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Childhood pseudohypacusis in patients with high risk for actual hearing loss
D Radkowski1, S Cleveland, E M Friedman
1Department of Otolaryngology-Head and Neck Surgery, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
Insights
Pediatric pseudohypacusis, or nonorganic hearing loss, is often linked to prior trauma. Early identification through standardized audiologic testing is crucial to avoid unnecessary medical interventions in children.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Child Psychology
Background:
- Pseudohypacusis (nonorganic hearing loss) is recognized in adults but less emphasized in pediatric cases.
- This study retrospectively reviewed 18 pediatric patients diagnosed with pseudohypacusis between 1983 and 1991.
Observation:
- A significant percentage of pediatric patients with pseudohypacusis presented with a history of antecedent trauma.
- The severity of trauma was often minor, yet extensive investigations were considered.
- Audiometric configurations, age, and sex distributions were analyzed.
Findings:
- Pseudohypacusis was identified in 18 pediatric patients.
- A majority of these cases had a preceding history of trauma, a novel finding in pediatric literature.
- Standardized audiologic testing facilitated the detection of true hearing thresholds.
Implications:
- Heightened physician awareness of pseudohypacusis in children is essential, even with low suspicion.
- A high index of suspicion and systematic audiologic evaluation can lead to early diagnosis.
- Early identification averts unnecessary and potentially invasive medical and surgical interventions in pediatric patients.
Objective:
While pseudohypacusis or nonorganic hearing loss is a well-recognized phenomenon in adults, it is the aim of this report to heighten the physician's awareness of the occurrence of nonorganic hearing loss in pediatric patients. The medical and otologic histories of 18 cases identified consecutively between 1983 and 1991 at The Children's Hospital, Boston, Massachusetts, were retrospectively reviewed. In these selected cases an analysis of the audiometric configuration, age range, and sex distribution is undertaken. This review highlights the need to rule out pseudohypacusis even in pediatric cases where suspicion is low. A precedent trauma was the presenting complaint in a high percentage of our patient population. This association has not been previously reported in the pediatric literature. While the severity of the traumatic incident was often minor, extensive medical and surgical investigations had been considered before the identification of nonorganic hearing loss.
Study Design:
A retrospective chart analysis of patients identified with pseudohypacusis over a 7-year period.
Methods:
A tertiary care children's hospital in an urban community. Eighteen consecutively identified patients examined by a staff audiologists at a tertiary care children's hospital. A specific battery of standard audiologic testing with the goal of detecting pseudohypacusis in children.
Results:
Successful if additional interventions such as exploratory tympanotomy were avoided.
Conclusions:
Pseudohypacusis was identified in 18 patients with a majority having an antecedent history of trauma. Additional interventions were canceled upon the detection of true threshold values. A high index of suspicion of pseudohypacusis in children and an organized standardized battery of audiologic testing will facilitate early identification of these patients and will avert inappropriate interventions.