[Problematic medical expertise concerning simulation and aggravation in audiology].
BACKGROUND
The effect of an incorrect audiological medical assessment of noise trauma deafness can be substantial. The impact will be demonstrated using a case example. The reasons for incorrect assessment are often insufficient examination conditions or simulation and aggression of the subject. The results of a study on this topic will be presented.


METHODS
A total of 61 patients who underwent a psycho-acoustic medical assessment were grouped into 1 of 4 categories ranging from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III reliable and valid thresholds of pure tone audiometry can only be achieved using objective audiological measurements. The frequency, extent and socio-economic factors were evaluated.


RESULTS
Of the 61 individuals 26 showed no simulation or aggravation behavior (category 0), 10% were grouped into category III and 48% into categories I and II. The tendency to simulation and aggravation increased with the patients' age, the level of education and the frequency of medical examinations prior to this investigation.


CONCLUSIONS
Simulation and aggravation is a more frequent phenomenon than previously assumed (approximately 58% of all audiological examinations). The effect in terms of economical damage could be substantial. The usage of a well-defined classification is highly recommended in order to improve the quality of medical assessment in ENT.
Streppel
M
M
Institut für Begutachtungen, Köln, Deutschland. michaelstreppel@googlemail.com
Brusis
T
T
D000328:Adult; D000367:Age Factors; D001300:Audiometry, Evoked Response; D001301:Audiometry, Pure-Tone; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005858:Germany; D006316:Hearing Loss, High-Frequency / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D006317:Hearing Loss, Noise-Induced / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008306:Malingering / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D017084:Otoacoustic Emissions, Spontaneous; D010036:Otolaryngology / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011571:Psychoacoustics; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D014942:Workers' Compensation / Q000331:legislation & jurisprudence