Hearing impairment and paraphrenia.

An elderly resident of a Home for the Aged, with an admission diagnosis of senile dementia, was referred for psychiatric assessment. Mental state examination revealed intact cognitive functions, but attitudes and beliefs symptomatic of paraphrenia, a late onset form of schizophrenia. Noting apparent hearing impairment, the psychiatrist suggested the patient be referred to the ENT clinic. ENT examination and audiological assessment revealed severe mixed hearing loss bilaterally, probably originating in early childhood. A hearing aid was prescribed, and the patient adjusted well to its use. On subsequent psychiatric examination, the patient demonstrated fewer disturbed behaviors and less delusional thought. It is suggested that conjoint assessment and treatment may be of benefit in diagnosis and management of behaviorally disturbed geriatric patients.