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Stenger

Description
The Stenger test is based on the auditory phenomenon “The Stenger Principle” and is used when a patient is suspected malingering a hearing loss. The Stenger Principle states that only the louder of two similar tones presented to both ears at the same time will be perceived.
Generally, it is recommended only to perform the Stenger test in cases of unilateral hearing losses or significant asymmetries (at least 20dB).

Required Items

• Headphones or insert phones
• A response button

Test Procedure

1. Press and hold the Tests button and use the scroll wheel to select Stenger.
   The Stenger test is as default set to present tones in both channel 1 and 2 simultaneously when pressing the tone switch of channel 1.
2. Typically, the instruction to the patient is not different than with normal audiometry. The patient should not be informed that stimuli are presented at both ears simultaneously.
3. Use Channel 2 for presenting tones to the better ear and set the intensity level to 10 or 20dB above the threshold (the example above shows 20dB).
4. Use channel 1 for presenting tones to the poorer ear and set the intensity level 10 or 20dB below the level of the poor ear (the example above shows 40dB).
5. Press the tone switch to present the tone on both channels. Keep the intensity level of the better ear fixed and increase the intensity for the worse ear in 5dB steps.
   If the hearing loss in the worse ear is genuine, the patient will keep responding to the signal presented to the better ear (Negative Stenger). If the patient is simulating the hearing impairment, he will not respond to the stimuli, which shows that the tone presented in the poorer ear is better than what the individual indicates (Positive Stenger).

Test Procedure for Speech Stenger

1. Choose settings for Stenger using the input and output for channel 1 and channel 2:
   Channel 1 output: Right
   Channel 1 input: Mic, CD, or Wave 
   Channel 2 output:Left
   Channel 2 input: Mic, CD, or Wave
   Select Man in Channel 1 and select Sim in Channel 2 so that the speech is presented simultaneously in both channels.
2. Clarify the test procedure to the patient. Explain that he/she will now hear speech and the assignment is to repeat the presented words or numbers.
3. Use channel 2 for presenting speech to the better ear and set the intensity level to 20dB above the threshold.
4. Use channel 1 for the poorer ear and set the intensity level 20dB below the level of the good ear.
5. Present the speech material to both ears simultaneously. Keep the intensity level of the better ear fixed and increase the intensity for the worse ear in 5dB steps. If the hearing loss in the worse ear is genuine, the patient will keep repeating correctly to the speech signal presented to the better ear (Negative Stenger). If the patient is feigning the hearing impairment, he will stop repeating correctly when the level of the worse ear exceeds the signal presented to the good ear (Positive Stenger).