Stenger's test is used to detect unilateral malingering. The principle is based on:

• A Binaural fusion — the brain fuses sounds of different frequencies from both ears
• B Binaural interaction — when the same tone is presented simultaneously to both ears, only the louder tone is perceived ✓
• C Auditory fatigue — the malingering ear fatigues faster than the normal ear
• D Bone conduction advantage — malingerers cannot suppress bone-conducted sound

Explanation

Stenger's test relies on the Stenger phenomenon: when the same pure tone is delivered simultaneously to both ears, the listener perceives only the louder signal. In unilateral malingering, the examiner presents the tone at a level above the patient's claimed threshold in the 'deaf' ear but below the threshold in the good ear. A true malingerer will not respond (denying perception), because the louder tone in the bad ear dominates and they do not want to admit they hear it. A person with genuine unilateral hearing loss will respond, perceiving only the tone in the good ear.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.