Management of Functional Hearing Difficulties Using Low-Gain Amplification: Case Reports on Auditory Processing Evaluations.

Background: Functional hearing difficulties are common among both the civilian population and military personnel with hearing thresholds less than 25 dB HL, particularly those exposed to blasts or with mild traumatic brain injuries (mTBIs). These individuals often report significant hearing challenges in noisy environments, despite "normal" audiometric thresholds. Low-gain hearing aids (LGHAs) have emerged as a promising intervention for managing these difficulties. Purpose: Describe the decision-making process for identifying a candidate for LGHAs and evaluate the outcomes. Research Design: Case reports. Study Sample: Three case reports of service members: two male and one female. Data Collection and Analysis: Three case reports who underwent auditory processing evaluations are presented to illustrate clinical decision-making and outcomes for patients with hearing thresholds less than 25 dB HL and functional hearing difficulties, highlighting the potential benefits and limitations of LGHAs. Results: Patient 1 exhibited improvement in functional hearing difficulties supported by standardized questionnaire results. Patient 2 initially struggled with hearing aid use but experienced significant benefit after device adjustments and counseling, as evidenced by increased usage and improved handicap scores. Patient 3, whose difficulties were attributed primarily to comorbid conditions rather than auditory system abnormalities, was referred for management of these conditions before any audiological intervention. Conclusions: These cases highlight the importance of individualized assessment and treatment strategies for optimizing outcomes. LGHAs are a feasible intervention for individuals with "normal" hearing thresholds who experience significant communication difficulties, particularly in challenging listening environments. These devices can provide measurable benefits, such as improved perceived speech understanding and reduced hearing handicap, making them a valuable option for this population. Clinical Relevance Statement: LGHAs offer a viable and measurable treatment option for patients with "normal" hearing thresholds who experience functional hearing difficulties, especially in noise. These case reports demonstrate how individualized assessment and device counseling can lead to improved communication outcomes, encouraging clinicians to consider amplification as part of a broader management strategy for this underserved population.