Non-Organic Hearing Loss

Non-organic hearing loss: Reported difficulty or behavioural thresholds exceed what the demonstrated auditory function explains. A functional component can coexist with organic hearing loss. Establish the best-supported thresholds without assuming intent.

Inconsistent audiometry: Check understanding, attention, instructions, transducer position, calibration, technique and masking before interpreting a discrepancy.

Cross-check behavioural thresholds against objective tests before acting on them. Normal otoacoustic emissions alone do not establish normal hearing.

Stenger testing: A positive result supports a functional component in asymmetric behavioural thresholds; it neither quantifies the whole loss nor establishes intent. ^{Bell 2025}

Objective cross-checks: OAEs assess outer-hair-cell function; ABR assesses brainstem neural synchrony and cortical evoked potentials assess later cortical responses. Preserved OAEs do not exclude auditory neuropathy.

Management: Explain the demonstrated responses, treat coexisting organic disease and arrange follow-up. Do not fit amplification on unverified thresholds.