Two cases of psychogenic hearing loss in adults

Abstract

Two cases of psychogenic hearing loss in adults are presented with the process of their mental states. Case 1 was a 20-year-old male who complained of unilateral hearing loss and tinnitus on his left side after receiving a "karate" kick on his left temple. Considering the perforation of his left tympanic membrane, his left hearing level was much worse (77. 5 dBHL). Later examination of ABR revealed the sensorineural system to be intact, and functional hearing loss was suspected. Further questions about his history disclosed that he was extremely unhappy in his job and wanted to leave his present employment. After discussion with psychiatrists, the diagnosis of psychogenic hearing loss was established. Case 2 was a 23-year-old male who complained of right tinnitus after hearing rifle shooting during night time maneuvers in the Self Defense Forces. In spite of the normal appearances of his external and middle ear, his hearing level was 72. 5 dBHL. Being treated as acoustic trauma, ABR was performed and it resulted in a completely normal response. In this case, the diagnosis of psychogenic hearing loss was also established. Especially in adults, psychogenic hearing loss is regarded as a kind of conversion disorder. In this disease, getting ill brings some "gain" to the patients. Admission to the hospital separates a patient from his unpleasant job and persons (secondary gain). This is almost compatible with the mental state of case 1. When their desires are converted to physical disorders and are appreciated by another person, they don't have to be concerned by their source of annoyance. Thus their mental states are stabilized (primary gain). This is almost compatible with the mental state of case 2. When assessing patients of psychogenic hearing loss, their mental states should be considered as there may be various processes involved in the disease.