In a patient with feigned (non-organic) hearing loss, which tuning fork test will show paradoxical results (e.g., apparent better bone conduction than air conduction in otherwise normal ears)?

• A Rinne test — falsely negative (BC > AC) in a feigning patient
• B Weber test — lateralizes to the 'normal' ear
• C Schwabach test — prolonged by the same duration bilaterally
• D Stenger test — the patient fails to acknowledge hearing in the supposedly deaf ear ✓

Explanation

The Stenger test exploits the Stenger principle: when the same tone is presented simultaneously to both ears, only the louder signal is perceived. In a patient claiming unilateral deafness (feigning), presenting a tone louder than threshold but below the acknowledged hearing level in the 'deaf' ear causes them to deny hearing anything (because the tone is now heard only in the feigned-deaf ear, but they won't admit to it). A positive Stenger test (patient stops responding) indicates functional/non-organic hearing loss. It is specifically designed to detect unilateral feigned deafness.

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

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Written and medically reviewed by the StethoPrep medical team.