Presentation on theme: "SPA 4302 Summer 2006 Nonorganic Hearing Loss. Some Terminology PseudohypacusisPseudohypacusis – False hearing loss FunctionalFunctional – Loss with no."— Presentation transcript:
Some Terminology PseudohypacusisPseudohypacusis – False hearing loss FunctionalFunctional – Loss with no organic disorder detected. PsychogenicPsychogenic – Loss/disorder arising from psychological conditions, hysterical deafness –older synonym was hysterical deafness NonorganicNonorganic – Apparent loss with no known disorder or insufficient evidence to explain it MalingeringMalingering – deliberately faking a loss
Patients with Nonorganic Hearing Loss Adults seeking financial or other gain (predominantly male) Children seeking attention or ? Persons with psychological disorders –conversion neurosis
What are the first signs? Disagreement: –among test results SRT vs PTA Audiometric vs AR thresholds, etc) –between test results and behavior Lack of Crossover –no shadow curve in the unmasked results Odd results –Repeating half of the spondees?
Tests for Nonorganic Hearing Loss The Stenger – for unilateral HL Delayed Auditory Feedback Tests –Tone Tap Test –Delayed Speech Test –Varying Intensity Story Test –Objective tests (AR, AEPs, OAEs)-
The Stenger Based on the “Stenger Phenomenon” When a listener is presented with the same type of sound in both ears, s/he will only hear a single sound and hear it in the ear in which it is louder. 2 tones: –At + 10 dB SL in good ear –At – 10 dB SL in “bad” ear If no response: you’ve caught them! --why? –Part II: reduce level in “bad” ear until they respond: “minimum contralateral interference level” --an estimate of the true threshold.
RE STIMULUS INITIAL LE STIMULUS Stenger Example at 1000 Hz
Delayed Auditory Feedback Tests Delayed speech test: Have pt talk while you play back their own voice to them with a 200 ms delay. Gradually raise level: when they hear their own voice, they will change their speech (intensity, rate, fluency) Pure tone DAF (Tone Tap Test): Have pt tap out a rhythm on a pressure transducer. Each tap will generate a tone. Gradually raise level of tone: when they hear the delayed tones, they will change their pattern of tapping.
Varying Intensity Story Test Patient is asked to listen to a story in one ear, parts are presented above the threshold and some parts are presented below the threshold The story is presented so rapidly that it is difficult for listeners to distinguish what they can admit to have heard and what they should not The listener is then asked questions about the story The topic of discussion changes based on whether or not they could hear the parts of the story presented below their threshold –Information on china (dishes) is presented above threshold –Information on China (the country) is presented below the threshold and fits into the other story line, thus changing the story topic if the patient is faking a hearing loss
Objective tests (AR, AEPs, OAEs) AR Өs at extremely low SL’s –e.g., pure tone Ө of 60 & AR Ө of 80. –SPAR: calculating audiogram from AR Өs AEP’s : objective Ө estimation – Tests we’ve already discussed –Auditory Steady State Responses (ASSRs) OAEs: measures of cochlear health –Valuable in noise exposure cases in particular
Management of Patients with Nonorganic Hearing Loss Once you have identified the problem: –let them know you know –shift blame onto your shoulders If they don’t come ‘round?... –don’t report audiometric thresholds if you don’t believe them –In your report, be careful about the terms you choose.