The clinical assessment of obscure auditory dysfunction--1. Auditory and psychological factors.

We define obscure auditory dysfunction (OAD) as the clinical presentation of reported difficulty understanding speech in the presence of noise accompanied by clinically "normal" hearing thresholds, and no other obvious cause. The term deliberately avoids particular pathophysiological connotations. A detailed characterization of such patients was undertaken as the basis for future diagnosis and management of OAD by clinicians. Twenty patients were compared with 20 pairs of controls (matched for age, sex, educational level, and noise exposure) on tests of auditory, linguistic, and psychological function. Patients showed a genuine performance deficit on a speech-in-noise task, due in part to minor auditory dysfunction and poor linguistic ability. Their high level of self-rated disability and handicap cannot, however, be entirely explained by this genuine deficit. An anxious personality and a history of otological symptoms typified the patient group; either or both have presumably contributed to patients' seeking of medical or audiological advice. OAD is thus a multifactorial syndrome with contributions from auditory, psychological, and linguistic factors. The variance in (and correlation between) performance levels on two sentence-in-noise tests, present only within the patient group, indicates that these patients are not a homogenous group.