Background/Objectives: Cochlear implantation is a crucial intervention for individuals
with severe hearing loss, aiming to restore auditory function and improve quality
of life. The decision to recommend cochlear implantation critically depends on accurate
audiological evaluations. However, challenges arise when subjective assessments of
hearing loss do not align with objective audiological measurements, leading to potential
misdiagnoses. Comparisons are to be made between subjective and objective results,
with an investigation into the characteristics, warning signs, and risk factors of
functional hearing loss (FHL). Methods: A retrospective study of hearing loss presentations
at an otorhinolaryngological university clinic between 2020 and 2024 was performed,
whereby we collected FHL cases. The evaluation process included measurements of subjectively
perceived hearing loss through pure-tone audiometry, speech understanding, and communication
testing. The objective assessments comprised impedance measurement, otoacoustic emission
measurement, auditory brainstem responses, auditory steady-state responses, and medical
imaging. Results: During the studied period, 11 patients, with an average age of 35.2
years (13 to 64 years), who were originally referred for cochlear implantation evaluation
and subsequently diagnosed with FHL, were identified. The majority (10 patients) were
female. No organic cause was identified in four cases, while seven cases exhibited
some organic ear abnormalities insufficient to justify the reported hearing loss.
The degree of FHL ranged from 30 dB to 90 dB, with an average of 60 dB. Conclusions:
Diagnosing FHL is challenging and requires comprehensive assessment and interdisciplinary
collaboration. Failure to recognize it may lead to inappropriate treatment, including
unnecessary cochlear implantation. This study advocates for the mandatory integration
of ABR and ASSR in the clinical evaluation of all cochlear implant candidates to ensure
accurate diagnosis and optimal treatment.
