Malingering

Three patients in the present series intentionally feigned profound hearing loss. These comprised two males and one female patient. The socio-economic background among the three individuals differed. One was a male economic refugee, who sought state benefit, by claiming profound bilateral hearing loss. A second male patient was an ex-soldier claiming compensation by the Greek Military for unilateral deafness, as a result of a grenade explosion. The third patient was a female, who had been receiving state benefit for incapacitation, due to profound bilateral hearing loss, for the past 40 years, and was re-examined, following strong reservations about her hearing loss from the State Otorhinolaryngologist.

Clinical ENT examination was unremarkable in all cases, and the tympanometric curves were suggestive of normal middle ear ventilation. Audiometric testing was suggestive of profound hearing loss, bilaterally in two cases, and unilaterally involving the right ear in the third case (Fig. 2A). Interestingly, the communicative abilities of all patients appeared significantly impaired. ASSR assessment proved normal with regard to the male patients (Fig. 2B), and demonstrated mild hearing loss in the low and severe in the high frequencies in the female patient (not justifying any state benefit). ABR and OAEs were also indicative of normal hearing in the male patients. The female patient did not elicit OAEs (Fig. 2C), and the respective ABR curves were suggestive of mild hearing loss (Fig. 2D).

Comprehensive audiologic testing of a 26-year-old ex-soldier feigning right-sided profound hearing loss, allegedly following a grenade explosion (A, B), and a female patient exaggerating a mild hearing loss, to continue receiving state benefit for incapacitation (C, D). A: Pure-tone audiogram. B: Estimated auditory steady-state response audiogram, indicative of normal hearing. C, D: auditory brainstem response curves, and otoacoustic emission graph. Partial elicitation of transient evoked otoacoustic emissions in the left ear, and easily distinguished wave V at 50 dBnHL bilaterally.