The Judd-Persaud Test: A Simple Office-Based Tuning Fork Test for Unilateral Feigned Hearing Loss

In the current litigious society, separating malingerers from true hearing loss patients is ever more important, especially when compensation for industrial hearing loss is claimed. We present a novel test for feigned hearing loss which is very quick and precise, and utilises equipment readily available in the Otolaryngology office. The test is based on the well established physiological phenomenon of bone conduction and exploits the fact that there is very little (0-12dB) attenuation of sound across the skull. Step 1: A 256Hz or 512Hz tuning fork is placed on the Mastoid process of the “Good Ear” (Left). Result – The patient reports hearing the sound. Step 2: The same 256Hz or 512Hz fork is placed on the Mastoid bone of the “Bad Ear” (Right). Result – The patient reports inability to hear the sound. Step 3: The test can be repeated as above as desired to confirm the results. The Judd-Persaud test is a simple, easy to perform, quick and accurate test for unilateral feigned hearing loss in the malingerer. INTRODUCTION Hearing loss is mostly subjective, but objectivity exists. In some cases the patient may be unaware of a hearing loss, whereas family and friends can often be objectively aware, noticing difficulties in communication. Audiometric tests therefore exist that can measure both subjective and objective hearing loss [1]. These range from simple free-field voice tests to sophisticated cortical evoked response testing. Problems can occur with subjective testing, as they rely greatly on the integrity and cooperation of the patient. Malingering has been reported frequently, with some patients feigning hearing loss in one or both ears [1]. In the current litigious society, separating malingerers from true hearing loss patients is ever more important, especially when compensation for industrial hearing loss is claimed. Due to certain physiological phenomenon, tests exist which can spot and refute these malingers claims. Tuning Fork tests such as Stenger and Chimani-Moos allow detection of malingering. Audiometric tests such as the automated Stenger, Lombard, Erhardt, Delayed speech feedback test and the Hummel double conversation test can also be used [2]. However, these tests require equipment not always easily obtainable and can be time consuming. We present a novel test for unilateral feigned hearing loss which is very quick and precise, and utilises equipment readily available in the Otolaryngology office. Method The Judd-Persaud Test The test is based on the well established physiological phenomenon of bone conduction and exploits the fact that there is very little (0-12dB) attenuation of sound across the skull [3].