Non-organic hearing loss redefined: understanding, categorizing and managing non-organic behaviour.

Addressing the complex factors that underpin any presentation of non-organic hearing loss (NOHL) is essential to that individual's proper management. The complex and often conflicting approaches taken to date are reviewed. Previous dichotomous models distinguish those assessed as consciously malingering for external benefits from those who generate symptoms unconsciously to meet psychological needs. Incorporating the DSM-IV-TR diagnosis of 'factitious disorder' into a new model bridges the conceptual gap. Three categories (malingering, factitious and conversion) are used distinctly, for the purpose of diagnosis, and on a continuum for the purpose of management. Motivating factors, type of gain, degree of intention and consistency of response during audiological assessment can all be related within the model. Advances in objective measurements have made the detection of NOHL easier. A reinvigoration of interest in effective diagnosis and management of the condition is therefore timely.