Occasionally patients will present with a complaint of hearing loss though, in fact, there is no loss. These individuals fall into two broad categories: those who consciously "fake" a loss (malingerers) and those who have psychological disturbances, usually of the hysterical type. The malingerers are often seeking compensation for some sort of injury, or have some other agenda whereby they will gain from their loss, such as a disability determination. The individuals with hysterical loss tend to be in the younger age group. These patients may be suffering from emotional stress and are not usually consciously shamming, although some secondary gain may be involved, as with other hysterical disorders. An office evaluation with simple clinical intuition and tuning fork testing may reveal inconsistencies with either type of patient, although the malingerers may be quite clever and convincing.
In either case, a good audiologist can perform special tests to prove and document the fictitious loss, whether unilateral or bilateral. The scope of this text precludes a detailed description of these procedures and how they work, but the Stenger and Doefler-Stewart tests, done with just a conventional audiometer, can catch the most skilled malingerers. Auditory brainstem recording (ABR) and acoustic reflex measurements, which do not depend on a patient's voluntary responses, can also be performed. ABR testing measures brainstem potentials in response to sound stimuli and is also a useful tool in the very young or mentally handicapped patient.
When malingering or hysteria is suspected, it is best for the primary physician to get early consultation from the ENT specialist, who can evaluate the patient before ordering the appropriate audiometric studies.
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