.
• Following recovery from coma, the patient reported profound bilateral hearing loss.

Observation:

• Pure tone audiometry indicated complete hearing loss, yet auditory brain stem responses and slow vertex responses were within normal limits.
• The patient could only understand speech from specific individuals, suggesting a non-organic basis for the hearing impairment.
• Psychological assessments (Rorschach, sentence completion) indicated a hysterical or neurotic state; CT scans revealed minor cerebral lesions.

Findings:

• Audiological and neurological assessments suggested hysterical deafness rather than auditory agnosia.
• Despite extensive rehabilitation over three years, the patient's hearing did not improve.
• A sudden improvement in hearing occurred when the patient's husband was admitted to the same hospital, coinciding with his illness.

Implications:

• This case supports the diagnosis of hysterical deafness as a distinct entity from auditory agnosia.
• The spontaneous resolution of symptoms linked to a significant emotional event highlights the psychogenic nature of the deafness.
• Understanding psychogenic hearing loss is crucial for accurate diagnosis and appropriate patient management.