Hearing

Pseudohypacusis

(false hearing loss, exaggerated hearing loss, non-organic hearing loss, functional hearing loss, or malingering)

Incidence reports of pseudohypacusis vary between 2% and 40% depending on the population being studied. The motivation to exaggerate hearing levels has usually to do with either attention or money.

Sometimes a hearing loss is feigned to bring attention to ones self; sometimes it is done to direct attention away from some other negative condition.

Money is most commonly the cause. If money is to be had as a result of hearing loss, 25% (according to my data) of people will give in to the temptation to exaggerate their hearing.

The literature is replete with techniques for identifying persons projecting or exaggerating hearing loss: comparison of the speech reception threshold to pure tone averages, Stenger test, otoacoustic emissions, Bekesy ascending-descending gap evaluation (BADGE), acoustic reflexes, and more.

Most pseudohypacusis is reasonably easy to detect if the audiologist specifically checks threshold reliability. A patient who is providing accurate threshold responses will reliably return to the threshold level, within 5 dB, whether threshold is approached in an ascending manner, or a descending manner.

However, it is not so clear what one should do after it is discovered that the patient is exaggerating. In adults who will get money as a result of hearing loss, I generally explain the result inconsistencies and reinstruct them up to three times. If accurate results are not obtained after 3 attempts, the audiogram is stopped and I may or may not seek what objective measure of audition can be obtained.

In young children, around about age 6, accurate thresholds usually can be obtained after some coaxing and imaginative threshold seeking techniques (such as counting the number of “beeps”).

In older children, usually about age 14, parents are often awaiting the “verdict” and can be perturbed if they discover that their 14 year old has been running them from specialist to specialist with an unfounded complaint. In most cases, honesty is the best policy all the way around.