In the Stenger test for suspected non-organic (functional/psychogenic) unilateral hearing loss, the test is considered POSITIVE when:
- A The patient reports hearing the tone in both ears
- B The patient denies hearing the tone despite it being presented louder in the 'deaf' ear than the better ear threshold ✓
- C The patient reports hearing in the ear with worse threshold only
- D Acoustic reflexes are absent bilaterally
Correct answer: B. The patient denies hearing the tone despite it being presented louder in the 'deaf' ear than the better ear threshold
Explanation
The Stenger principle states that when two tones of the same frequency are presented simultaneously to both ears, only the louder tone is perceived. In non-organic unilateral hearing loss, when the examiner presents the tone well above the true (normal) threshold in the 'deaf' ear but below the simulated threshold declared by the patient, the patient — perceiving only the louder signal in the 'deaf' ear — will deny hearing it to maintain the pretense. This positive Stenger response confirms functional overlay.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.