Functional hearing loss and its relationship to resolved hearing levels.

The nature of functional hearing loss was retrospectively studied with respect to hearing sensitivity after resolution of the nonorganic components in 63 adults with bilateral exaggerated losses (126 ears). The configuration of the functional components (difference between the functional and resolved thresholds) was found to be related to that of the resolved hearing levels. The size of the functional overlay was essentially the same across the audiometric frequency range when the hearing was actually normal or if there was only mild loss. In cases of precipitously sloping high-frequency losses, the magnitude of the functional overlay became dramatically smaller for the impaired frequencies than for lower frequencies where hearing was normal or only mildly impaired. Moderate and severe losses represented a transitional situation, in which the functional components became gradually smaller with increasing frequency. Subjects with different resolved hearing in each ear (e.g., mild loss in one ear and a precipitous loss in the other) demonstrated nonorganic overlays that were consistent with the actual hearing levels for each respective ear. The findings suggest the use of an internalized, loudness level-based anchor by subjects with functional losses: the test signal must sound as loud as the anchor at each frequency in order for an exaggerated threshold response to be volunteered at that respective frequency. The pure-tone audiometric configuration and amount of functional loss at least in bilateral cases is thus consistently accounted for on the basis of known and explainable auditory factors.