Classification and Detection
Psychogenic hearing loss, also known as pseudohypacusis, non-organic or functional, originates in the mind of an individual and is thereby psychological rather than physiological in nature. The loss may be classified either as intentional and based on underlying motives such as monetary compensation or sympathy needs or unintentional and based on underlying stress or anxiety.
The detection of psychogenic hearing loss has long been the concern of audiologists from our earliest history as a profession in the l940s just after World War II to the present. Just a few of the tests used over the years for such detection include Galvanic Skin Response (GSR) audiometry, Delayed Auditory Feedback (DAF), Stenger, Varying Intensity Story Test, Pure-Tone Tap Test, Lengthened Off-Time, BADGE, and pure-tone/SRT differences.
In today's clinic, discrepancies in behavioral and electroacoustical/physiological tests are probably most valuable in first arousing audiological suspicions. For example, elevated pure-tone thresholds associated with normal otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs) will prompt further investigation.
Occurrence in Sudden Hearing Loss
Audiologists must be vigilant for the possibility of psychogenic hearing loss in their everyday practices, even though the overall occurrence of such losses in most settings is small. Of most concern is their detection in cases of sudden hearing loss with no established cause. Korean researchers reviewed the records of 277 patients who were hospitalized with the initial diagnosis of idiopathic sudden hearing loss.1 A psychiatrist provided the classification of psychogenic sudden deafness for seven of the 277 patients, or 2.5 percent. The recovery rate and prognosis were."better in patients who had accurate audiometry and were under the care of a psychiatrist."
A psychogenic hearing loss may be due to a psychiatric condition in which the patient unconsciously converts an emotional problem into a physical one. Such conversion disorders typically affect motor or sensory skills such as walking, swallowing, speaking, and hearing. Other examples of the disorder include vertigo, numbness, paralysis in an arm or leg, loss of touch sensation, inability to swallow, visual impairment, hallucinations, seizures, convulsions, trembling, vomiting and diarrhea.2
Episodes of conversion disorder are usually triggered by severe stress, anxiety, conflict, or depression and can occur at any age but tend to develop most often during adolescence or early childhood. Published case studies of sudden hearing loss attributed to conversion disorder are few and include the following:
- In a 2002 article, Japanese researchers described a "very rare" case of a 50-year old female with a panic anxiety attack that complicated an acute sensorineural hearing loss.3 The patient presented at the first visit with a unilateral sensorineural hearing loss that unexpectedly increased in severity five days later. The next day, she experienced a severe panic attack with anxiety. A combined treatment of corticosteroid therapy, psychiatric counseling, and the administration of a minor tranquilizer led to an immediate hearing threshold recovery except in the higher frequencies. Here, the psychogenic hearing loss complicated the primary sudden hearing loss.
- In a 2005 article, Canadian researchers reported the case of an 11-year-old boy with an auditory conversion disorder associated with mild head trauma.4 The child presented with a unilateral sensorineural hearing loss, no accompanying vestibular symptoms, and no history of otologic disease. A CT scan was normal. There was a family history of conversion disorder and the child was undergoing an "emotionally stressful" period.