8.1 Non-organic Hearing Loss

• Presentation:

Consistent display of auditory deficit when none exists or exaggeration of a real hearing loss

Need high index of clinical suspicion for diagnosis

May be more common in those seeking compensation claims and adolescent girls with underlying psychological concerns

• Investigations:

Tuning forks: e.g., Stenger test

Pure tone audiogram: may show erratic or hesitant performance; look for denial of crossover effect (when stimulus >70 dB played to “deaf” ear it should be heard by the nontest ear)

Tympanometry: normally stapedial reflex 70–95 dB greater than the pure-tone threshold; if thresholds are within 20 dB or less—NOHL likely

Otoacoustic emission (OAE), evoked response audiometry (especially cortical responses): provide objective assessment

Speech audiometry: harder to “fake”

Delayed auditory feedback test

• Management:

Main aim is recognition of NOHL and ascertaining the true auditory thresholds

In child patient with psychological issues, normally disappears within a few weeks or months, but up to 20% may require referral to psychiatry

8.2 Auditory Processing Disorder

• Definition

Also known as: selective dysacusis, King–Kopetzky syndrome, obscure auditory dysfunction

An umbrella term for a variety of disorders that affect the way the brain processes auditory information; relates to the difference between hearing and listening

NB: not = malingering!

• Presentation

Convincing self-report of auditory disability accompanied by normal pure-tone thresholds