LM104 - Looking Back to Move Forward: A Retrospective on FHD in Clinical Practice

Abstract: Functional hearing difficulties (FHD), or self-reported hearing challenges despite a normal pure-tone audiogram, affect millions of adults and remain a source of clinical uncertainty among hearing healthcare professionals. This session presents real-world clinical data from a clinic and research lab actively assessing and managing FHD. Attendees will gain insight into patient demographics, common complaints, comorbidities, assessment results, and outcomes, with practical strategies for integrating FHD care into existing workflows. Join us to explore emerging clinical patterns, reflect on current practices, and engage in a data-driven conversation about evolving care models for this diagnostically complex and underserved population.

Summary: Functional hearing difficulties (FHD), defined as self-reported hearing challenges despite normal pure-tone thresholds (PTA ≤25 dB HL), represent a significant and often overlooked concern in audiologic practice. Approximately 10% of ENT referrals for hearing difficulty involve adults with normal audiograms, and recent survey data indicate that 45% of audiologists encounter 1–3 FHD patients monthly. Prevalence estimates suggest that up to 25.3 million adults, including 10–25% of younger adults and 51% of older adults, experience speech-in-noise difficulties and communication challenges in complex acoustic environments despite "normal hearing" as defined by the pure tone audiogram.

Despite its prevalence, FHD is often met with clinical uncertainty by audiologists and ENT physicians. Patients with FHD frequently report dissatisfaction with their care, describing experiences of being dismissed or misunderstood. This disconnect between patient-reported difficulties and the standard audiologic assessment highlights a critical gap in hearing healthcare. While attention to this population is mounting, many audiologists continue to express uncertainty about how to assess and manage FHD and how to integrate care for this population into existing workflows.

This session will present retrospective clinical data from our clinic, specific to adults with FHD. We will describe demographic characteristics, common presenting complaints, frequently reported comorbidities, and assessment findings. Preliminary data on management recommendations and outcomes will also be shared. These findings will be contextualized within the existing literature.

Attendees will gain a clear picture into one clinic's experience in actively providing both assessment and management services for adults with FHD allowing attendees to gain a clearer, data-driven picture of common trends and the vast diversity of the FHD population. By sharing real-world data from a clinic that routinely serves FHD patients, we aim to equip clinicians with tools and insights to better support this diagnostically complex population and tailor their clinical approach accordingly. Additionally, exploring clinical patterns and patient profiles may prompt new research questions and inspire future investigations into clinical operations workflow, assessment, and management strategies for FHD. The session will also encourage reflection on current practices and foster discussion around evolving care models based on the data provided.

Brief Summary of Clinical Takeaways: The clinical takeaway for this session is a clearer understanding of the patient profiles and audiologic assessment patterns associated with functional hearing difficulties, enabling clinicians to better recognize and respond to this diagnostically complex population.

Assumptions: Attendees should have foundational knowledge of adult audiologic assessment, suprathreshold testing, auditory processing disorders, and common comorbidities, as these will be referenced but not covered in depth.