A Thought on “Self-Reported Hearing Difficulties”

Response to Letter to the Editor from Peck

In their fine article, [Roup et al (2018)] found that patients who complained of hearing difficulty (HD) despite normal pure-tone thresholds had decreased central auditory processing abilities. The authors concluded that patients with such complaint may need more extensive testing.

This writer’s experience ([Peck, 2011]) with a small number of patients aligns with that of Roup et al, as well as with the literature and obscure auditory disorder. However, there are patients whose HD, whether or not due to a central auditory processing disorder, may have an additional explanation. They complain credibly of difficulty understanding speech, yet they are easily tested, display normal sensitivity, and have no explanatory history. They tend to be female, young adults, and achievement oriented. Their hearing complaint goes back months or a few years, and arose during a difficult time in their lives. They feel considerable stress, expect much of themselves, and know or suppose that others have high expectations of them, too. They are also dealing with much sadness.

It seems unlikely that people with a central auditory processing disorder would function well through the first two decades of life with no academic difficulties or unusual trouble understanding in noise. Moreover, these patients’ HD had an onset that coincided with a terrible stress and/or sorrow in their lives. Tellingly, some had unexplained bowel complaints.

The key element here is the time line. As with any complaint, a clinician must ask when did it start, but in such cases as these, it is important also to ask what else was going on at the same time. People with HD may need further auditory testing, but they may also need consideration of psychological issues.

• REFERENCES

• Peck JE. 2011. Pseudohypacusis: False and Exaggerated Hearing Loss. San Diego, CA: Plural Publishing;
• Roup CM, Post E, Lewis J. 2018; Mild-gain hearing aids as a treatment for adults with self-reported hearing difficulties. J Am Acad Audiol 29: 477-494