Why so much emphasis on fakers?

I have been reading through a few audiology texts to try to improve my understanding of my hearing and hearing aids. What has really struck me is how much weight is given to the detection of “fakers” and “malingerers” in each text. Yes, I understand that audiologists involved with testing that may be involved with compensation claims have to have some understanding of that element of things, but there is just so much stuff in there.

They also talk about faking among school age children. Most alarmingly they talk about the reason for faking among children most commonly being need for psychological help and then advise that you make sure to nip any “fuss” in the bud by turfing them out of screening telling them they are fine.

The texts read as if every second person through the door is, for some reason, going to be faking a hearing test.

Most worrying of all, however, is that I do quite a number of these “signs of faking” and for perfectly valid reasons. Apparently you are faking if you press the button one time a sound at a particular level is played and then you miss it when it’s mixed in with ones at other levels. Well sometimes I don’t press the button because I am actually not sure if I hear something. I might, I might not. Since I have been in trouble as a child for continuing to press the button when the audiologist had actually stopped testing to deal with a problem I know they get equally upset if you press when you don’t hear anything. So I don’t press if I may or may not have heard it. Equally, I can create noises in my ears if I am expecting them hard enough, and I press for those. Or my hand gets carried away and presses the button anyway because I am nervous! When you know how a hearing test goes already you can anticipate what the next noise will sound like and wait for it with your brain, so you see the audio’s hand move towards the equipment and you push the button!

All that tuning fork stuff - I have no idea what I hear, they ask me if it seems louder here or there, I have no clue, it all sounds like not a lot to me. Can I hear it left or right, up or down, I don’t know, it just goes “bong”. I can’t localise sounds, I have never been able to localise sounds. to this day I can think a noise of water running from the (upstairs back) bathroom is someone breaking a window in the front door!

Maybe why this is why it took so long for me to be treated at school, why I had so many years of being sent away for months to see if the problem resolved on its own.

Do you guys seriously spend your days on the eager lookout for hearing test fakers? The way the text books read it could turn a reasonable person into a suspicious one very easily. :frowning:

In this litigious society we have to be on our toes and fakers are not uncommon. Adults and children alike unfortunately. They are usually easy to spot but proof beyond a reasonable doubt is needed, hence the many different tests to “out” them. Sometimes a disability claim or lawsuit depends on this proof.

Agreed, we see “malingerers” more often than people would think. But you are misinterpreting the material you have read. It is not that we think a patient is faking if they respond when there is no beep or dont respond when there is a beep - it isnt that simple. There is a definite pattern to hearing loss that is being faked or exagerrated, and the signs you speak of are merely a couple of the many signs. We dont look at one of the behaviors, we have to look at the entire picture. Detecting malingerers is an art that takes practice and experience, that is why it is spoke of so much in educational materials.

Just as we want to be sure that a patient is being treated effectively, pinpointing exactly how much hearing loss (if any) is present is vital. The are hundreds of reasons why people fake hearing loss, so an audi needs to be aware of the myriad of reasons, so its discussed in literature.

dr. amy

I can understand why a child might try to cheat on a gearing test, because he or she doesn’t want to be labeled as hearing impaired, thus considered abnormal. But why would a child want to make it look like they have a hearing loss when they actually don’t. My experiences were similar to rose when I took the yearly school hearing test. Sometimes I would “imagine” I heard a beep and raise my hand and sometimes the school nurse would tell me I was responding to nothing, and I would explain I thought I heard something. I would think that that would be easy to check by replaying that tone but in a different sequence, Anyway in third grade they eventually detected a hearing problem, so I guess you can’t fake or fool them forever, not that I was trying to do that. Still even now I am always surprised when my hearing test year after year come out close to what I tested the previous yr.

Yes, I have been known to pass a hearing test if I have any need to. I passed a forces hearing test for years because they kind of set them up that way. It cost them money and ‘men’ if you failed. I am still always nervous when I get my hearing tested in case they take my hearing aids away. Becuase NHS hearing aids are ‘given’ to you on loan they could do just that at any appointment if my hearing test for whatever reason comes out well. It has never happened, but all those bad experiences from school just make me panic in there, which I am sure is not the best thing for commiting to accuracy when you aren’t sure if you heard something or made it up!

Must take my own notes next time of which frequency it is I told them I can’t hear a sound but I can feel a sensation in my ear. They promised they would mark it differently on my test, but my audiogram just shows everything as sounds heard. Might account for some of the fitting problems as they are not fitted by the same hospital

I’d be interested to see if the increase in awareness of auditory processing disorders cuts down the number of “fakers” through the doors. I reckon some people find themselves unable to understand anything and can only possibly account for that by assuming they have a hearing loss. They become quite attached to that theory, on the basis that a hearing aid will sort the problem out, and that the only way to get a hearing aid is to show a hearing loss, which they genuinely believe they have, rather than “faking” in the sense of making it up. Research is actually showing that in many cases it does help with APD, but people still need the correct diagnosis to move forward with.

And given that I have a fluctuating hearing loss of a rare and misunderstood cause A: I am open to much bigger accusations of fakery, my usually “better” ear is severe today and B: it would be most phenomenally unlikely for me to show the exact same hearing test twice, however I have on my table just now 2 tests from 6 years apart and they are practically twins!

Many times we see this between the ages of 9 and 13 years. The reasons vary wildly, but most boil down to either academic problems or issues in the home. I’m not referring to bold psychological issues, just simple issues such as not wanting to listen to parents or having academic problems and it seems easiest to say you cant hear your teachers. Some kids will attempt to exaggerate their hearing thresholds so that their “story” holds up. I see very few children, however, that can’t be coaxed into responding in an accurate manner. Especially now that we have tests that can closely approximate hearing thresholds without the patient having to respond.

And yes, the awareness of APD and such disorders has brought a new spin to the area. But with today’s technology, it becomes increasingly easy to distinguish between malingerers and patients who suffer from APD.

dr. amy

Out of interest, which tests are these? We keep getting told to come back in 6 months for another hearing test for my daughter because she doesn’t respond very reliably, so if there is something out there which will get us a reading without her being required to respond then bring it on! I bet it’s more expensive so they are hoping they will get away without spending the money.

We spend ages playing mock hearing tests at home listening for the noise (xylophones, music, computer sounds) and building the tower, but she can’t do it at all. Now she’s had an eye test which she immediately understood and sailed through I am even more concerned about her hearing result. The only information they recorded as accurate at present is that her test is a “fail” rather than a “pass”.

Last year when I was first searching for forums and groups such as this one I happened upon a bizarre group of people who wanted some level of hearing loss, to need hearing aids etc as a fetish. Apparently there are people who try to deafen themselves, act deaf , use hearing aids when unneeded and so on. (there are all sorts of similar fetishes regarding almost every kind of handicap).

These folks sound like the ultimate fakers.

I don’t find anything about wearing aids glamorous. I love the fact that they that work as well as they do but do. Creepy, like going around in a walker or wheel chair.

Oh brother, what’s next?

The most common is an ABR (Auditory Brainstem Response). It is expensive, so your intuition is right about that. How old is your daughter/ Has she had OAE (otoacoustic emission) Testing??

dr. amy

She had the OAE/ABR newborn hearing screen, but then she could hear then! She’s not had any since, but then I have read that middle ear fluid will mess up those tests, and she has some of that so maybe they think it’s not worth doing?

She is now 3y6m but she has real trouble understanding the hearing tests. I have taken her for other evaluations and she gets it no bother, having her eyes tested was a breeze, but when we try to do things with hearing she just doesn’t get what she has to do. They ask her (face on) did she hear something and she says yes, but when we do the same at home she says yes she heard it even the times I haven’t made any noises! We play listening games and sometimes she will point out the correct animal and other times she seems to pick one at random, and who knows if she doesn’t hear the word or she is just more interested in the pig than the cow?

An objective test would be really useful, but with this fluid in there it seems like it’s not going to happen. The fluid could be 100% of the problem but then that doesn’t really reassure me either, as our genetic defect starts out as a conductive loss, which is ignored assuming it’s normal childhood ear trouble, and then progresses to a mixed loss, and nobody is quite sure why.

At what age has the hearing loss started in other family members?

Right, middle ear fluid can affect the results of objective testing. Has the insertion of PE Tubes been discussed at all?

dr. amy

What in the name of God would someone want that? and what would happen to a hearing person’s hearing if they used one with needing to? :eek:

I would of loved to pass a hearing test in school rather than be teased every time I had to leave class to go have another retest. Every time the hearing test were given there was a group of us who had to go for 2 retests after the initial hearing test before a letter was sent home and we were teased as the “deaf kids” for weeks after. This was before mainstreaming and all the kids who had HA went to a separate school. My hearing wasn’t bad enough at that time to need HA, but I never passed any hearing test that I was given and I would of done almost anything to pass one to avoid the teasing that came our way.