Non-organic hearing loss (NOHL) is a common cause of sudden hearing loss in children. However, the diagnosis may be missed or delayed if the clinician does not consider the possibility of its occurrence.


Synonym: pseudoacusis


Clinical features:

(1) sudden hearing loss

(2) depressed auditory thresholds

(3) inconsistencies in audiological testing

(4) absence of an organic cause found after a complete evaluation

(5) reversal with a behavioral intervention


Holenweg and Kompis (2010) noted that a small air-bone gap (5-20 dB) was typical for non-organic hearing loss.


Risk factors:

(1) sudden psychological trauma or stress (conversion disorder)

(2) underlying psychiatric disorder


Barriers to diagnosis:

(1) failure to consider diagnosis

(2) presence of a concurrent ear disorder

(3) failure to perform appropriate testing (otoacoustic emissions testing, speech audiometry, auditory-evoked potentials)

(4) failure to recognize inconsistencies in audiological testing

(5) patient's skill at malingering (pediatric patients are usually less practiced than adults)

(6) failure to recognize motivation


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