Welcome to the January 2012 issue of Plural Community, the free newsletter by your community, for your community.

This issue features a fascinating piece by James Peck, PhD, who writes on the troubling issue of pseudohypacusis – the topic of his recent book of the same name.

Additionally, congratulations are extended to Kim Willenborg from Effingham, IL, who was the winner of our monthly competition for December and wins a free copy of Here's How to Do Early Intervention for Speech and Language: Empowering Parents. For details of this month’s competition, see below!

Lastly, please check out our list of new publications – there are some great new titles to come this year, from balance disorders, through stuttering, singing, and more.

Thanks for reading on...

Pseudohypacusis – An Issue Born of Issues

James E. Peck, PhD

Audiology and psychology come together in various situations: responding at the feelings level to a person who is reluctant to try a hearing aid, talking with parents of a child newly found to be hearing impaired, and so forth. Another area less in the spotlight but where the connection is just as strong is false or exaggerated hearing loss (FEHL).

The literature and my experience tell me that people who present a nonexistent hearing loss or who exaggerate an existing one are likely to have some issue in their lives in the realm of psychology. In other words, they may have a problem; it’s just that it is not a hearing problem. Health care professionals must respond to any human concern, even one outside of their field, if merely by recognizing it and making appropriate referral. Furthermore, whether the problem could be a psychological one is irrelevant. The “psyche versus soma” model went out of date decades ago.

More and more, we are hearing how common so many difficulties are: anxiety, depression, ADHD, “bipolar.” Although audiologists are aware that some patients with FEHL are more likely to have an emotional problem than the average person, probably most would be surprised at just how prevalent such problems are. Going a step further, there is growing awareness that a family member in distress probably means the entire family is in distress and vice versa. Furthermore, the effects of distress on well-being are pervasive. For example, among 5,000 fifth graders, those who had stressful life-change events—a family death, substance addiction, even loss of a pet or a recent move, among others—had substantially lowered health quality of life (Coker et al., 2011).

A more dramatic case—and one especially pertinent to audiologists—is the person with little or no hearing loss, but who presents a very severe loss and undergoes surgery for implantation of a cochlear prosthesis. A recent report told of a girl with Waardenberg syndrome who received a unilateral cochlear implant at age 6 (Carlson, Archibald, Gifford, & Driscoll, 2011). Because of her complaints, she had revision surgery. Afterwards, she had remarkable speech perception skills. However, she then reported hearing popping and ringing and had intermittent drops in hearing. She had a second revision. Eventually, the child was found to have multiple, significant psychosocial stressors, which led to a diagnosis of a conversion disorder (a disorder in which the patient unwittingly presents false symptoms due to psychological conflict, and which is more common in female children and young adults).

Many adjustment problems stem from maltreatment. Neglect and abuse are extensive enough in childhood that an entirely new specialty in pediatrics has come about—child abuse pediatrics. In 2010, nearly 200 pediatricians received board certification in child abuse by the American Board of Pediatrics (Giardino, Hanson, Hill, & Leventhal, 2011).

A stark example of adults showing an association between FEHL and a troubled life is given by Jacobson, Jacobson, and Crowe (1989). They evaluated the hearing of 34 prison inmates and found 29% had some degree of hearing impairment. Of interest here is that an additional 12% displayed false hearing loss. All subjects in the sample were drug abusers, which, along with incarceration, is hardly a sign of emotional health.

In some cases, it may be apparent that a patient has substantial psychosocial difficulties. That should alert the clinician to the potential for erroneous audiometric results and the need for other sorts of intervention (if not already in play). Of course, an audiologist often doesn’t know that the patient has some sort of psychosocial disorder. For this reason, I use a battery of tactics when there is cause for suspicion of either the patient’s report or the patient’s responses. They include: (a) methodical history and interview, (b) astute observations, and (c) a flexible, adaptive approach to auditory testing, both behavioral and objective. In the process, I incorporate techniques from psychology known to be effective when asking and talking about sensitive issues. It is dangerous to dismiss invalid reporting and test taking, because overlooking a trouble spot in a patient can prolong a person’s distress.

About the Author

Dr. James E. Peck, PhD, is associate professor emeritus in the Department of Otolaryngology and Communicative Sciences and Disorders at the University of Mississippi Medical Center. He has worked as a teacher and clinician in university and medical settings. Dr. Peck was an editorial consultant and associate editor for journals of the American Speech-Language-Hearing Association and served on the association’s Legislative Council. He has a career-long interest in false and exaggerated hearing loss.

References

Carlson, M. L., Archibald, D. J., Gifford, R. H., & Driscoll, C. L. W. (2011). Conversion disorder—A missed diagnosis leading to cochlear reimplantation. Otology and Neurotology, 32, 36–38.

Coker, T. R., Elliott, M. N., Wallander, J. L., Cuccaro, P., Grunbaum, J. A., Corona, R., . . . Schuster, M. A. (2011). Association of family stressful life-change events and health-related quality of life in fifth-grade children. Archives of Pediatrics and Adolescent Medicine, 165, 354–359.

Giardino, A. P., Hanson, N., Hill, K. S., & Leventhal, J. M. (2011). Child abuse pediatrics: New specialty, renewed mission. Pediatrics, 128, 156–159.

Jacobson, C. A, Jacobson, J. T., & Crowe, T. A. (1989). Hearing loss in prison inmates. Ear and Hearing, 10, 178–183.

If you are attending, make sure to visit Plural Publishing at the following conferences—receive an exclusive conference discount, meet our authors, and browse our new publications.

Competition time! This month, we are offering a copy of Jean Blosser’s new edition – School Programs in Speech-Language Pathology: Organization and Service Delivery, Fifth Edition.

To enter, all you have to do is email your name and address to pluralcommunity, placing “January 2012 Competition” in the subject line. The drawing will take place on or around January 23, 2012, and the winner will be announced in the February 2012 issue of Plural Community.

Congratulations again to Kim Willenborg from Effingham, IL, who was the winner of our monthly competition for December and wins a free copy of Here's How to Do Early Intervention for Speech and Language: Empowering Parents. A copy is on its way to her, with our good wishes.

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