Identification of pseudohypacusis using speech recognition thresholds

Objective: To determine the extent to which procedural variations affect pure-tone average-spondee threshold (PTA-SRT) agreement in pseudohypacusis, to propose a theoretical framework to account for threshold differences due to procedural variations, and to devise an effective screening test for identification of pseudohypacusis. Design: The subjects were normally hearing listeners who feigned a hearing loss. One experimental group received an ascending pure-tone (PT) technique combined with an ascending SRT procedure. A second experimental group received an ascending PT technique paired with a descending SRT procedure. A third experimental group received an ascending SRT procedure paired with a descending PT procedure. Results: The group mean difference between the three-frequency PTA and the SRT was 10.6, 2.3, and 41.6 dB for the first, second, and third experimental groups, respectively. Comparison SRTs and PTAs from cooperative patients with hearing loss showed that a two-frequency PTA yielded a more effective test for pseudohypacusis than did a three-frequency PTA. Conclusions: The procedural differences noted in this study are consistent with a loudness bias. It is recommended that clinicians employ an ascending procedure to measure SRTs and a descending procedure to measure PT thresholds to maximize the effectiveness of a screening test for pseudohypacusis based on PTA-SRT differences.