title: Auditory agnosia as a clinical symptom of childhood adrenoleukodystrophy.
abstract: OBJECTIVE
  To investigate detailed auditory features in patients with auditory impairment as the first clinical symptoms of childhood adrenoleukodystrophy (CSALD).
  
  
  METHODS
  Three patients who had hearing difficulty as the first clinical signs and/or symptoms of ALD. Precise examination of the clinical characteristics of hearing and auditory function was performed, including assessments of pure tone audiometry, verbal sound discrimination, otoacoustic emission (OAE), and auditory brainstem response (ABR), as well as an environmental sound discrimination test, a sound lateralization test, and a dichotic listening test (DLT). The auditory pathway was evaluated by MRI in each patient.
  
  
  RESULTS
  Poor response to calling was detected in all patients. Two patients were not aware of their hearing difficulty, and had been diagnosed with normal hearing by otolaryngologists at first. Pure-tone audiometry disclosed normal hearing in all patients. All patients showed a normal wave V ABR threshold. Three patients showed obvious difficulty in discriminating verbal sounds, environmental sounds, and sound lateralization and strong left-ear suppression in a dichotic listening test. However, once they discriminated verbal sounds, they correctly understood the meaning. Two patients showed elongation of the I-V and III-V interwave intervals in ABR, but one showed no abnormality. MRIs of these three patients revealed signal changes in auditory radiation including in other subcortical areas.
  
  
  CONCLUSIONS
  The hearing features of these subjects were diagnosed as auditory agnosia and not aphasia. It should be emphasized that when patients are suspected to have hearing impairment but have no abnormalities in pure tone audiometry and/or ABR, this should not be diagnosed immediately as psychogenic response or pathomimesis, but auditory agnosia must also be considered.
authors.affiliation: Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; Department of Pediatrics, Tokyo Medical and Dental University, Japan.
authors.forename: Wakana
authors.initials: W
authors.lastname: Furushima
authors.affiliation: Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; Department of Child Neurology, Tokyo Metropolitan Tobu Medical Center for Children/Adults with Developmental Disabilities, Japan. Electronic address: kaga@ncnp.go.jp.
authors.forename: Makiko
authors.initials: M
authors.lastname: Kaga
authors.affiliation: Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; Department of Otorhinolaryngology, Mita Hospital, International Health and Welfare University, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Gunji
authors.affiliation: Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
authors.forename: Masumi
authors.initials: M
authors.lastname: Inagaki
mesh_terms: D000161:Acoustic Stimulation; D000293:Adolescent; D000326:Adrenoleukodystrophy / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D000377:Agnosia / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D001299:Audiometry; D001307:Auditory Perception / Q000502:physiology; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002648:Child; D016057:Evoked Potentials, Auditory, Brain Stem; D006320:Hearing Tests; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests
keywords: Adrenoleukodystrophy (ALD); Auditory agnosia; Speech discrimination