Pseudohypacusis/Pseudohypacusis/Nonorganic/Nonorganic/

Functional Hearing Loss:Functional Hearing Loss:

What do you do when someone What do you do when someone shows a hearing loss you don't shows a hearing loss you don't think is true?think is true?

InconsistenciesInconsistencies

Behavior vs. test resultsBehavior vs. test results SRT vs. PTASRT vs. PTA Air-Bone Gap and Type A Air-Bone Gap and Type A

tympanogramtympanogram No Shadow CurveNo Shadow Curve

Other ExplanationsOther Explanations

Psychogenic--Conversion Neurosis:Psychogenic--Conversion Neurosis: Psychological conflictPsychological conflict Similar to glove anaesthesia.Similar to glove anaesthesia.

Cortical Deafness: Cortical Deafness: Damage to primary auditory cortexDamage to primary auditory cortex or auditory association areas.or auditory association areas.

Malingering:Malingering:

Often in compensation casesOften in compensation cases IndustrialIndustrial MilitaryMilitary

In children, to get attentionIn children, to get attention Most often ages 10 to 12Most often ages 10 to 12

Tests for Tests for pseudohypacusis:pseudohypacusis:

The Stenger TestThe Stenger Test Delayed Auditory Feedback testsDelayed Auditory Feedback tests Swinging Story TestSwinging Story Test ABRABR Bekesy AudiometryBekesy Audiometry

The Stenger Test: The Stenger Test:

for use in unilateral HLfor use in unilateral HL Based on the Based on the STENGER EFFECTSTENGER EFFECT: :

If a listener is presented with the If a listener is presented with the same stimulus in each ear, she will same stimulus in each ear, she will only hear the tone in the ear in only hear the tone in the ear in which it is louder.which it is louder.

The Stenger Test (cont’d)The Stenger Test (cont’d)

tone 10 dB SL in better ear, -10 in tone 10 dB SL in better ear, -10 in poorer, if no response: caughtpoorer, if no response: caught

Minimum Contralateral Minimum Contralateral Interference Level: Lowest level at Interference Level: Lowest level at which you can get the Stenger which you can get the Stenger Effect, usually within 20 dB of real Effect, usually within 20 dB of real threshold.threshold.

Speech Stenger is like pure-tone Speech Stenger is like pure-tone although using SRTalthough using SRT

Delayed Speech Feedback Delayed Speech Feedback Test: Test:

person speaks into microphoneperson speaks into microphone output of mic is delayed (100-200 output of mic is delayed (100-200

ms)ms) seek level where DAF produces seek level where DAF produces

difficulty in speaking.difficulty in speaking.

Pure-tone DAF Test: Pure-tone DAF Test:

Called “Tone Tap Test”Called “Tone Tap Test” Ask person to tap a pattern over and Ask person to tap a pattern over and

overover beep delivered to the ear with each beep delivered to the ear with each

tap (with a delay) tap (with a delay) level of beep is raised until pattern level of beep is raised until pattern

changeschanges

Swinging Story Test:Swinging Story Test:

to catch a unilateral loss.to catch a unilateral loss. Story switches from one ear to Story switches from one ear to

both and to the other earboth and to the other ear Two possible meanings:Two possible meanings: --one if you hear whole story--one if you hear whole story --other if you hear only what is in --other if you hear only what is in

both ears or in good earboth ears or in good ear

Bekesy audiometry: Bekesy audiometry:

Looking for Type VLooking for Type V Person is trying to respond at a Person is trying to respond at a

consistent loudnessconsistent loudness Continuous tone produces greater Continuous tone produces greater

loudness than the interrupted toneloudness than the interrupted tone So, Cont gives lower So, Cont gives lower

thresholds//Inter gives higher thresholds//Inter gives higher thresholdsthresholds

Electrophysiological Tests: Electrophysiological Tests: ABRABR

““Objective” Assessment of hearingObjective” Assessment of hearing Beware higher level disorders, Beware higher level disorders,

(e.g., Cortical).(e.g., Cortical).

Electrophysiological Tests: Electrophysiological Tests: Acoustic ReflexesAcoustic Reflexes

VERY LOW SL’s--suspect VERY LOW SL’s--suspect malingeringmalingering

SPAR-- Sensitivity Prediction from SPAR-- Sensitivity Prediction from the Acoustic Reflexthe Acoustic Reflex

based on changes in AR thresh with based on changes in AR thresh with increasing stimulus bandwidth.increasing stimulus bandwidth.

Doerfler-Stewart Test:Doerfler-Stewart Test:

based on the effect of masking on based on the effect of masking on the SRT.the SRT.

Lombard Test: Lombard Test:

Raising of voice in presence of Raising of voice in presence of noise. noise.

Not a greatly sensitive or specific Not a greatly sensitive or specific test.test.