​Pseudohypacusis

Pseudohypacusis, also known as functional hearing loss and nonorganic hearing loss, is the name applied to intra-test and inter-test inconsistencies that cannot be explained by medical examinations or a known physiologic condition (Ventry and Chaiklin, 1965). Most persons who present with this condition are feigning a hearing loss for monetary or psychological gain, but a very small percentage of per- sons have subconscious motivations related to psychological problems (see Chapter 33).

Persons presenting with pseudohypacusis are often identified from inconsistencies in their responses to the puretones. In addition to general poor reliability during threshold searches, there is a tendency for the threshold to become poorer as more presentations are made (Green, 1978). Methods of identifying the pseudohypacusis by com- paring PT thresholds with other measures and the use of special tests are covered in Chapter 33. 

Practical Audiology

​Signs from the Case History

• Reported hearing loss from work; accident/event suggesting malingering
• Legal Action Causes
• Children seeking attention

Site of Lesion

• N/A

Severity of Loss

• Intentionally elevated manipulated thresholds

Tympanometry

• Type A; normal

Acoustic Reflexes

• Present or at normal levels

OAEs

• Present and Robust at normal levels

Pure Tone Audiometry

• Intentionally Elevated/Manipulated thresholds

Speech Audiometry (SRT/WRS/QuickSIN)

• SRT/PTA not in agreement
• Poor Word Recognition Scores

Additional testing for confirmation of diagnosis

• Stenger Test
  • Positive = No Response -> functional HL/malingering
  • Negative = Response -> True HL
• ABR
  • ​insure integrity of brain stem functionality