APPLICATION

Functional Hearing Loss in Children

An objective, non-confrontational threshold check when a child's behavioural audiogram does not add up.

What the cortical response shows

  • A robust cortical response at levels better than the volunteered thresholds confirms hearing is essentially normal, without confronting the child.[6]
0100200300400latency (ms)Stimulus at 30 dB HL
A cortical response present at low levels reassures that hearing is essentially normal when a child volunteers inconsistent or exaggerated behavioural thresholds.

Audiogram companion

The pure-tone audiogram below accompanies the scenario. Reading the volunteered thresholds against the objective cortical result is the core skill on this page.

0204060801002505001k2k4k8kFrequency (Hz)
○ Right — PTA 48 dB (Moderate)✕ Left — PTA 47 dB (Moderate)
Pure-tone audiogram companion. dB HL increases downward, following clinical convention. Illustrative thresholds — not recorded patient data.

Why the cortical response here

  • Functional (non-organic) hearing loss is not uncommon in children, where behavioural testing can be inconsistent and an objective threshold is reassuring to all involved.[5]

How it changes management

  • The objective result reassures family and school and redirects attention to any underlying psychosocial contributors rather than to amplification.

TEACHING POINT

In a child with an audiogram that does not fit, an objective cortical threshold settles the question gently and definitively.[5]

Sources for this page are listed on the References page. Browse all applications from the atlas home.