{"paper_id":"13a9d4c9-ae5e-4aee-8a49-ba63a55f1400","body_text":"Unexplained sudden sensorineural hearing loss in adolescent: a warning for functional hearing loss | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unexplained sudden sensorineural hearing loss in adolescent: a warning for functional hearing loss Kun Zhang, Xijian Xin, Bo Hou, Xinbo Xu, Tao Yan, Ruru Qiao, Xiao Han, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5173879/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Functional hearing loss refers to a type of hearing impairment that occurs without any identifiable organic damage to the auditory system. Most of the existing literature focuses on adults, with little attention given to the pediatric population. However, there is an increasing number of psychosomatic issues among children and adolescent, and dysthymic deafness in adolescent is not uncommon in clinical practice. Methods In our article, we presented 21 cases of functional hearing loss in adolescent treated in our center over the last 3 years. We summarized our experience in diagnosing and treating these cases to reduce diagnostic errors and improve the patients' quality of life. Results The study identifies academic stress (19.04%), Violence by parents or teachers (14.29%), interpersonal conflicts (4.76%), and mental health issues such as anxiety and depression (23.81%) as significant factors contributing to the development of functional hearing loss. Additionally, 47.62% of patients reported an unknown reason for their deafness. We found that 66.67% of dysthymic deafness was monaural, making it difficult to differentiate it from sudden deafness. It's important to note that in functional hearing loss, a history of sudden onset of hearing loss deserves attention, and the unusual mental demeanor of the patient may be helpful. Objective auditory examination should be carried out as early as possible for those patients with sudden unilateral deafness who were inconsistent on successive audiometric tests. Conclusions Accurate diagnosis and treatment are crucial for the prognosis of patients. For childhood dysthymic disorders, timely and effective psychotherapy often leads to a better prognosis, which requires a well-established multidisciplinary cooperation mechanism. Functional hearing loss Nonorganic Sudden adolescent Figures Figure 1 Figure 2 Introduction According to the World Health Organization, around 466 million people worldwide suffer from hearing impairment. It is estimated that by 2050, more than 900 million people will have disabling hearing loss [ 1 ]. The majority of patients affected by unilateral hearing loss (> 80%) suffer from sensorineural hearing loss, and sudden sensorineural hearing loss (SSNHL) is the most frequent cause [ 2 , 3 ]. SSNHL is a suddenly appearing within 72 hours, generally unilateral hearing loss of cochlear origin with an unknown cause, resulting in varying degrees of hearing impairment [ 4 ]. Additionally, vertigo and/or tinnitus may occur [ 5 ]. In industrialized countries, the estimated incidence of SSNHL ranges from 5 to 20 cases per 100,000 inhabitants, and there is a noticeable trend towards a younger age of onset [ 6 , 7 ]. Functional hearing loss is a clinically rare condition, characterized by unilateral or bilateral sensorineural hearing loss, typically without any evidence of organic damage [ 8 ]. The earliest reported cases of functional hearing loss were from soldiers who had experienced war [ 9 ], and patients usually had a history of major trauma before the onset of the condition. Along with hearing impairment, it may be accompanied by symptoms of hysteria in other parts of the body. Clinical reports of functional hearing loss are rare, especially among pediatric patients [ 10 ]. As a result, the clinical diagnosis and management of this condition often lack experience, leading to a significant risk of oversight and misdiagnosis. However, given the complexity of the school environment and increasing learning pressures, adolescent functional hearing loss should be concerning. This article reports 21 cases of functional hearing loss in adolescent treated at our center in the past 3 years and summarizes our experience in the diagnosis and treatment of these patients. Materials and methods We reviewed dysthymic deafness in adolescent admitted in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University, from January 2021 to September 2023. 21 patients were enrolled in the study and all of them provided written informed consent. The study received ethical approval from the Medical Ethical Commission of the Qilu Hospital of Shandong University. All participants in the study had sensorineural hearing loss in unilateral or bilateral ear, with no identifiable external or physical cause. The exclusion criteria included the presence of conductive or mixed hearing loss, a history of otitis media, tympanic membrane perforation, inner ear disease, family history of genetic disorders, systemic conditions affecting hearing, tumors, congenital malformations, head or acoustic trauma, and the inability to undergo necessary diagnostic tests such as audiometry or imaging studies. The study involved collation and analysis of detailed clinical records, including medical history, ear endoscopy, subjective and objective auditory function tests, imaging data, and follow-up after treatment. Auditory function tests The participants simultaneously underwent both subjective and objective audiological assessments, which included pure-tone audiometry (PTA), acoustic impedance, distortion-product otoacoustic emissions (DPOAE), auditory brainstem response (ABR), and auditory steady-state response (ASSR). The level of hearing loss was determined by calculating the average air conduction thresholds at frequencies of 500, 1000, 2000, and 4000 Hz according to WHO standards. Psychological assessment To evaluate anxiety and depressive symptoms in children, we employed standardized and validated self-report and parent-report questionnaires that are widely recognized for their reliability and accuracy in measuring these constructs in pediatric populations. The Child Anxiety Scale (CAS) assesses various dimensions of anxiety, including generalized anxiety, social anxiety, and specific phobias. The scale features a series of statements about typical anxiety-related behaviors, with responses rated on a 3-point Likert scale (0 = never, 1 = sometimes, 2 = always). Higher scores indicate greater severity of anxiety symptoms. The Children’s Depression Inventory (CDI) consists of 27 items that measure mood, behavior, and physical symptoms commonly associated with depression. Each item is scored on a scale from 0 to 2, with higher scores indicating more severe depressive symptoms. All participants completed the questionnaires in a quiet, distraction-free environment, while the parent-report versions were administered concurrently to ensure accurate and reliable data collection. Data Analysis Descriptive statistics were used to summarize continuous variables, including means, standard deviations (SD), and ranges, while categorical variables were expressed as counts and percentages. To evaluate changes in audiometric values within each group from early to late follow-up, paired t-tests were used, unless the normality assumption was significantly violated; in such cases, the nonparametric Wilcoxon Signed-Rank test was utilized instead. All statistical analyses were performed using SPSS software (version 26). A p-value of less than 0.05 was considered statistically significant. Results Patient Demographics The study involved 21 patients, with a male-to-female ratio of 0.75-1 and a median age of 11 (age range 6 to 18) years at diagnosis. Digital otoscopy confirmed that all patients had intact tympanic membranes. The age of onset was determined as the first documented instance of hearing loss in the patient's medical records. The average duration of the condition was 15.44 ± 10.54 days. Hearing loss was the primary complaint reported by the patients, with bilateral hearing loss occurring in 7 cases (33.33%). Among these cases, the main accompanying symptoms were tinnitus (19.04%), earache (19.04%), and insomnia (9.52%). Additionally, some patients had a combination of vertigo (4.76%), hypopsia (4.76%), and gastrointestinal symptoms (4.76%). The patient demographics are presented in Table 1 . Table 1 Patient Demographics Characteristic Patients(%) Sex Male 9 (42.86%) Female 12 (57.14%) Age, years (median; range) 11.47 (11,6–18 ) Side Left 8 (38.10%) Right 6(28.57%) Bilateral 7(33.33%) Time from onset of symptoms to diagnosis 15.44 ± 10.54 Hearing loss AC 62.64 ± 24.04 BC 45.29 ± 16.46 Complication Tinnitus 4(19.04%) Earache 2(9.52%) Ear fullness 1(4.76%) Otorrhea 0 Vertigo 1(4.76%) Insomnia 2(9.52%) Hypopsia 1(4.76%) Gastrointestinal symptoms 1(4.76%) Tympanic membrane Normal 21(100%) Pathological 0 Following-up, month (median; range) 15.24(14,7–42) Audiology Characteristics In our cohort, the mean air and bone conduction levels were 62.64 ± 24.04 dB and 45.29 ± 16.46 dB, respectively. Notably, 52.38% of patients exhibited severe hearing loss (Table 2 ). Acoustic impedance, DPOAE, ABR and ASSR tests were normal in all patients, which may lead to confusion with SSNHL when relying solely on subjective audiological examinations. For example, a 13-year-old girl presented with two weeks of sudden hearing loss in her right ear. No ear pain, headache, vertigo, or nystagmus was noted. PTA revealed profound hearing loss in the right ear, while HRCT and MRI of the temporal bone showed no abnormalities. The initial diagnosis was sudden hearing loss. Before visiting our department, the patient had received treatment at other hospitals for one week according to the standard SSNHL protocol, including intravenous administration, hyperbaric oxygen treatment, and intratympanic administration. During this period, repeated PTA tests surprisingly did not align with the expected disease progression (Fig. 1). Table 2 Audiological examination and degree of hearing loss Degree Patients(%) PTA Slight hearing loss 4(19.05%) Moderate hearing loss 6(28.57%) Severe hearing loss 6(28.57%) Profound hearing loss 5(23.81%) Acoustic Impedance A-curve DPOAE All in the normal range ABR All in the normal range ASSR All in the normal range Subsequently, objective audiological indicators were further examined in our centre. ABR testing displayed a normal bilateral response, with all recorded waves being regular. The binaural ABR response threshold was 25dB, and the binaural ASSR response threshold was 20dB (Fig. 2). The patient's ABR, ASSR, and DPOAE were all within the normal range, leading to the consideration of the diagnosis of functional deafness. The patient was referred for psychological intervention and fully recovered. This case highlights the need for objective audiological evaluations when assessing functional hearing loss in adolescents. Causes analysis of 21 patients with deafness This study presents a thorough analysis of potential factors contributing to functional hearing loss in 21 patients (Table 3 ). Academic stress was identified as a significant factor in 4 patients (19.05%), highlighting the potential psychological impact of intense academic pressures on auditory health. Interpersonal conflicts, particularly violence perpetrated by parents or teachers, accounted for 3 cases (14.29%), emphasizing the damaging effects of emotional and physical abuse on hearing ability. Conflicts with classmates, though less prevalent, were reported in 1 patient (4.76%), indicating that social stressors may also play a role. One (4.76%) patient experienced a history of intimidation from parents and one (4.76%) patient had a history of brief noise exposure. Anxiety and depression-related personality traits were reported in 5 patients (23.81%), showing a notable correlation between mental health conditions and functional hearing loss. Lastly, the largest proportion of patients, 10 individuals or 47.62%, reported an unknown reason for their deafness. This underscores the complexity and often elusive nature of identifying the root cause of hearing loss, which further complicates clinical diagnosis and treatment. Table 3 Causes analysis of 21 patients with deafness Causes Patients(%) Academic stress 4(19.04%) Violence by parents or teachers 3(14.29%) Conflicts between classmates 1(4.76%) Scare 1(4.76%) Exposure to noise 1(4.76%) Anxiety and depression personality 5(23.81%) Medicine 0 Genetic factor 0 Unknown reason 10(47.62%) Treatment options and prognosis In our group, one patient who was lost to follow-up was excluded from the 21 patients. The average follow-up time for these patients was 15.23 months. In terms of treatment, the majority of patients (55%) received psychological counseling or intervention, indicating that a significant number of cases were linked to psychological factors or conditions that required non-pharmacological management. Conversely, neurotrophic medication was prescribed for a smaller portion of patients (25%), suggesting that pharmaceutical treatment was not the primary therapeutic approach in this sample. Additionally, 20 percent of patients did not receive any treatment. In regards to prognosis, our data shows a very positive outcome for most patients, with 95% reporting complete recovery. However, One patient showed partial recovery of hearing; however, the improvement remained incomplete, and the condition was further complicated by the onset of otitis media, which may have contributed to the limited recovery. The treatment options and prognosis are presented in Table 4 . Table 4 Treatment and prognosis Characteristic Patients(%) Treatment Medication 5(25%) Psychological counseling or intervention 11(55%) No treatment 4(20%) prognosis Recover completely 19(95%) Partially recovered 1(5%) No improvement 0 Loss to follow-up 1(4.76%) Discussion Functional hearing loss is a rare manifestation of functional neurological disorders (FNDs), presenting with monaural or bilateral sequential onset [ 11 ]. It is often caused by acute and intense mental stimulation or psychological and social factors that lead to long-term psychological stress and internal conflict [ 12 ]. Therefore, the incidence rate of functional hearing loss is high in young females workers due to psychological pressure or mental trauma [ 13 ]. However, functional hearing loss has been less frequently reported in adolescent [ 10 , 14 ]. In this article, we analyze the clinical features of 21 cases of dysthymic deafness in adolescent and provide a detailed consultation regarding a child who displayed symptoms without any history of trauma, which also presented difficulties in diagnosis. The mental and psychological development of children and adolescents is still maturing, and their ability to cope with psychological stress is relatively limited. In recent years, there has been a noticeable rise in mental and psychological issues among children and adolescents [ 15 , 16 ]. Our study's analysis, presented in Table 3 , underscores the diverse causes of deafness among the 21 patients studied. The significant role of academic stress as a causative factor (19.04%) emphasizes the need to recognize and address psychosocial stressors as potential contributors to functional hearing loss. The prevalence of violence by parents or teachers (14.29%) highlights the critical importance of safe and nurturing environments in protecting auditory health. The correlation between deafness and anxiety-depression personality traits (23.81%) further emphasizes the intricate relationship between mental health and auditory outcomes, suggesting that mental health interventions may be beneficial in managing functional hearing loss. Additionally, the high proportion of cases with unknown causes (47.62%) underscores the complex and heterogeneous nature of functional hearing loss, emphasizing the ongoing need for comprehensive studies to understand the underlying causes and develop targeted interventions. In this article, it was discovered that 66.67% of cases of dysthymic deafness originated from only one ear. If the clinician lacks experience, there is a risk of misdiagnosis or missed diagnosis. When a patient complains of hearing loss in one ear, it is important to differentiate between organic deafness (e.g., sudden deafness, mumps infection, acoustic neuroma, otitis media, trauma, surgery, and congenital unilateral deafness) and non-organic deafness (e.g., hysterical deafness and simulated deafness) [ 17 , 18 ]. A history of sudden hearing loss and the patient's unusual mental state can provide important clues. Patients with functional hearing loss often show behaviors that may be mistaken for genuine hearing loss, and standard audiometric tests such as tuning fork and whisper tests are not very helpful. King PF found that the responses of patients with functional hearing loss to successive audiometric tests were inconsistent [ 19 ]. He used ascending and descending intensity scales in pure-tone audiometry tests and observed divergent results in the first test. Therefore, in cases where pure-tone audiometry tests produce different results, it is important to conduct early objective auditory examinations such as ABR, ASSR, and DPOAE. The latency and V wave response threshold of ABR in patients with functional hearing loss were found to be normal. Otolaryngologists should make accurate diagnoses as early as possible, and subsequent treatment should be handled by psychiatrists. Interest in functional neurological disorders has significantly increased over the past few decades [ 20 , 21 ]. Patients who present with physical symptoms for which no disease pathology can be found are common in medical practice [ 22 , 23 ]. Symptoms are maintained by a set of beliefs regarding the symptoms and by associated maladaptive behavior. Functional hearing loss differs from sensorineural hearing loss in that it is not caused by structural damage to the ear or auditory pathways. Instead, it stems from issues within the central nervous system, including psychological, emotional, and neural regulation disruptions [ 24 , 25 ]. The primary mechanism of functional hearing loss involves interference with the brain's ability to process auditory signals, often linked to factors like psychological stress, anxiety, and post-traumatic stress [ 26 , 8 ]. Targeted psychological interventions and behavioral therapies have shown promise in alleviating or even reversing functional hearing loss, thereby restoring normal auditory perception [ 27 ]. Koelen et al. concluded that there were positive benefits from psychotherapeutic interventions in terms of physical symptoms and functional impairment [ 28 ]. However, it should be pointed out that if treatment is improper and repeated several times without success, physical symptoms will turn into chronic symptoms, thus increasing the difficulty of treatment [ 29 ]. In future work, otolaryngologists, neurologists, psychiatrists, physiotherapists, and relevant specialists should be encouraged to work extensively together to find more effective ways to improve the health and prognosis of patients with functional hearing loss in adolescent [ 30 ]. Conclusion Regarding children with functional hearing loss, it's important to rule out any physical issues that could be causing the deafness. Sudden onset of hearing loss and unusual mental behavior should be taken seriously. It's crucial to conduct objective tests of the patient's hearing as soon as possible, especially for children who show inconsistent results on multiple hearing tests. Accurate diagnosis and prompt treatment are vital for the patients' prognosis. For children with dysthymic disorders, timely and effective psychotherapy often leads to better outcomes, which requires a well-established multidisciplinary cooperation system. Declarations Ethics approval and consent to participate This study and its design were approved by the Medical Ethical Commission of Qilu Hospital of Shandong University. Participants were informed of the purposes and procedures before the study commenced. In accordance with Declaration of Helsinki, we obtained written informed consent from all children and their parents or legal guardians. Consent for publication Not applicable. Clinical trial number Not applicable. Funding The present study was supported in part by the Natural Science Foundation of Shandong Province (no.ZR2022QH373, ZR2022QH292 and ZR2023MH2474). Conflict of interest The authors declare no competing interests. Data Availability Statement Not applicable. Author Contribution K.Z., R.Q. and H.Z. designed the research and analyzed the data. X.X. and B.H. acquired the data and created a draft of the manuscript; X.H., T.Y. and R.Q. conducted and further performed the study, processed and analyzed the data. 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Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy Behav Rep. 2021,3;16:100478. doi: 10.1016/j.ebr.2021.100478. Lehn A, Gelauff J, Hoeritzauer I, et al. Functional neurological disorders: mechanisms and treatment[J]. Journal of neurology, 2016,263(3):611-20. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 02 Sep, 2025 Editor assigned by journal 29 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviewers agreed at journal 08 Apr, 2025 Reviewers invited by journal 08 Apr, 2025 Submission checks completed at journal 28 Mar, 2025 First submitted to journal 28 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5173879\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":440013418,\"identity\":\"929226bc-4d96-49fd-adf0-cabf866572e9\",\"order_by\":0,\"name\":\"Kun Zhang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIie3QIQ7CMBTG8TZNNtMx2wXCrtBlFsFROsPUfCVNyZsZV+AYBNkG2xuAGFnCGSYIAYsgKw7Rn35/8T2EguAfUayGh3wuo7g1vgnRnDpTzqgTvkkMLNmZ6sDW3K/IO6t5tr3WwJBAozxOJ3ivVF+c7g3MlcGdu0wnJMWaV440sDCCYPBIohQDs0DqiAnul9BEQabgLPwTRq0ukdsU8H6y9dqSd/VtQHKV521r+1F6JB/Mj/dBEATBNy+etj09RUslNAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Kun\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"},{\"id\":440013419,\"identity\":\"a40ccf8a-aabd-4898-bd65-a288e023e1f7\",\"order_by\":1,\"name\":\"Xijian Xin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xijian\",\"middleName\":\"\",\"lastName\":\"Xin\",\"suffix\":\"\"},{\"id\":440013420,\"identity\":\"3d4b2528-8fb4-4abf-84ef-92260bf55b30\",\"order_by\":2,\"name\":\"Bo Hou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Bo\",\"middleName\":\"\",\"lastName\":\"Hou\",\"suffix\":\"\"},{\"id\":440013421,\"identity\":\"cebf10d8-b6b6-4132-8aab-1cb4e993f726\",\"order_by\":3,\"name\":\"Xinbo Xu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xinbo\",\"middleName\":\"\",\"lastName\":\"Xu\",\"suffix\":\"\"},{\"id\":440013422,\"identity\":\"ea4efdf2-7a3c-4c72-b1a6-3dc070cc575a\",\"order_by\":4,\"name\":\"Tao Yan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tao\",\"middleName\":\"\",\"lastName\":\"Yan\",\"suffix\":\"\"},{\"id\":440013423,\"identity\":\"55593664-c38d-4ffb-a83c-e7433c0a9750\",\"order_by\":5,\"name\":\"Ruru Qiao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ruru\",\"middleName\":\"\",\"lastName\":\"Qiao\",\"suffix\":\"\"},{\"id\":440013424,\"identity\":\"9dc76787-80a9-496a-ae9c-4d524e9f7bfb\",\"order_by\":6,\"name\":\"Xiao Han\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xiao\",\"middleName\":\"\",\"lastName\":\"Han\",\"suffix\":\"\"},{\"id\":440013425,\"identity\":\"e6081b74-215d-497e-bc68-ddc88cfbcd14\",\"order_by\":7,\"name\":\"Hanbing Zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shandong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hanbing\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-09-29 08:38:09\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5173879/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5173879/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":80274830,\"identity\":\"374fd24e-9c7b-40eb-9a92-bf4f342e7156\",\"added_by\":\"auto\",\"created_at\":\"2025-04-10 04:40:34\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":337545,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePure-tone audiometry detection results prior to visit. (A) Pure-tone audiometry (PTA) detection shows right ear severe hearing loss before treatment. (B) PTA detection shows right ear profound severe hearing loss and moderate hearing loss in left ear after treatment.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"FIGURE1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5173879/v1/a73b6453db1e7c3cdef6822d.jpg\"},{\"id\":80274828,\"identity\":\"b635b8f1-350d-4e8e-a900-4832ea06c14f\",\"added_by\":\"auto\",\"created_at\":\"2025-04-10 04:40:34\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":311795,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eObjective auditory examination. (A) Auditory Brain Response (ABR) testing showed normal bilateral response and all recorded waves were regular. (B) Binaural ABR response threshold are 25dB, and the binaural aditory steady-state response (ASSR) response threshold are 20dB．\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"FIGURE2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5173879/v1/8cf3e929eacbc09e3652f2e9.jpg\"},{\"id\":80275952,\"identity\":\"46ac5fab-f267-4d49-8176-8dec66890ce9\",\"added_by\":\"auto\",\"created_at\":\"2025-04-10 04:56:38\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1263238,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5173879/v1/70746f97-be39-4e50-9911-f309a48015aa.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Unexplained sudden sensorineural hearing loss in adolescent: a warning for functional hearing loss\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAccording to the World Health Organization, around 466\\u0026nbsp;million people worldwide suffer from hearing impairment. It is estimated that by 2050, more than 900\\u0026nbsp;million people will have disabling hearing loss [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The majority of patients affected by unilateral hearing loss (\\u0026gt;\\u0026thinsp;80%) suffer from sensorineural hearing loss, and sudden sensorineural hearing loss (SSNHL) is the most frequent cause [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. SSNHL is a suddenly appearing within 72 hours, generally unilateral hearing loss of cochlear origin with an unknown cause, resulting in varying degrees of hearing impairment [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Additionally, vertigo and/or tinnitus may occur [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. In industrialized countries, the estimated incidence of SSNHL ranges from 5 to 20 cases per 100,000 inhabitants, and there is a noticeable trend towards a younger age of onset [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eFunctional hearing loss is a clinically rare condition, characterized by unilateral or bilateral sensorineural hearing loss, typically without any evidence of organic damage [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. The earliest reported cases of functional hearing loss were from soldiers who had experienced war [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], and patients usually had a history of major trauma before the onset of the condition. Along with hearing impairment, it may be accompanied by symptoms of hysteria in other parts of the body. Clinical reports of functional hearing loss are rare, especially among pediatric patients [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. As a result, the clinical diagnosis and management of this condition often lack experience, leading to a significant risk of oversight and misdiagnosis. However, given the complexity of the school environment and increasing learning pressures, adolescent functional hearing loss should be concerning. This article reports 21 cases of functional hearing loss in adolescent treated at our center in the past 3 years and summarizes our experience in the diagnosis and treatment of these patients.\\u003c/p\\u003e\"},{\"header\":\"Materials and methods\",\"content\":\"\\u003cp\\u003eWe reviewed dysthymic deafness in adolescent admitted in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University, from January 2021 to September 2023. 21 patients were enrolled in the study and all of them provided written informed consent. The study received ethical approval from the Medical Ethical Commission of the Qilu Hospital of Shandong University. All participants in the study had sensorineural hearing loss in unilateral or bilateral ear, with no identifiable external or physical cause. The exclusion criteria included the presence of conductive or mixed hearing loss, a history of otitis media, tympanic membrane perforation, inner ear disease, family history of genetic disorders, systemic conditions affecting hearing, tumors, congenital malformations, head or acoustic trauma, and the inability to undergo necessary diagnostic tests such as audiometry or imaging studies. The study involved collation and analysis of detailed clinical records, including medical history, ear endoscopy, subjective and objective auditory function tests, imaging data, and follow-up after treatment.\\u003c/p\\u003e \\u003cp\\u003eAuditory function tests\\u003c/p\\u003e \\u003cp\\u003e The participants simultaneously underwent both subjective and objective audiological assessments, which included pure-tone audiometry (PTA), acoustic impedance, distortion-product otoacoustic emissions (DPOAE), auditory brainstem response (ABR), and auditory steady-state response (ASSR). The level of hearing loss was determined by calculating the average air conduction thresholds at frequencies of 500, 1000, 2000, and 4000 Hz according to WHO standards.\\u003c/p\\u003e \\u003cp\\u003ePsychological assessment\\u003c/p\\u003e \\u003cp\\u003eTo evaluate anxiety and depressive symptoms in children, we employed standardized and validated self-report and parent-report questionnaires that are widely recognized for their reliability and accuracy in measuring these constructs in pediatric populations. The Child Anxiety Scale (CAS) assesses various dimensions of anxiety, including generalized anxiety, social anxiety, and specific phobias. The scale features a series of statements about typical anxiety-related behaviors, with responses rated on a 3-point Likert scale (0\\u0026thinsp;=\\u0026thinsp;never, 1\\u0026thinsp;=\\u0026thinsp;sometimes, 2\\u0026thinsp;=\\u0026thinsp;always). Higher scores indicate greater severity of anxiety symptoms. The Children\\u0026rsquo;s Depression Inventory (CDI) consists of 27 items that measure mood, behavior, and physical symptoms commonly associated with depression. Each item is scored on a scale from 0 to 2, with higher scores indicating more severe depressive symptoms. All participants completed the questionnaires in a quiet, distraction-free environment, while the parent-report versions were administered concurrently to ensure accurate and reliable data collection.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Analysis\\u003c/h2\\u003e \\u003cp\\u003eDescriptive statistics were used to summarize continuous variables, including means, standard deviations (SD), and ranges, while categorical variables were expressed as counts and percentages. To evaluate changes in audiometric values within each group from early to late follow-up, paired t-tests were used, unless the normality assumption was significantly violated; in such cases, the nonparametric Wilcoxon Signed-Rank test was utilized instead. All statistical analyses were performed using SPSS software (version 26). A p-value of less than 0.05 was considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003ePatient Demographics\\u003c/p\\u003e \\u003cp\\u003eThe study involved 21 patients, with a male-to-female ratio of 0.75-1 and a median age of 11 (age range 6 to 18) years at diagnosis. Digital otoscopy confirmed that all patients had intact tympanic membranes. The age of onset was determined as the first documented instance of hearing loss in the patient's medical records. The average duration of the condition was 15.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.54 days. Hearing loss was the primary complaint reported by the patients, with bilateral hearing loss occurring in 7 cases (33.33%). Among these cases, the main accompanying symptoms were tinnitus (19.04%), earache (19.04%), and insomnia (9.52%). Additionally, some patients had a combination of vertigo (4.76%), hypopsia (4.76%), and gastrointestinal symptoms (4.76%). The patient demographics are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePatient Demographics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9 (42.86%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (57.14%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge, years (median; range)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.47 (11,6\\u0026ndash;18 )\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSide\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLeft\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8 (38.10%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRight\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6(28.57%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBilateral\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7(33.33%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTime from onset of symptoms to diagnosis\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHearing loss\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e45.29\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.46\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eComplication\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTinnitus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4(19.04%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEarache\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2(9.52%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEar fullness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOtorrhea\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVertigo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInsomnia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2(9.52%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypopsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGastrointestinal symptoms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTympanic membrane\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNormal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePathological\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFollowing-up, month (median; range)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15.24(14,7\\u0026ndash;42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAudiology Characteristics\\u003c/p\\u003e \\u003cp\\u003eIn our cohort, the mean air and bone conduction levels were 62.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.04 dB and 45.29\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.46 dB, respectively. Notably, 52.38% of patients exhibited severe hearing loss (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Acoustic impedance, DPOAE, ABR and ASSR tests were normal in all patients, which may lead to confusion with SSNHL when relying solely on subjective audiological examinations. For example, a 13-year-old girl presented with two weeks of sudden hearing loss in her right ear. No ear pain, headache, vertigo, or nystagmus was noted. PTA revealed profound hearing loss in the right ear, while HRCT and MRI of the temporal bone showed no abnormalities. The initial diagnosis was sudden hearing loss. Before visiting our department, the patient had received treatment at other hospitals for one week according to the standard SSNHL protocol, including intravenous administration, hyperbaric oxygen treatment, and intratympanic administration. During this period, repeated PTA tests surprisingly did not align with the expected disease progression (Fig.\\u0026nbsp;1).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eAudiological examination and degree of hearing loss\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDegree\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePTA\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSlight hearing loss\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4(19.05%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eModerate hearing loss\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6(28.57%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSevere hearing loss\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6(28.57%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProfound hearing loss\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(23.81%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAcoustic Impedance\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eA-curve\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDPOAE\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAll in the normal range\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eABR\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAll in the normal range\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eASSR\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAll in the normal range\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eSubsequently, objective audiological indicators were further examined in our centre. ABR testing displayed a normal bilateral response, with all recorded waves being regular. The binaural ABR response threshold was 25dB, and the binaural ASSR response threshold was 20dB (Fig.\\u0026nbsp;2). The patient's ABR, ASSR, and DPOAE were all within the normal range, leading to the consideration of the diagnosis of functional deafness. The patient was referred for psychological intervention and fully recovered. This case highlights the need for objective audiological evaluations when assessing functional hearing loss in adolescents.\\u003c/p\\u003e \\u003cp\\u003eCauses analysis of 21 patients with deafness\\u003c/p\\u003e \\u003cp\\u003eThis study presents a thorough analysis of potential factors contributing to functional hearing loss in 21 patients (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Academic stress was identified as a significant factor in 4 patients (19.05%), highlighting the potential psychological impact of intense academic pressures on auditory health. Interpersonal conflicts, particularly violence perpetrated by parents or teachers, accounted for 3 cases (14.29%), emphasizing the damaging effects of emotional and physical abuse on hearing ability. Conflicts with classmates, though less prevalent, were reported in 1 patient (4.76%), indicating that social stressors may also play a role. One (4.76%) patient experienced a history of intimidation from parents and one (4.76%) patient had a history of brief noise exposure. Anxiety and depression-related personality traits were reported in 5 patients (23.81%), showing a notable correlation between mental health conditions and functional hearing loss. Lastly, the largest proportion of patients, 10 individuals or 47.62%, reported an unknown reason for their deafness. This underscores the complexity and often elusive nature of identifying the root cause of hearing loss, which further complicates clinical diagnosis and treatment.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCauses analysis of 21 patients with deafness\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCauses\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAcademic stress\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4(19.04%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eViolence by parents or teachers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3(14.29%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eConflicts between classmates\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eScare\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eExposure to noise\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnxiety and depression personality\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(23.81%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMedicine\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGenetic factor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnknown reason\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10(47.62%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eTreatment options and prognosis\\u003c/p\\u003e \\u003cp\\u003eIn our group, one patient who was lost to follow-up was excluded from the 21 patients. The average follow-up time for these patients was 15.23 months. In terms of treatment, the majority of patients (55%) received psychological counseling or intervention, indicating that a significant number of cases were linked to psychological factors or conditions that required non-pharmacological management. Conversely, neurotrophic medication was prescribed for a smaller portion of patients (25%), suggesting that pharmaceutical treatment was not the primary therapeutic approach in this sample. Additionally, 20 percent of patients did not receive any treatment. In regards to prognosis, our data shows a very positive outcome for most patients, with 95% reporting complete recovery. However, One patient showed partial recovery of hearing; however, the improvement remained incomplete, and the condition was further complicated by the onset of otitis media, which may have contributed to the limited recovery. The treatment options and prognosis are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eTreatment and prognosis\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePatients(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTreatment\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMedication\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePsychological counseling or intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11(55%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo treatment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4(20%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eprognosis\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRecover completely\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19(95%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePartially recovered\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo improvement\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLoss to follow-up\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1(4.76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eFunctional hearing loss is a rare manifestation of functional neurological disorders (FNDs), presenting with monaural or bilateral sequential onset [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. It is often caused by acute and intense mental stimulation or psychological and social factors that lead to long-term psychological stress and internal conflict [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Therefore, the incidence rate of functional hearing loss is high in young females workers due to psychological pressure or mental trauma [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. However, functional hearing loss has been less frequently reported in adolescent [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. In this article, we analyze the clinical features of 21 cases of dysthymic deafness in adolescent and provide a detailed consultation regarding a child who displayed symptoms without any history of trauma, which also presented difficulties in diagnosis.\\u003c/p\\u003e \\u003cp\\u003e The mental and psychological development of children and adolescents is still maturing, and their ability to cope with psychological stress is relatively limited. In recent years, there has been a noticeable rise in mental and psychological issues among children and adolescents [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Our study's analysis, presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, underscores the diverse causes of deafness among the 21 patients studied. The significant role of academic stress as a causative factor (19.04%) emphasizes the need to recognize and address psychosocial stressors as potential contributors to functional hearing loss. The prevalence of violence by parents or teachers (14.29%) highlights the critical importance of safe and nurturing environments in protecting auditory health. The correlation between deafness and anxiety-depression personality traits (23.81%) further emphasizes the intricate relationship between mental health and auditory outcomes, suggesting that mental health interventions may be beneficial in managing functional hearing loss. Additionally, the high proportion of cases with unknown causes (47.62%) underscores the complex and heterogeneous nature of functional hearing loss, emphasizing the ongoing need for comprehensive studies to understand the underlying causes and develop targeted interventions.\\u003c/p\\u003e \\u003cp\\u003eIn this article, it was discovered that 66.67% of cases of dysthymic deafness originated from only one ear. If the clinician lacks experience, there is a risk of misdiagnosis or missed diagnosis. When a patient complains of hearing loss in one ear, it is important to differentiate between organic deafness (e.g., sudden deafness, mumps infection, acoustic neuroma, otitis media, trauma, surgery, and congenital unilateral deafness) and non-organic deafness (e.g., hysterical deafness and simulated deafness) [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. A history of sudden hearing loss and the patient's unusual mental state can provide important clues. Patients with functional hearing loss often show behaviors that may be mistaken for genuine hearing loss, and standard audiometric tests such as tuning fork and whisper tests are not very helpful. King PF found that the responses of patients with functional hearing loss to successive audiometric tests were inconsistent [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. He used ascending and descending intensity scales in pure-tone audiometry tests and observed divergent results in the first test. Therefore, in cases where pure-tone audiometry tests produce different results, it is important to conduct early objective auditory examinations such as ABR, ASSR, and DPOAE. The latency and V wave response threshold of ABR in patients with functional hearing loss were found to be normal.\\u003c/p\\u003e \\u003cp\\u003eOtolaryngologists should make accurate diagnoses as early as possible, and subsequent treatment should be handled by psychiatrists. Interest in functional neurological disorders has significantly increased over the past few decades [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. Patients who present with physical symptoms for which no disease pathology can be found are common in medical practice [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Symptoms are maintained by a set of beliefs regarding the symptoms and by associated maladaptive behavior. Functional hearing loss differs from sensorineural hearing loss in that it is not caused by structural damage to the ear or auditory pathways. Instead, it stems from issues within the central nervous system, including psychological, emotional, and neural regulation disruptions [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. The primary mechanism of functional hearing loss involves interference with the brain's ability to process auditory signals, often linked to factors like psychological stress, anxiety, and post-traumatic stress [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Targeted psychological interventions and behavioral therapies have shown promise in alleviating or even reversing functional hearing loss, thereby restoring normal auditory perception [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. Koelen et al. concluded that there were positive benefits from psychotherapeutic interventions in terms of physical symptoms and functional impairment [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]. However, it should be pointed out that if treatment is improper and repeated several times without success, physical symptoms will turn into chronic symptoms, thus increasing the difficulty of treatment [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. In future work, otolaryngologists, neurologists, psychiatrists, physiotherapists, and relevant specialists should be encouraged to work extensively together to find more effective ways to improve the health and prognosis of patients with functional hearing loss in adolescent [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e].\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eRegarding children with functional hearing loss, it\\u0026apos;s important to rule out any physical issues that could be causing the deafness. Sudden onset of hearing loss and unusual mental behavior should be taken seriously. It\\u0026apos;s crucial to conduct objective tests of the patient\\u0026apos;s hearing as soon as possible, especially for children who show inconsistent results on multiple hearing tests. Accurate diagnosis and prompt treatment are vital for the patients\\u0026apos; prognosis. For children with dysthymic disorders, timely and effective psychotherapy often leads to better outcomes, which requires a well-established multidisciplinary cooperation system.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study and its design were approved by the Medical Ethical Commission of Qilu\\u0026nbsp;Hospital\\u0026nbsp;of\\u0026nbsp;Shandong\\u0026nbsp;University. Participants were informed of the purposes and procedures before the study commenced. In accordance with Declaration of Helsinki, we obtained written informed consent from all children and their parents or legal guardians.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe present study was supported in part by the Natural\\u0026nbsp;Science\\u0026nbsp;Foundation\\u0026nbsp;of\\u0026nbsp;Shandong\\u0026nbsp;Province (no.ZR2022QH373, ZR2022QH292 and ZR2023MH2474).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eK.Z., R.Q. and H.Z. designed the research and analyzed the data. X.X. and B.H. acquired the data and created a draft of the manuscript; X.H., T.Y. and R.Q. conducted and further performed the study, processed and analyzed the data. H.Z. and X.X. supervised the research. All authors read and approved the manuscript and agree to be accountable for all aspects of the research in ensuring that the accuracy or integrity of any part of the work are appropriately investigated and resolved.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eworld health organization (WHO), Deafness and hearing loss. 20 March 2019. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss.\\u003c/li\\u003e\\n\\u003cli\\u003eSchreiber BE, Agrup C, Haskard DO. Sudden\\u0026ensp;sensorineural hearing loss[J]. Lancet, 2010,375(9721):1203-11.\\u003c/li\\u003e\\n\\u003cli\\u003eLi YT, Bai K, Li GZ, Hu B, Chen JW, Shang YX, Yu Y, Chen ZH, Zhang C, Yan LF, Cui GB, Lu LJ, Wang W. Functional to structural plasticity in unilateral sudden sensorineural hearing loss: neuroimaging evidence. Neuroimage. 2023,283:120437. doi: 10.1016/j.neuroimage.2023.120437. \\u003c/li\\u003e\\n\\u003cli\\u003eChandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, Hollingsworth DB, Kelley DM, Kmucha ST, Moonis G, Poling GL, Roberts JK, Stachler RJ, Zeitler DM, Corrigan MD, Nnacheta LC, Satterfield L. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019;161(1_suppl):S1-S45. doi: 10.1177/0194599819859885. \\u003c/li\\u003e\\n\\u003cli\\u003eHao W, Ye L, Yu H, Li H. Prognosis of vestibular dysfunction in idiopathic sudden sensorineural hearing loss with vertigo: a prospective cohort study. J Neurol. 2023 Nov;270(11):5516-5526. doi: 10.1007/s00415-023-11894-w. \\u003c/li\\u003e\\n\\u003cli\\u003eChoi HG, Min C, Kim SY. Air pollution increases the risk of SSNHL: A nested case-control study using meteorological data and national sample cohort data[J]. Sci Rep, 2019,9(1):8270. \\u003c/li\\u003e\\n\\u003cli\\u003eFrosolini A, Franz L, Daloiso A, de Filippis C, Marioni G. Sudden Sensorineural Hearing Loss in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Diagnostics (Basel). 2022 Dec 12;12(12):3139. doi: 10.3390/diagnostics12123139\\u003c/li\\u003e\\n\\u003cli\\u003eHussain SAS, Hohman MH. Nonorganic Functional Hearing Loss. 2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.\\u003c/li\\u003e\\n\\u003cli\\u003eAdeloye A. Hysterical\\u0026ensp;deaf-mutism in a Nigerian soldier[J]. Lancet M 1972,2(7788):1200-1.\\u003c/li\\u003e\\n\\u003cli\\u003eJennifer R. HYSTERICAL SENSORY APHASIA-WORD-DEAFNESS-IN A CHILD[J]. JAMA, 2001,285(16):2054. \\u003c/li\\u003e\\n\\u003cli\\u003eJAMA 100 Years Ago: HYSTERICAL SENSORY APHASIA-WORD-DEAFNESS-IN A CHILD. JAMA. 2001,285(16):2054.\\u003c/li\\u003e\\n\\u003cli\\u003eConroy K, Malik V. Hearing loss in the trenches - a hidden morbidity of World War I[J]. J Laryngol Otol, 2018,132(11):952-955. \\u003c/li\\u003e\\n\\u003cli\\u003eHiraumi H, Tsuji J, Kanemaru S, Fujino K, Ito J. Non-organic hearing loss. Acta Otolaryngol Suppl. 2007,(557):3-7. doi: 10.1080/03655230601065142. \\u003c/li\\u003e\\n\\u003cli\\u003eSchmidt CM, am Zehnhoff-Dinnesen A, Matulat P, Knief A, Rosslau K, Deuster D. Nonorganic hearing loss in children: audiometry, clinical characteristics, biographical history and recovery of hearing thresholds. Int J Pediatr Otorhinolaryngol. 2013,77(7):1190-3. doi: 10.1016/j.ijporl.2013.04.037.\\u003c/li\\u003e\\n\\u003cli\\u003eCompas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, Williams E, Thigpen JC. Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychol Bull. 2017 Sep;143(9):939-991. doi: 10.1037/bul0000110. \\u003c/li\\u003e\\n\\u003cli\\u003eG\\u0026aacute;lvez-Lara M, Corpas J, Moreno E, Vencesl\\u0026aacute; JF, S\\u0026aacute;nchez-Raya A, Moriana JA. Psychological Treatments for Mental Disorders in Children and Adolescents: A Review of the Evidence of Leading International Organizations. Clin Child Fam Psychol Rev. 2018 Sep;21(3):366-387. doi: 10.1007/s10567-018-0257-6. \\u003c/li\\u003e\\n\\u003cli\\u003eLin PH, Hsu CJ, Lin YH, et al. Etiologic and Audiologic Characteristics of Patients With Pediatric-Onset Unilateral and Asymmetric Sensorineural Hearing Loss[J]. JAMA Otolaryngol Head Neck Surg,2017,143(9):912-919. \\u003c/li\\u003e\\n\\u003cli\\u003eVila PM, Lieu JE. Asymmetric and unilateral hearing loss in children[J]. Cell Tissue Res. 2015,361(1):271-8.\\u003c/li\\u003e\\n\\u003cli\\u003eKing PF. Psychogenic Deafness[J]. Proc R Soc Med, 1954,47(11):941-2.\\u003c/li\\u003e\\n\\u003cli\\u003eEspay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, LaFaver K, LaFrance WC Jr, Lang AE, Nicholson T, Nielsen G, Reuber M, Voon V, Stone J, Morgante F. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2018,75(9):1132-1141. doi: 10.1001/jamaneurol.2018.1264. \\u003c/li\\u003e\\n\\u003cli\\u003eHallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022,21(6):537-550. doi: 10.1016/S1474-4422(21)00422-1. \\u003c/li\\u003e\\n\\u003cli\\u003eKaton S, Carson A, Duncan R, et al. Symptoms unexplained by organic disease in 1144 new neurology out-patients: how often does the diagnosis change at follow-up[J]. Brain, 2009, 132(Pt 10):2878-88.\\u003c/li\\u003e\\n\\u003cli\\u003eWitth\\u0026ouml;ft M, Hiller W. Psychological approaches to origins and treatments of\\u0026ensp;somatoform disorders[J]. Annu Rev Clin Psychol, 2010,6:257-83.\\u003c/li\\u003e\\n\\u003cli\\u003eNelson SC. Non-organic hearing loss. J R Army Med Corps. 2012,158(4):329-30. doi: 10.1136/jramc-158-04-11. \\u003c/li\\u003e\\n\\u003cli\\u003eNallet, Carolinea,b,; Gervain, Judita,b,c. Atypical neural oscillations in response to speech in infants and children with speech and language impairments: a systematic review. Hearing, Balance and Communication 2022,20(3):p 145-154. doi: 10.1080/21695717.2022.2084864.\\u003c/li\\u003e\\n\\u003cli\\u003eCardon G, Cate M, Cordingley S, Bown B. Auditory Brainstem Response in Autistic Children: Implications for Sensory Processing. Hearing Balance Commun. 2023;21(3):224-232. doi:10.1080/21695717.2023.2181558.\\u003c/li\\u003e\\n\\u003cli\\u003ePflug C, Kiehn S, Koseki JC, Pinnschmidt H, M\\u0026uuml;ller F, Nienstedt JC, Fl\\u0026uuml;gel T, Niessen A. Prognostic factors in non-organic hearing loss in children. Int J Audiol. 2022,61(5):400-407. doi:10.1080/14992027.2021.1922942.\\u003c/li\\u003e\\n\\u003cli\\u003eKoelen JA , Houtveen JH , Abbass A, et al. Effectiveness of psychotherapy for severe somatoform disorder: meta-analysis[J]. Br J Psychiatry, 2014, 204(1):12-19.\\u003c/li\\u003e\\n\\u003cli\\u003eMyers L, Sarudiansky M, Korman G, Baslet G. Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy Behav Rep. 2021,3;16:100478. doi: 10.1016/j.ebr.2021.100478.\\u003c/li\\u003e\\n\\u003cli\\u003eLehn A, Gelauff J, Hoeritzauer I, et al. Functional neurological disorders: mechanisms and treatment[J]. Journal of neurology, 2016,263(3):611-20.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pediatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bped\",\"sideBox\":\"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bped/default.aspx\",\"title\":\"BMC Pediatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Functional hearing loss, Nonorganic, Sudden, adolescent\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5173879/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5173879/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eFunctional hearing loss refers to a type of hearing impairment that occurs without any identifiable organic damage to the auditory system. Most of the existing literature focuses on adults, with little attention given to the pediatric population. However, there is an increasing number of psychosomatic issues among children and adolescent, and dysthymic deafness in adolescent is not uncommon in clinical practice.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eIn our article, we presented 21 cases of functional hearing loss in adolescent treated in our center over the last 3 years. We summarized our experience in diagnosing and treating these cases to reduce diagnostic errors and improve the patients' quality of life.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe study identifies academic stress (19.04%), Violence by parents or teachers (14.29%), interpersonal conflicts (4.76%), and mental health issues such as anxiety and depression (23.81%) as significant factors contributing to the development of functional hearing loss. Additionally, 47.62% of patients reported an unknown reason for their deafness. We found that 66.67% of dysthymic deafness was monaural, making it difficult to differentiate it from sudden deafness. It's important to note that in functional hearing loss, a history of sudden onset of hearing loss deserves attention, and the unusual mental demeanor of the patient may be helpful. Objective auditory examination should be carried out as early as possible for those patients with sudden unilateral deafness who were inconsistent on successive audiometric tests.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eAccurate diagnosis and treatment are crucial for the prognosis of patients. For childhood dysthymic disorders, timely and effective psychotherapy often leads to a better prognosis, which requires a well-established multidisciplinary cooperation mechanism.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Unexplained sudden sensorineural hearing loss in adolescent: a warning for functional hearing loss\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-04-10 04:40:29\",\"doi\":\"10.21203/rs.3.rs-5173879/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-09-02T05:00:36+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-04-29T10:46:17+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-08T09:41:03+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"69645554036900663761892663883042065602\",\"date\":\"2025-04-08T05:40:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-04-08T04:30:18+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-03-29T03:31:15+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Pediatrics\",\"date\":\"2025-03-29T01:33:50+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pediatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bped\",\"sideBox\":\"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bped/default.aspx\",\"title\":\"BMC Pediatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"6876c754-5acf-4af5-8628-a743df9caaa5\",\"owner\":[],\"postedDate\":\"April 10th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-10T07:24:15+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-04-10 04:40:29\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5173879\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5173879\",\"identity\":\"rs-5173879\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}