-Apparent loss of hearing sensitivity without an organic pathology to explain that loss.
-Nonorganic: either functional or malingering
-Truly cannot hear, but it is usually a psychological problem, for some psychological reason they can not hear
-Cortical deafness: they just stop hearing
-People in a traumatic situation can subconsciously choose to no longer hear
-Purposeful and willful
-They are actually faking a loss
-The reason can be to gain something
-Socioeconomic: Probably tied to lower academics b/c the higher ones know that they will probably not get away with faking
-Gender: More common in males than female
-Age: Teenage girls and young children
-IQ: Think they can get away with it
-Self Esteem: Usually they are struggling in school in this case
-Desire for Control
-Lack of Eye Contact
-Oblivious to Everything
-SRT < PTA
-BC > AC
-No Shadow Curve
-Ascending vs. Descending
-ARTs below Threshold
Why: What could be there problem?
-Unable to respond
-Check equipment first, always blame yourself first
-Check setting are correct
Why: Misinterpreted Instructions
-Say that "even if you barely hear it respond"
-Make sure they know they don't have to hear it well
Why: Poor Motivation/Attention
-If they are tired
-If they are bored
-Could have poor attention, so have an activity
Why: Unable to Respond
-Double check that they can respond (ex: raise your hand, but they arm is handicapped, so have them respond a different way)
-Or unwilling to respond - if you need to give them the button b/c the hand raising gets old and tiresome; change your response mode, have an activity to respond to maintain attention
Why: Concealed Handicaps
-Not always a handicap, but might be hiding that they are hurting (e.g., missing someone, being bullied, etc.)
-Could be an actual handicap or and emotional situation they are trying to avoid
-Kids would rather say they can't hear, rather than saying they are hurting physically/emotionally
-If it will keep them out or away from a certain situation
-EX: workers comp, military
Change Test Method
Ascend: If they say they can't hear till 80 dB, put in speech noise at speech noise and it will startle them
-Startle: Lets you know they are faking b/c they can hear it
-Below Threshold Comments: If they respond below you know they are faking
-Mind Games: A lot of them don't know that you can hear them, so they may respond without knowing you can hear them.
-Use a clinician they think is "cute" so they will talk to them
-Once someone else comes in and they act like they can't hear them โ you know they are faking
-Based on psychoacoustic research
-Say yes/no if you hear it or not
If two tones are played in each ear at the same time you will perceive the tone as louder in the ear with the higher intensity.
If they are played at the same intensity the tone will be perceived as in the midline or "in the head"
1. Instruct the patient to respond by raising his/her hand when they hear the signal.
2. Present two signals simultaneously, one in each ear.
3. Present signal 10 dB above threshold in the better ear.
4. Present signal 10 dB below threshold in the poorer ear.
5. Record results
FAKING HEARING LOSS
The patient chooses not to respond when the tone is louder in the poorer ear.
TRUE HEARING LOSS
The patient will respond when the tone is louder in the poorer ear.
-For lip reading
-Made of homophemous words - words you can not tell apart of the lips (e.g., bud - mud); can only way to tell apart by voicing
1. Instruct patient that their lip reading abilities will be measured by how many words they are able to repeat back to you.
2. Present homophemous words (words that can only be told apart by voicing) approximately 20 dB below their threshold.
3. If the patient gets 6 words or less correct, perform another lip reading test.
-True hearing loss: approximately 6 words correct
-Malingering (fake) hearing loss: > 6 words correct
Dichotic Digits: Procedure
1. Instruct the patient to respond by repeating the numbers they hear.
2. Present two digits, one each ear, simultaneously at the same intensity level.
3. Record whether the patient heard both digits, or just one digit.
Dichotic Digits: Results
-True hearing loss: the patient will respond by saying the number/word presented in the better ear.
-Malingering (fake) hearing loss: the patient responds by saying both numbers/words
1. Perform normal reflexes, both ipsi and contra at 500, 1000, and 2000 Hz, then with BBN
2. Then you have a choice to put in something other than tone, you can put in broadband noise (BBN) instead
3. The noise should come in lower b/c more of the BM is responding so start LOWER and stop at 100 dB
4. Then average the results together
5. Take the average then subtract the broadband noise from it
-Normal: Avg-BBN = > 20
-Mild: Avg-BBN = 15-20
-Moderate: Avg-BBN = 10-15
-Severe: Avg-BBN = 1-10
-Used for bilateral loss
-Based on the lombard effect
-You need something for them to read
Whenever you are in a situation and you start hearing noise (party/football game), you will raise your own voice when there is noise present
1. Place the transducer on the patient's ears (headphones or inserts).
2. Place a sound meter or turn on the speaker and the mic on the audiometer (use 2 channels) to monitor the patient's speech levels.
3. Ask the patient to read a passage from a book.
4. Introduce noise in both ears. The level of the noise will be dependent on the pure-tone scores. If the patient indicates that his threshold is at 60 dB HL, then play the noise at a level that the patient would definitively not hear if he/she had a hearing loss such as 30 dB HL.
5. If the patient reacts to the noise or starts reading at a higher level because of the noise then that is indicative of malingering or exaggerating the hearing loss.
6. Increase the noise level by 5 dB HL. If the patient increases the level of his/her voice then this is an additional sign of malingering.
if the patient is malingering a hearing loss, he/she will react to background noise and raise their voices while they read a test
Delayed Auditory Feedback (DAF) Test
-Have the patient read, and assess his/her voice quality
-Not incredibly accurate at finding an exact threshold
1. Instruct the patient to read a passage or pages of a book.
2. Place the transducer on the patient's ears (headphones or inserts).
3. Select a level at approximately 30 dB HK below the patient's threshold.
4. Instruct the patient to start reading.
5. Using an app or recording equipment record the patient as he/she reads.
6. Play the recording. The patient will hear a delayed recording of his reading.
7. If the patient stutters or has difficulties reading then this suggests malingering.
Malingering hearing loss: patient will react to the presence of his/her own delayed speech and will stutter, speak louder, or pause.
Switched Speech Test
-For unilateral loss
-If you go back and forth from one ear to the other fast enough, you will hear in both ears b/c you can't tell which side its coming from
-CD plays two stories, one in each ear; together they create a third fused story
Switched Speech: Procedure
1. Instruct patient to listen to the story on the CD.
2. Ask the patient questions about the story.
3. Determine whether the story information was fused.
-They are too busy counting, so they don't remember level they were faking at
1. Instruct the patient to count the number of beeps.
2. Present the same frequency at several intensities, while adding an intensity that they should not be able to hear.
3. Record the number of beeps the patient heard.
-True hearing loss: if they do not count the correct number of beeps.
-Malingering haring loss: if they do count the correct number of beeps.
-Trick the patient
-Be very careful not to get into a pattern - This could effect the results
1. Instruct the child to say "yes" if they hear a beep, or "no" if they do not hear a beep.
2. Make sure you do not create a pattern while presenting the tones.
-True hearing loss: they do not respond by saying "yes/no" when you play a tone.
-Malingering hearing loss: they respond by saying "no" when you play a tone.
Pitch Patterns Test
-Change the pitches b/w the beeps
-Then have them tell you the pattern
Pitch Patterns: Procedure
1. Instruct the patient to repeat the pattern back to you.
2. Change the pitch between each presentation of the signal.
3. Drop the intensity of one of the tones in the middle to trick them.
Pitch Patterns: Results
-True hearing loss: abnormal/absent OAE responses
-Malingering hearing loss: normal OAE responses
-Put a sound into the ear, if the peripheral system is working properly it will take the sound and put it back out through the ear
-Usually gone w/ a mild to moderate cochlear loss
-Once there gone, you can't rank the loss
-So someone comes in with a moderately severe HL, if there is nice pretty OAEs they are either faking or it's a retrocochlear loss
-If retrocochlear, do WRS testing
-With WRS if there is no roll-over there are faking