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Nichtorganische (funktionelle) Hörstörungen bei Kindern

Nonorganic (functional) hearing loss in children

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Zusammenfassung

Die nichtorganische (funktionelle) Hörstörung bezeichnet Hörauffälligkeiten ohne erkennbares organpathologisches Korrelat im auditorischen System. Das Krankheitsbild ist im Kindesalter nicht selten. Typisch ist eine Diskrepanz zwischen erhöhter Tonschwelle und wenig beeinträchtigter Sprachdiskrimination im Alltag. 85 Originalpublikationen (645 Fälle), 27 Übersichtsarbeiten und 4 Lehrbuchartikel wurden ausgewertet. Das mittlere Alter bei Diagnose lag bei 11,3 Jahren. Mädchen waren doppelt so oft betroffen wie Jungen. Familiäre und emotionale Probleme und Schulschwierigkeiten waren häufig. Bei organischen Hörstörungen traten funktionelle Verschlechterungen auf. Zur Diagnosesicherung sollte eine Hirnstammaudiometrie erfolgen. Differenzialdiagnosen sind auditive Verarbeitungs- und Wahrnehmungsstörungen, erhöhte Schwellen bei Entwicklungsverzögerungen und auditorische Neuropathien. Empfohlen werden eine biographische Anamnese, eine psychologische Untersuchung mit Intelligenzdiagnostik und ggf. eine kinderpsychiatrische/-psychotherapeutische Weiterbehandlung. Die Prognose scheint abhängig vom Ausmaß der belastenden Faktoren.

Abstract

Nonorganic (functional) hearing loss in children is characterized by hearing loss without a detectable corresponding pathology in the auditory system. It is not an uncommon disease in childhood. Typically, there is a discrepancy between elevated pure tone thresholds and normal speech discrimination in everyday life. We evaluated 85 original publications, 27 reviews and 4 textbook articles. Mean age at diagnosis was 11.3 years. Girls were affected twice as often as boys. Patient histories showed a high prevalence of emotional and school problems. Pre-existing organic hearing loss can be worsened by nonorganic causes. A brainstem audiometry should confirm the diagnosis. The differential diagnosis includes auditory processing disorder, elevated thresholds in mental retardation and auditory neuropathy. We recommend taking a personal history including biographical factors, a psychological assessment including intelligence testing and referral to a child psychiatrist. Prognosis seems to be dependent on the severity of the patient’s school and/or personal problems. Categorization following the Austen-Lynch model can be a valuable prognostic factor.

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Schmidt, CM., am Zehnhoff-Dinnesen, A. & Deuster, D. Nichtorganische (funktionelle) Hörstörungen bei Kindern. HNO 61, 136–141 (2013). https://doi.org/10.1007/s00106-012-2504-3

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