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Additional resources for Functional Otology: The Practice of Audiology
Same patients may present the symptom of deafness as their dominant problern when in reality they are psychologically ill. They may have auditory hallucinations, and the sounds they seem to hear may be symptomatic of their mental illness and not tinnitus at all. Other patients may have fugue-like states or momentary episodes of detachment which members of the family or friends may interpret as deafness. The otologist must be alert to many factors which in one fashion or another may simulate deafness or other otic or auditory symptoms.
The second patient was a woman of about forty years, who complained of difficulty in hearing dictation. Her employer dictated with a pipe in his mouth, which made it difficult for her to understand clearly what he said. She had noted the onset of this about three years prior to the examination. Her history seemed free of any etiologic factors. The otological examination was negative. The functional examination revealed an air conduction and bone conduction loss at 4000 cps only. The speech reception threshold by phones and in the free field were within normal limits.
One way whereby the ear not being tested can be occluded is to keep it occupied by another sound-a masking sound. Measurements have determined that the skull has an impedance of between 55 decibels and 65 decibels. Intensities greater than 65 decibels will cross through the skull, from one side to the other, and be heard as sound by the other ear. The problern is to obtain a masking sound whose own spectrum is wide enough to embrace the frequencies of the several tones used during the test, to obtain an intensity of sound that accomplishes effective masking, and to avoid such intensities of the masking sound that would cross over to the opposite ear-the one being tested-and thereby mask both ears.