I saw a patient today who fell at work, and is complaining of pain on
the right side of her face, and right ear. The patient does not speak English,
and an interpreter was used.
Her hearing in the left ear is normal, and she responded at 30-50 in the
right ear. Stenger test was positive at at least 3 frequencies. Unmasked
bone on the left side was normal. UNmasked bone on the right side suggested
thresholds ~ the air conduction line for that ear. Tymps were normal.
SRT's were obtained using tape @35 dB, and using MLV, @50 dB, in the right
ear. SRT in the left ear was 15 dB. Yes, masking was used for the right ear.
My feeling is that this is a clear cut case of melingering. My supervisor,
who is very experienced & bright (in my opinion) feels that it is probably
nonorganic, but possibly a bizarre case, of a temporal bone fracture or
something. We are planning to speak directly with the referring doctor and
hope that ABR or CT scan will be ordered to get to the bottom of this.
I'd be interested to hear (read) peopl's opinions about this case.
Based on the results we got today (which, by the way, took us nearly
2 hours to obtain), what organic types of problems might cause this?
Can you definitively say to a Dr., "Your patient is faking this?" Or do
you need to follow up with more testing?
(this took place at U. Mass. Med. Center)