What is a Functional Hearing Loss

“Functional hearing loss” is a term used by audiologists and hearing professionals to describe a type of hearing loss that is not caused by a medical or physical issue. It’s sometimes referred to as “malingering,” “erroneous,” or “psychogenic” hearing loss. In other words, it indicates that the person’s hearing test results cannot be considered accurate or valid.

The use of the term “functional hearing loss” on an audiogram is not meant to hide the meaning from the patient, but rather to convey specific information to other professionals involved in the patient’s care.

It’s important to understand that functional hearing loss is not a diagnosis of a psychological or mental health issue. Instead, it simply means that the hearing loss cannot be explained by a physical cause and may require further evaluation or a different approach to testing.

In summary, if you see “functional hearing loss” on an audiogram, it’s important to understand that the results of the hearing test are not considered accurate or valid. Further evaluation may be necessary to determine the cause of the hearing loss.

Function Hearing Loss

A year ago, a patient brought a hearing exam to the author’s audiology practice that was done at another clinic. The audiometric thresholds on the graph showed moderate hearing loss with a flat pattern, and the patient proudly pointed out the “Functional hearing loss” written in marker in the comment section below the audiogram.

However, the author knew that this term indicated that the previous audiologist suspected that the patient was not being truthful during the hearing test. To address this, the author told the patient that their clinic does not accept results from outside clinics and that the test would need to be repeated, even though this wasn’t exactly true.

The author wanted to find a nice way to convey that they couldn’t trust the results that had been handed to them. The term “functional hearing loss” was introduced as a replacement for “malingering” as it conveys that results are suspicious and not reliable without implying the intention of the patient.

Possible explanations for functional hearing loss include a lack of understanding of test instructions or not putting forth the required effort during the exam.

Reason Why Someone Would Fake a Hearing Loss

  1. To excuse poor academic performance, such as getting bad grades in school.
  2. To avoid being accused of selective hearing loss.
  3. To file a disability claim or get out of military service.
  4. To receive financial compensation or benefits.
  5. To receive attention or sympathy from others.
  6. To avoid certain activities or situations, such as noisy work environments.
  7. To receive accommodations, such as captioning or sign language interpretation.
  8. To receive a higher rating for a service-connected disability from the VA.

It’s important to note that while these are some common reasons for faking a hearing loss, every individual’s motivations may vary.

It Is Extremely Hard to Fake A Hearing Loss Without Being Caught

Audiologist often sees patients who for some reason or another want us to believe they have a larger hearing loss than they actually do. It could be a fairly innocent reason like a teenager who wants an excuse for why they are getting bad grades in school.

Perhaps, it could be a husband who wants their wife to stop saying they have selective hearing loss. On the other hand, it could be someone who is going to use the hearing test in court to file a disability claim or try to get out of military service.

Whatever the reason a patient may have, false results will likely be caught by the audiologist. In a hearing test, there are multiple cross-check principles and when results do not come together, the audiologist gets suspicious. I don’t want to give away what all those clues are but suffice it to say that it is extremely difficult to fake a hearing loss and not have the audiologist realize it.

Is it impossible to fool the subjective part of the hearing test? Probably not, but I like to think I myself could fool another audiologist about a hearing loss if I pretended to have one. That is because I know every audiological test inside and out and know what the audiologist would be looking for.

However, if the audiologist used objective hearing tests measures like OAEs, ABR, or ASSR. I would be unable to foil those results. Any false move in the subjective hearing test would likely mean that they would switch to an objective measure to validate the pure-tone results.

Most Audiologists Will Attempt To Give Patient An Out When They Get Suspicious

When I test someone and the results are not adding up together. I try to get the patient to cooperate with me and get valid results. I don’t want the patient to waste my time and I don’t want to waste their time either. Invalid results would mean that I would likely fit hearing aids at a much LOUDER level than the person will be able to tolerate. Then it would mean countless reprogramming visits and dissatisfaction with the hearing aids.

There are certain strategies that I use to help get the person to cooperate.
Step one would be just reinstruction. I would probably reinstruct 2 or 3 times if I thought that they were not performing the task intentionally wrong. This will get some people to change their behavior but not all.

Next, I would go around to the other side of the hearing test booth and tell them I am switching headphones because I don’t think the results are valid. This is a clear indication to the patient that I know something is not right however, I am placing the blame on the equipment and not on the patient. For most, people this is enough for them to shape up.

To prevent the potential for false results, the audiologist may increase the difficulty of the hearing test by reducing the increment in sound level from the typical 5 dB to 1 or 2 dB. This makes it challenging for the patient to accurately judge their previous response compared to the current one. Additionally, the audiologist may frequently switch frequencies, alternating between low and high, and testing different ears to make it difficult for the patient to provide consistent results at elevated thresholds.

Related Questions

How long does a hearing test take? Most hearing tests at ENT offices are 15-20 minutes long. At an audiologist’s office, it may be 45-60 minutes long and would also include a case history portion and time for hearing aid selection.

How is hearing loss measured? The hearing is measured by pitch and intensity. Specifically, results are recorded on an audiogram and grafted by frequency and decibel level. Read the complete article on how hearing loss is measured.

Jonathan Javid Au.D.

Jonathan Javid Au.D., a seasoned audiologist with an extensive background in the field of audiology. With over 11 years of invaluable clinical experience, Jonathan has dedicated his career to helping individuals enhance their hearing and improve their quality of life.

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