Which test would yield information of greatest importance for an adult with a very large interaural difference in hearing thresholds (one ear 90 dB HL, other ear normal)?

Which test would yield information of greatest importance for an adult with a very large interaural difference in hearing thresholds (one ear 90 dB HL, other ear normal)?

• A. Tympanometry
• B. Reflex-decay test
• C. The Stenger test
• D. Acoustic reflex testing

Answer: (C)

When there is a large difference between ears, the most useful information is whether the reported loss in one ear is genuine or feigned. The Stenger test is designed for this. It presents two tones of the same frequency to both ears at once, with the levels arranged so that the ear with better hearing would hear the tone at a lower level, while the ear with poorer hearing would need a higher level to detect it. If the loss is real, the person’s responses will align with the ear that can actually hear. If the loss is nonorganic or exaggerated, responses tend to be inconsistent as the test shifts which ear should be hearing the tone. A positive Stenger result—inconsistencies or evidence that the supposedly deaf ear is responding under the right conditions—strongly suggests nonorganic unilateral loss. The other tests screen middle-ear function or neural pathways and don’t directly address whether the unilateral loss is genuine in the same way.

When there is a large difference between ears, the most useful information is whether the reported loss in one ear is genuine or feigned. The Stenger test is designed for this. It presents two tones of the same frequency to both ears at once, with the levels arranged so that the ear with better hearing would hear the tone at a lower level, while the ear with poorer hearing would need a higher level to detect it. If the loss is real, the person’s responses will align with the ear that can actually hear. If the loss is nonorganic or exaggerated, responses tend to be inconsistent as the test shifts which ear should be hearing the tone. A positive Stenger result—inconsistencies or evidence that the supposedly deaf ear is responding under the right conditions—strongly suggests nonorganic unilateral loss. The other tests screen middle-ear function or neural pathways and don’t directly address whether the unilateral loss is genuine in the same way.