Current Evaluation of Pseudohypacusis: Strategies and Classification

Abstract

Some cases of pseudohypacusis may involve medicolegal aspects and require a confirmed and quantitative diagnosis. These challenging cases must be identified, and then evaluated with basic audiologic and sophisticated electrophysiologic tests. Data on 64 patients with pseudohypacusis collected over a 4-year period are reported. A classification system was developed from an analysis of these cases and is presented for clinical evaluation and diagnosis. In many cases, conventional audiologic evaluation involving pure tone and speech audiometry may be adequate and sufficient for diagnosis. In more complex cases, evoked otoacoustic emissions (EOAEs) and auditory brain stem responses (ABRs) are needed for confirmation of peripheral auditory sensitivity. We found that EOAEs were the most rapid economical, and objective method, and confirmed the diagnosis of hearing loss in 78.1% of cases. Fifteen percent of subjects required ABRs to substantiate the diagnosis. The reliability of basic audiologic tests based on previous clinical investigations and data from the literature are discussed. We conclude that a thorough knowledge and understanding of pseudohypacusis is essential to verify the existence of pseudohypacusis, to determine its type, and to quantify the auditory thresholds.

Diagnostic tools in pseudohypacusis in children

“…The recording of normal evoked otoacoustic emissions usually confirms normal middle ear and cochlear function, thereby ruling out a moderate to severe hearing loss and the presence of conductive components. Qiu et al found that evoked otoacoustic emissions were the most rapid, economical and objective method, which confirmed the diagnosis of hearing loss in 78.1% of cases in their reported series [6].…”

“…The prevalence of pseudohypacusis is estimated at 1.35% based on a study involving 4720 patients [6]. However, the true prevalence may be higher as pseudohypacusis goes unrecognised in many cases [3].…”

“…Testing of evoked otoacoustic emissions can be used initially to confirm the hearing status in patients with pseudohypacusis [6]. Evoked otoacoustic emissions can be recorded in nearly all ears with normal or near normal hearing.…”

Acute-Onset Unilateral Psychogenic Hearing Loss in Adults: Report of Six Cases and Diagnostic Pitfalls

“…As shown in the representative case we described above, some PHL cases resemble ISSHL in terms of clinical symptoms and are thus difficult to distinguish from ISSHL solely on the basis of conventional hearing tests. ABR is a standard test used to verify the behavioral thresholds in nonorganic hearing loss [18] . However, using ABR as an initial diagnostic test and performing it on every patient with suspected PHL is time-consuming.…”

Diagnostic utility of Stenger test: reappraisal of its value

“…In most adult cases of NOHL, the subject usually aims at a financial reward or tries to evade taking up responsibility 5,6 . On the other hand, childhood NOHL may be presented as a conversion disorder from emotionally or physically traumatic events 7,8 .…”