While rare, most audiologists will eventually encounter a patient with Non–Organic Hearing Loss – in other words, an individual presenting with a lack of consistency in audiological testing. These patients are also often referred to as “malingerers.” This presents a difficult situation for providers, both socially and clinically! Several objective measures, like otoacoustic emissions (OAE), auditory brainstem response (ABR), and acoustic reflex thresholds (ART) can be used to parse out true versus functional hearing loss, but the Stenger test is a good way to quickly and behaviorally screen for non-organic hearing loss in certain scenarios.  

What is the Stenger Effect? The Stenger Test Explained

The Stenger test is based on the principle of binaural hearing, which means that the brain processes sound information from both ears to create a perception of sound. When two sounds of the same frequency and intensity are presented to each ear simultaneously, the brain perceives them as a single sound. The Stenger effect, on which the Stenger test is based, states that when a sound is presented to both ears, the listener perceives only the tone in the ear of the higher presentation level. This test is useful in determining if an individual presenting with unilateral profound hearing loss is providing true and accurate responses or not. 

How to Perform a Stenger Test

When performing a Stenger Test, a tone is presented simultaneously to both ears at any given frequency. The intensity, however, differs between the ears. In the better ear, the presentation level should be 10 dB better than the threshold originally obtained. In the poorer ear, the presentation level should be 10 dB below the original threshold. The tones can then be presented, but with increasing intensity in the poorer ear, and the individual is asked to respond as normal.

This test can be completed immediately following pure tone audiometry without repeating instructions. It may, in fact, be more useful if the patient is not alerted to the fact that the test method has changed.

The results of the Stenger test are described as either positive or negative. With a negative Stenger test, the patient will continue to respond to the tone when it is presented simultaneously, meaning they are perceiving it in the better ear and the threshold of the poorer ear is true. With a positive Stenger, the patient will not respond to the simultaneous tones as they are perceiving the tone in the ear they are attempting to pass as poorer.

It is important to note that while the Stenger test can be helpful in identifying non-organic hearing loss and unilateral hearing loss, it may not be useful in all cases. For example, if a patient presents with bilateral hearing loss, the Stenger test may not be able to accurately determine if the loss is true or functional. Additionally, other objective measures should be used in conjunction with the Stenger test to confirm results.