Current evaluation of pseudohypacusis: strategies and classification.

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.