Cases reported "Hearing Loss, Functional"

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1/22. Non-organic hearing loss redefined: understanding, categorizing and managing non-organic behaviour.

    Addressing the complex factors that underpin any presentation of non-organic hearing loss (NOHL) is essential to that individual's proper management. The complex and often conflicting approaches taken to date are reviewed. Previous dichotomous models distinguish those assessed as consciously malingering for external benefits from those who generate symptoms unconsciously to meet psychological needs. Incorporating the DSM-IV-TR diagnosis of 'factitious disorder' into a new model bridges the conceptual gap. Three categories (malingering, factitious and conversion) are used distinctly, for the purpose of diagnosis, and on a continuum for the purpose of management. Motivating factors, type of gain, degree of intention and consistency of response during audiological assessment can all be related within the model. Advances in objective measurements have made the detection of NOHL easier. A reinvigoration of interest in effective diagnosis and management of the condition is therefore timely. ( info)

2/22. conversion disorder in a child presenting as sudden sensorineural hearing loss.

    Pseudohypoacacusis is a form of conversion disorder in which a hearing loss is found in the absence of organic disease. A case of an 11-year-old boy with auditory conversion disorder after mild head trauma is reported. The child presented with unilateral hearing loss, with no accompanying vestibular symptoms and no history of otologic disease. Auditory testing revealed severe right-sided sensorineural hearing loss, however, CT scan was normal. There was a family history of conversion disorder and the child was undergoing an emotionally stressful period. It was decided to treat the child conservatively with close monitoring and a repeat audiogram 2 weeks later. One week after presentation, the child's hearing suddenly returned to normal after a second very minor head injury. It is important to consider pseudohypoacusis or conversion disorder even in cases such as trauma, when the clinical history supports a diagnosis of hearing loss. ( info)

3/22. Conversion deafness presenting as sudden hearing loss.

    Conversion deafness is a somatoform disorder characterized by hearing loss without an anatomic or pathophysiologic lesion. Clinically, discrepancies between behavior hearing thresholds and objective electrophysiologic examinations, such as impedance audiometry, otoacoustic emissions (OAE), and auditory brainstem response (ABR), will raise the suspicion of this disorder. It is judged to be due to psychological factors and that patients do not intentionally produce the symptom. Conversion deafness is sometimes reported in children but is extremely rare among adults. Two young adults with this disease are presented. These 2 patients were both under enormous stress from the national entrance examinations for universities. Pure tone audiometry showed bilateral hearing deterioration, but OAE and ABR were normal. The hearing of both patients recovered after treatment. The diagnosis, prognosis and treatment of this disorder are also discussed. It is important to discover the psychological stress in patients with conversion deafness. This report aims to increase awareness of this condition and avoid unnecessary steroid use in its treatment. ( info)

4/22. Glossopharyngeal schwannoma: review of five cases and the literature.

    Glossopharyngeal schwannomas are rare tumors in spite of the fact that acoustic schwannomas account for 8%-10% of intracranial tumors. There have been 23 reported cases in the literature. This report of five cases is the largest series of these tumors. The presentation, radiological workup, operation, and long-term postoperative results will be presented, along with a review of the literature. ( info)

5/22. temporal bone pathology of a patient without hearing and caloric reaction, and with counter-rolling after chronic myelocytic leukemia.

    The temporal bone pathology of a 36-year-old man who suffered from chronic myelocytic leukemia and sudden hearing loss of both ears, was studied from the viewpoint of neurotology. Neurotological examination showed bilaterally profound hearing loss and no caloric reaction but good counter-rolling reaction to the right and the left head tilt and no other abnormal neurological findings. He died of intracranial hemorrhage. A study of histopathology of the temporal bones revealed extensive destruction of the organ of corti, dilatation of Reissner's membrane, leukemic infiltration in the cochlea but good preservation of sensory hair cells in the vestibular endorgans. Leukemic cell infiltration in perilymphatic and endolymphatic spaces, and leukemic hemorrhage in the perilymphatic spaces were observed. And also in the left internal auditory canal, obvious leukemic infiltration and marked hemorrhage were observed, but in the right internal auditory canal, no abnormal change was found. We discuss the correlation between neurotological findings and histopathological findings. ( info)

6/22. Functional hearing loss in children.

    This report reviewed 39 school-age children diagnosed as having a functional hearing loss utilizing auditory brainstem response (ABR) audiometry during the past 5 years at the Department of otolaryngology, Kyushu University Hospital in japan. Twenty-seven cases were females and 12 were males. Seven cases had a hearing loss unilaterally and 32 bilaterally. Although pure-tone audiometry revealed a variety of audiogram shapes, two-thirds of the cases had a flat or saucer-shaped audiogram with a mild to moderately severe hearing loss. ABR audiometry for the frequencies of 1, 2 and 4 kHz indicated a normal hearing threshold in 65 ears of 35 patients, and mild threshold elevations of at least one frequency in the remaining 6 ears of 4 patients. Three illustrative cases were demonstrated, and a discussion was held regarding the features in audiometric tests, and environmental factors surrounding the children with this condition. We emphasized that the physiological hearing measurement such as ABR audiometry should be performed when any discrepancy was noted between the patient's history and results of pure-tone audiometry, because of not infrequent occurrence of functional hearing loss. ( info)

7/22. Limitations of ABR as a hearing test as exemplified in multiply handicapped adults.

    Some limitations of the audiometric application of the click-evoked ABR are exemplified in the results for this sample of multiply handicapped hearing-impaired adults. Normal ABR thresholds were not necessarily indicative of normal hearing. Complete absence of ABR was not necessarily associated with total deafness. These findings underscore the need for conservative interpretation when the ABR is used to assess hearing of neurologically impaired patients at risk for more central auditory dysfunction. Additional diagnostic information in problematic cases may be obtained with cortical auditory potentials. Electrophysiological data must, in turn, be integrated with behaviorally obtained results. ( info)

8/22. vertigo in the pediatric and adolescent age group.

    Since episodic vertigo in the pediatric and adolescent age group is unusual and therefore not well known to most otolaryngologists, we present six cases to show some of the various presentations and different underlying causes. These cases covered a wide diagnostic spectrum: meningioma, medulloblastoma, childhood migraine with vestibular symptoms, childhood Meniere's syndrome (one case due to perilymph fistula), and benign paroxysmal vertigo of childhood. The two patients with tumor and the patient with perilymph fistula were treated surgically; the other patients are being managed conservatively since these childhood conditions usually tend to diminish with time. ( info)

9/22. hearing loss in a uraemic patient: indications of involvement of the VIIIth nerve.

    A case of acute renal failure associated with severe uraemic hearing loss is presented. Audiometric site-of-lesion testing revealed cochlear as well as neural involvement. After therapy hearing recovered up to an almost normal level, with normal auditory nerve conduction velocities. This case report supports the suggestion that the improvement of hearing after renal transplantation or dialysis might be correlated with the influences of these forms of therapy upon the peripheral neuropathy. ( info)

10/22. Functional hearing loss presenting as sudden hearing loss: a case report.

    A case of functional hearing loss presenting as sudden sensorineural hearing loss in the only hearing ear of a musician is presented. Pure-tone audiometric evaluation showed good intratest and intertest consistency. The pitfalls of diagnosis, ultimately made by brain stem evoked response audiometry, are discussed in light of the literature on sudden and functional hearing loss. Psychiatric evaluation revealed features consistent with hysterical conversion. It is argued that it is important to establish the exact etiologic agent of functional hearing loss despite the difficulty of diagnosis so that the patient may receive appropriate treatment. ( info)
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