title: Nonorganic hearing loss in children: audiometry, clinical characteristics, biographical history and recovery of hearing thresholds.
abstract: OBJECTIVE
  The term "nonorganic hearing loss" (NOHL) (pseudohypacusis, functional or psychogenic hearing loss) describes a hearing loss without a detectable corresponding pathology in the auditory system. It is characterized by a discrepancy between elevated pure tone audiometry thresholds and normal speech discrimination. The recommended audiological management of NOHL in children comprises history taking, diagnosis, and counseling. According to the literature, prognosis depends on the severity of the patient's school and/or personal problems. Routine referral to a child psychiatrist is discussed as being controversial.
  
  
  METHODS
  The clinical history of 34 children with NOHL was retrospectively evaluated. In 15 children, follow up audiometry was performed. Results of biographical history, subjective and objective audiometry, additional speech and language assessment, psychological investigations and follow up audiometry are presented and discussed.
  
  
  RESULTS
  The prevalence of NOHL was 1.8% in children with suspected hearing loss. Mean age at diagnosis was 10.8 years. Girls were twice as often affected as boys. Patient history showed a high prevalence of emotional and school problems. Pre-existing organic hearing loss can be worsened by nonorganic causes. Children with a fast recovery of hearing thresholds (n=6) showed a high rate (4/6) of family, social and emotional problems. In children with continuous threshold elevation (n=9), biographical history showed no recognizable or obvious family, social or emotional problems; learning disability (4/9) was the most frequently presented characteristic.
  
  
  CONCLUSIONS
  Due to advances in objective audiometry, the diagnosis of NOHL is less challenging than management and counseling. Considering the high frequency of personal and school problems, a multidisciplinary setting is helpful. On the basis of our results, drawing conclusions from hearing threshold recovery on the severity of underlying psychic problems seems inappropriate. As a consequence, a referral to a child psychiatrist can be generally recommended.
authors.affiliation: Muenster University Hospital, Clinic of Phoniatrics and Pedaudiology, Kardinal-von-Galen-Ring 10, 48129 Muenster, Germany. michael.schmidt@uni-muenster.de
authors.forename: Claus-Michael
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Antoinette
authors.initials: A
authors.lastname: am Zehnhoff-Dinnesen
authors.forename: Peter
authors.initials: P
authors.lastname: Matulat
authors.forename: Arne
authors.initials: A
authors.lastname: Knief
authors.forename: Ken
authors.initials: K
authors.lastname: Rosslau
authors.forename: Dirk
authors.initials: D
authors.lastname: Deuster
mesh_terms: D000293:Adolescent; D001299:Audiometry / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006309:Hearing / Q000502:physiology; D006315:Hearing Loss, Functional / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D013067:Speech Perception