The Journal of Laryngology & Otology (2009), 123, 840–844.

Main Article
# 2009 JLO (1984) Limited
doi:10.1017/S0022215109004769

Efficiency of Stenger test in confirming profound,

unilateral pseudohypacusis
A DURMAZ, S KARAHATAY, B SATAR, H BIRKENT, Y HIDIR

Abstract
Objective: Conscious and deceptive exaggeration of hearing loss is termed pseudohypacusis. Even though
the Stenger test has been used in the management of pseudohypacusis for almost a century, its sensitivity,
specificity and predictive values for unilateral pseudohypacusis have not previously been reported, to our
best knowledge. We investigated the efficiency of the Stenger test in detecting unilateral pseudohypacusis,
accepting auditory brainstem response testing as the ‘gold standard’.
Materials and methods: Candidates with questionable profound or total hearing loss were enrolled in
the study. Pure tone audiometry, speech and tonal Stenger tests, and click test auditory brainstem
response measurement were performed. Accepting auditory brainstem response testing as the gold
standard, the sensitivity, specificity and predictive values of the Stenger test for unilateral, profound
pseudohypacusis were assessed.
Results: Two hundred military candidates were enrolled in the study. The sensitivity and specificity of
the Stenger test in verifying unilateral, profound hearing loss were 99.4 and 70 per cent, respectively.
The positive and negative predictive values of the test were 87.5 and 98.4 per cent, respectively.
Conclusion: The Stenger test is widely used for the evaluation of unilateral or asymmetrical
pseudohypacusis. In our opinion, it is a powerfully reliable test. More difficult cases require objective
electrophysiological testing to verify functional hearing loss and to exclude specific diagnoses that may
imitate pseudohypacusis.
Key words: Sensorineural Deafness; Pure Tone Audiometry; Auditory Brain Stem Response

Introduction misdiagnosis of hearing levels may result in involve-

Conscious and deceptive exaggeration of hearing loss ment in litigation proceedings.
is termed pseudohypacusis.1 Although this label is Several historical audiological tests have been used
widely accepted, several different terms have been in detecting pseudohypacusis, including the Doerfler
used to define the same phenomenon, including mal- Stewart test, swinging story test, delayed auditory
ingering, feigning, simulated, nonorganic or func- feedback (Azzi’s) test and Lombard’s test. Develop-
tional hearing loss.1 – 4 Several factors may ment of electrophysiological techniques has enabled
contribute to the aetiology of pseudohypacusis. the introduction of new methods with much greater
Expectation of financial compensation or some reliability and accuracy. Auditory brainstem
administrative benefit plays a significant role, response (ABR), electrocochleography, tone decay,
especially in industrial workers and the military evoked otoacoustic emission (OAE) and sensori-
population.1,3,4 On the other hand, childhood pseu- neural acuity level testing are ‘new generation’ tests
dohypacusis is usually attributed to a subconscious which have been reported to be successful in the
psychological defence mechanism, and is thus dis- management of pseudohypacusis.1,3,4 The Stenger
cussed in a different debate.5,6 The prevalence of test may be placed in between these two groups of
pseudohypacusis is variable and dependent on the tests. Although it was introduced by Stenger in the
demographic and occupational characteristics of the early 1900s and requires only a conventional two
group examined, ranging from 2 to 90 per cent.1,3,4 channel audiometer for testing, this test still has
Regardless of the aetiological factors, diagnosing an important diagnostic role in the management of
pseudohypacusis and establishing exact hearing unilateral, profound hearing loss.1,3,4,7 The initial
thresholds are time- and energy-consuming pro- Stenger test was conducted with tuning forks, and
cedures for audiology clinic staff. In addition, has since been upgraded and modified. It relies

From the Department of Otorhinolaryngology Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Accepted for publication: 10 November 2008. First published online 19 March 2009.

840

Downloaded from https://www.cambridge.org/core. Pontificia Universidad Catolica de Chile, on 13 Mar 2020 at 16:40:12, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0022215109004769
 STENGER TEST FOR PROFOUND, UNILATERAL PSEUDOHYPACUSIS 841

primarily on the Stenger effect, that is, a sound pre- even when the stimulus to the poor ear was higher
sented to both ears is perceived only in the ear in than the stimulus to the good ear, because the stimulus
which it is louder. Stenger test results are interpreted was perceived by the good hearing ear. If the patient
as negative when the hearing thresholds in the poorer chose not to respond to the test when the stimulus
ear are real, and as positive when the thresholds are to the poor ear was greater than the good hearing
faked or exaggerated. Estimating the real hearing ear thresholds, then the test was interpreted as posi-
thresholds of pseudohypacusis patients is also poss- tive, i.e. suggestive of pseudohypacusis.
ible using the Stenger test.8 Even though it has After Stenger testing had been completed, auditory
been used for almost a century, the Stenger test’s sen- brainstem response testing was performed under deep
sitivity, specificity and predictive values for unilateral sedation (induced by intramuscular injection of mida-
pseudohypacusis have not previously been reported, zolam (50 mg/kg)). An auditory evoked potential
to our best knowledge. system (Nicolet Compact Electrodiagnostic system;
Due to Turkish national military regulations, can- Nicolet Biomedical Instruments, Madison, Wisconsin,
didates with unilateral profound or total hearing USA) was used for recordings. Silver disc electrodes
loss (i.e. a pure tone average equal to or greater recorded potentials. The positive and reference elec-
than 90 dB HL) are deemed unsuitable for military trodes were placed on the forehead and the mastoid
service. Statutory regulations also require clinical skin, respectively, while another forehead electrode
practitioners to perform ABR testing to confirm served as a ground. Care was taken to attain an elec-
pure tone audiometry results. Since our institution trode impedance and an inter-electrode impedance
has been designated an official examining centre for difference of less than 5 and 1 kV, respectively.
hearing loss, military candidates who may potentially Click stimuli of alternating polarity and with a
present with pseudohypacusis are frequently referred duration of 100 ms were delivered monaurally at a
to us. Thus, taking advantage of our particular patient repetition rate of 20 per second to each ear through
population, and accepting ABR testing as the ‘gold a tubal insert earphone (Nicolet Biomedical
standard’, we investigated the efficiency of the Instruments). A total of 1500 sweeps was averaged.
Stenger test in detecting unilateral pseudohypacusis. Bio-electric signals were amplified 105 times and
band-pass filtered over 150 –3000 Hz. Analysis
time was set at 10 ms. The test commenced with an
Materials and methods 80 dB nHL stimulus. The hearing threshold calcu-
The study was performed in the otolaryngology lation was based on the V wave generated by the
department of the Gulhane Military Medical lowest stimulus intensity. The contralateral ear was
Academy, between August 2007 and March 2008. masked when necessary. Candidates with no V wave
Two hundred male candidates (mean age 22 at 100 dB nHL were diagnosed as having at least pro-
years + 3,4 standard deviation; range 20 to 32 found hearing loss (Figure 1). Detection of a V wave
years) had already been evaluated and referred to evoked by a stimulus intensity of less than 100 dB
our department with questionable profound or total nHL, in candidates whose pure tone audiograms
hearing loss. These men were enrolled in the study were suggestive of total or profound hearing loss,
and underwent pure tone and speech audiometry. was taken to indicate pseudohypacusis (Figure 2).
Speech and tonal Stenger tests were performed
immediately after pure tone audiometry. The tests
were performed with calibrated audiometers (Audio- Results
med AC-40; Interacoustics, Assens, Denmark) in a
sound-proof booth (Interacoustics). Earphones Two hundred candidates were referred to our insti-
(TDH-39; Telephonics, Farmingdale, USA) and a tution with a possible diagnosis of unilateral pro-
bone vibrator (B-71; Radioear, New Eagle, Pennsyl- found or total hearing loss. On ABR testing, which
vania, USA) were used for measuring air and bone we accepted as the gold standard, 190 (95 per cent)
conduction thresholds, respectively. An audiologist of the 200 candidates had a V wave which was ident-
who was unaware of the Stenger test results per- ified only at 100 dB nHL (confirming profound
formed click ABR testing. The sensitivity, specificity
and predictive values of the Stenger test for unilat-
eral, profound pseudohypacusis were assessed,
using the ABR test as the gold standard.
Stenger testing was performed immediately after
pure tone and speech audiometry. Stenger testing
began with presentation of a steady sound stimulus
to the good hearing ear, at 1000 Hz and 5 dB higher
than the threshold. The patient was asked to press
the button when he heard the stimulus. Simultaneous
stimuli at the same tone, beginning from 0 dB HL and
increasing in 5 dB increments, were given to the poor FIG. 1
hearing ear. Increment, by 5 dB-step was continued
Auditory brainstem response trace showing no V wave at
until the candidate ceased to respond or maximum 100 dB nHL, indicating at least profound hearing loss. The
intensity was achieved. The test was interpreted as x-axis presentes: time (ms: millisecond); the y-axis presents:
negative when the patient continued to respond amplitude (mV: microvolt).

Downloaded from https://www.cambridge.org/core. Pontificia Universidad Catolica de Chile, on 13 Mar 2020 at 16:40:12, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0022215109004769
 842 A DURMAZ, S KARAHATAY, B SATAR et al.

warrants special attention in centres where patients

are evaluated regarding monetary compensation
claims or military service.1 The prevalence of pseu-
dohypacusis is greater in industrial workers and mili-
tary staff, compared with the normal population, and
practitioners caring for these patient groups should
keep the condition in mind when managing hearing
loss. Industrial workers may receive compensation
for occupational hearing loss, and this possibility
clearly motivates some individuals to feign hearing
loss or to exaggerate the degree of hearing loss.9
FIG. 2 Pseudohypacusis in a new military recruit is a
Auditory brainstem response trace of a patient with strong indicator that the individual should be separ-
pseudohypacusis, showing a V wave at 95 dB nHL. This
patient’s pure tone audiogram indicated total hearing loss. ated immediately from active military duty. It may
The x-axis presentes: time (ms: millisecond); the y-axis be cost-effective to separate such individuals from
presents: amplitude (mV: microvolt). active duty as soon as the diagnosis is made.10 The
prevalence of pseudohypacusis is variable and
dependent on the demographic characteristics of
hearing loss) or was not identified (indicating poss- the group examined, ranging from 2 to 90 per
ible total hearing loss; since click-evoked ABR cent.1,3,4 The prevalence of pseudohypacusis in our
testing lacks the capacity to detect hearing reserve study population, consisting of new military recruits
at low frequencies, the term ‘possible’ was used). and veterans, was 5 per cent (Table I).
Thus, these 190 candidates were diagnosed as An experienced clinician or audiologist may
having at least profound hearing loss. Stenger quickly suspect pseudohypacusis from informal
testing confirmed profound hearing loss correctly in observation of the patient before and during conven-
189 (99.4 per cent) of these 190 candidates. tional tests. However, formal diagnosis of pseudohy-
In the remaining 10 (5 per cent) candidates, a V pacusis and objective assessment of hearing
wave was generated by a stimulus intensity lower thresholds are time- and energy-consuming pro-
than 100 dB nHL, as opposed to audiometry findings. cesses. The clinician may be alerted to the possibility
These candidates were thus diagnosed with pseudo- of pseudohypacusis by a patient’s hesitancy in
hypacusis. These 10 patients had the following responding to pure tone and speech audiometry
ABR thresholds: 95 dB nHL in two patients, 80 dB testing, and by discrepancies between the patient’s
nHL in two patients, 60 dB nHL in one patient, behaviour and the test results.4
50 dB nHL in three patients, 40 dB nHL in one In all physiological conditions tested by standar-
patient and 30 dB nHL in one patient. The Stenger dised, calibrated audiometric equipment, bone
test confirmed pseudohypacusis in seven (70 per conduction thresholds should be better than air con-
cent) of these 10 candidates (Table I). Taking these duction thresholds; results to the contrary suggest
results into consideration, the sensitivity and speci- pseudohypacusis.
ficity of the Stenger test in verifying unilateral, pro- The test– retest variability of pure tone audiometry
found hearing loss were 70 and 99.4 per cent, should be 0– 15 dB; greater variability should prompt
respectively. The positive and negative predictive suspicion of pseudohypacusis. The speech reception
values of the test were 87.5 and 98.4 per cent, threshold should be consistent with the pure tone
respectively. average of 500, 1000 and 2000 Hz thresholds, to
within approximately 10 dB.11 Patients with pseudo-
Discussion hypacusis tend to score better than expected for their
alleged pure tone hearing losses.1 – 4
Although there are a limited number of published The tonal acoustic reflex is elicited in normal indi-
studies on pseudohypacusis, this phenomenon viduals at 60 to 100 dB SPL. Pseudohypacusis should
be suspected if this reflex is present at levels within
TABLE I 10 dB of the patient’s alleged thresholds.12 Tonal
STENGER TEST RESULTS
acoustic reflex thresholds are an effective, non-
behavioural tool for identifying or substantiating
Stenger test results ABR results the presence of functional hearing loss when
Pseudohypacusis Hearing loss thresholds are 60 dB HL or more; however, acoustic
(n) (n)† reflex thresholds cannot identify functional com-
ponents when thresholds are 55 dB HL or less.13
Pseudohypacusis (n) 7 1‡ Lack of congruity between different audiological
Hearing loss (n) 3§ 189
tests, even if each individual test demonstrates an
For Stenger test: sensitivity ¼ 7/(7 þ 3) ¼ 0.7 (i.e. 70%); objective hearing loss, may be accepted as indicating
specificity ¼ 189/(189 þ 1) ¼ 0.994 (i.e. 99.4%); positive pre- pseudohypacusis.
dictive value ¼ 7/(7 þ 1) ¼ 0.875 (i.e. 87.5%); negative predic- Although unilateral pseudohypacusis represents 28
tive value ¼ 189/(189 þ 3) ¼ 0.984 (i.e. 98.4%).  n ¼ 10 (i.e.
5% of study population); †n ¼ 190 (i.e. 95% of study popu- per cent of all cases of the condition,14 several specific
lation). ‡Stenger test false positive; §Stenger test false audiological tests have been used in the management
negatives. of this entity, including the Lombard reflex test, the

Downloaded from https://www.cambridge.org/core. Pontificia Universidad Catolica de Chile, on 13 Mar 2020 at 16:40:12, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0022215109004769
 STENGER TEST FOR PROFOUND, UNILATERAL PSEUDOHYPACUSIS 843

delayed auditory feedback speech test and the swing- above true values) but not significantly at 1 kHz.16
ing story test. However, these tests provide only quali- Although it can predict functional hearing loss, the
tative information and are thus no longer efficiency of the Stenger test is apparently affected
recommended for pseudohypacusis diagnosis. More- by interaural sensitivity differences and by the size
over, assessing objective hearing thresholds with of the functional component in the better ear.17,18
these tests is not always possible.1 – 4,15 Otoacoustic emission tests may also play a role in
Two different physiological effects play a significant the management of pseudohypacusis, but with two
role in the management of unilateral profound or total major drawbacks. These tests are easy and quick to
hearing loss: the ‘shadow curve’ and the Stenger perform, but test solely the integrity of the cochlea,
effect. If a profoundly hearing-impaired ear is stimu- specifically the outer hair cells. Thus, the presence
lated at 40 dB or more above the contralateral ear’s of otoacoustic emissions does not guarantee trans-
threshold, the contralateral ear perceives the stimulus. mission of neural signals to the central auditory path-
Thus, the audiogram of such an ear should show a ways. Additionally, otoacoustic emissions are only
similar pattern to the contralateral ear’s audiogram, abolished when cochlear hearing losses of up to
but with the threshold shifted nearly 40 dB higher. 40– 50 dB HL are present, depending on the type
This phenomenon is known as a shadow curve, and of emissions.19 Keeping these limitations in mind,
is not seen in patients feigning hearing loss.1,4,8 If otoacoustic emissions can be used to provide actual
the same tone is presented to both ears, the tone is threshold measurements when performed in combi-
perceived centrally as arising from one source nation with routine speech and pure tone
(binaural fusion). This ‘fused’ tone is localised only audiometry.1 – 4
to the ear that is better able to detect it; this phenom- Auditory evoked potentials provide an estimate of
enon is known as the Stenger effect. true hearing thresholds if a detectable evoked
Of the tests created specifically to detect pseudo- response is seen at a specific stimulus intensity. Audi-
hypacusis, the Stenger test is the best known. It can tory evoked potentials have been used to verify
be used for patients feigning asymmetrical hearing hearing sensitivity in pseudohypacusis cases.20 Fur-
loss with an interaural difference of at least 30 to thermore, the application of ABR testing is probably
40 dB. The test relies on the Stenger effect. The a potent force in motivating the patient to return to
Stenger test consists of presenting either a pure improved and even normal threshold levels through
tone or spondee word at a level just above the voluntary responses.21 Auditory brainstem response
threshold hearing in the better-hearing ear, simul- testing has the advantage of not depending on the
taneously with a signal just below threshold in the patient’s state of consciousness. The presence of
worse-hearing ear, while asking the patient to evoked potentials demonstrates only a synchronised
respond ‘yes’ or ‘no’ regarding hearing a tone in neural discharge in response to noise stimuli; it
either ear. A patient with actual asymmetrical does not guarantee the perception of sound. The
hearing loss will respond ‘yes’, because he or she opposite is also true; the absence of a response
should hear the tone in their better-hearing ear, does not necessarily imply that a sound is not being
due to binaural fusion. Patients with functional perceived by the subject, as demonstrated by the dis-
hearing loss will, due to binaural fusion, hear the orders collectively known as auditory neuropathy.4
tone only in the worse-hearing ear, and will choose Click-evoked ABR thresholds result in reasonable
not to respond because they cannot tell that there predictions of the average behavioural thresholds at
is a stimulus above threshold in the better-hearing 2 and 4 kHz, thus limiting their utility in patients
ear. By using these techniques, and carefully present- with functional hearing loss who have underlying
ing the tone above threshold in the better ear while high-frequency hearing loss. However, cases have
slowly increasing the tone level in the ‘bad’ ear been reported in which click-evoked ABR thresholds
until the patient fails to respond, the actual threshold underestimated hearing loss at these frequencies.20,22
of the bad ear can be estimated.1,8 In the current study, click-evoked ABR measure-
Boyd et al. have reported an interesting study ments were used since these generally result in well
investigating the efficacy of the Stenger test, formed responses. The test also assisted in determin-
employed in two forms to estimate genuine hearing ing whether auditory neuropathy existed.20
thresholds in normally hearing volunteers simulating The assessment of sensitivity and specificity is one
total unilateral hearing loss. The Stenger test was approach to quantifying the diagnostic ability of a
carried out in its standard form and also in a modified test.23 In clinical practice, however, the test result is
form, in which a phase shift was introduced between all that is known, so clinicians need to know how
the signals delivered to the two ears, set to produce good that test is at predicting abnormality; in other
phase-induced lateralisation towards the ‘poor’ ear. words, what proportion of patients with abnormal
The standard test estimated hearing thresholds at a test results is truly abnormal? In the current study,
mean of 13.5 dB above the true thresholds, at five fre- the sensitivity and specificity of the Stenger test for
quencies from 250 Hz to 4 kHz. Hearing thresholds verifying unilateral profound hearing loss were 70
at the different frequencies were compared, and and 99.4 per cent, respectively. These findings mean
although thresholds were lower for the higher fre- that the Stenger test recognises 70 per cent of all pseu-
quencies, the apparent effect of frequency was not dohypacusis cases as pseudohypacusis, and that it also
statistically significant. The modified test, using a correctly detects 99 per cent of all hearing loss cases.
908 phase shift, was found to enhance the test at The positive and negative predictive values of the test
250 and 500 Hz (thresholds estimated at about 7 dB were 87.5 and 98.4 per cent, respectively. The Stenger

Downloaded from https://www.cambridge.org/core. Pontificia Universidad Catolica de Chile, on 13 Mar 2020 at 16:40:12, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0022215109004769
 844 A DURMAZ, S KARAHATAY, B SATAR et al.

test has few false positives and false negatives; thus, a 3 William WQ, Fred JS, Shengguang SY, Louis WW. Current
positive Stenger test is powerful enough to confirm evaluation of pseudohypacusis: strategies and classifi-
cation. Ann Otol Rhinol Laryngol 1998;107:638– 47
pseudohypacusis (positive predictive value ¼ 87.5 4 James L, Hinrich S. Nonorganic hearing loss. Semin Neurol
per cent), and it will detect 70 per cent of all pseudo- 2006;26:321– 30
hypacusis cases (i.e. sensitivity of 70 per cent). A 5 Pracy JP, Bowdler DA. Pseudohypacusis in children. Clin
negative Stenger test result represents an effective Otolaryngol Allied Sci 1996;21:383– 4
reassurance that the patient’s condition is not pseudo- 6 Radkowski D, Cleveland S, Friedman EM. Childhood
pseudohypacusis in patients with high risk for actual
hypacusis (negative predictive value ¼ 98.4 per cent). hearing loss. Laryngoscope 1998;108:1534– 8
The Stenger test also correctly identifies 99.4 per cent 7 Martin FN, Shipp DB. The effects of sophistication on
of patients with objective hearing loss (i.e. specificity three threshold tests for subjects with simulated hearing
of 99.4 per cent) (Table I). loss. Ear Hear 1982;3:34 –6
8 Gelfand SA. Nonorganic hearing loss. In: Gelfand SA, ed.
Essentials of Audiology, 2nd edn. New York: Thieme, 2001;
421–42
. Conscious and deceptive exaggeration of 9 Barelli PA, Ruder L. Medico-legal evaluation of hearing
hearing loss is termed pseudohypacusis problems. Eye Ear Nose Throat 1970;49:398– 405
10 Gold SR, Hunsaker DH, Haseman EM. Pseudohypacusis
. This study evaluated the sensitivity, specificity in a military population. Ear Nose Throat J 1991;70:710– 12
and predictive values of the Stenger test in 11 Schlauch RS, Arnce KD, Olson LM, Sanchez S, Doyle TN.
diagnosing unilateral pseudohypacusis Identification of pseudohypacusis using speech recognition
thresholds. Ear Hear 1996;17:229 –36
. A positive Stenger test is sufficiently powerful 12 Gelfand SA. Acoustic immittance assessment. In: Gelfand
to confirm pseudohypacusis (positive SA, ed. Essentials of Audiology, 2nd edn. New York:
predictive value 5 87.5 per cent), and will Thieme, 2001;219–55
detect 70 per cent of all cases of 13 Gelfand SA. Acoustic reflex threshold tenth percentiles
and functional hearing impairment. J Am Acad Audiol
pseudohypacusis (i.e. sensitivity of 70 per cent) 1994;5:10 – 16
. The Stenger test remains a relevant clinical 14 Gelfand SA, Silman S. Functional components and
test; it should be used in association with resolved thresholds in patients with unilateral nonorganic
hearing loss. Br J Audiol 1993;27:29 –34
objective tests (e.g. auditory brainstem 15 Rintelmann WF, Schvvan SA. Pseudohypacusis. In: Rintel-
response testing) when indicated mann WF, ed. Hearing Assessment, 2nd edn. Boston: Allyn
and Bacon, 2001;603– 52
16 Boyd PJ, Rowson VJ, Reeves D. Application of
phase-induced lateralization to the Stenger test. Audiology
The hallmark of nonorganic hearing loss is lack of 1991;30:241– 8
inter-test consistency. The Stenger test is widely used 17 Kinstler DB, Phelan JG, Lavender RW. The Stenger and
for the evaluation of unilateral or asymmetrical pseu- Speech Stenger tests in functional hearing loss. Audiology
dohypacusis, and in our opinion it is powerfully 1972;11:187– 93
18 Monsell EM, Herzon FS. Functional hearing loss present-
reliable. The major drawback of the test is that it ing as sudden hearing loss: a case report. Am J Otol 1984;
requires some amount of cooperation from the 5:407 –10
patient. More difficult cases require objective electro- 19 Durrant JD, Kesterson RK, Kamerer DB. Evaluation of
physiological testing to verify that a patient has func- the nonorganic hearing loss suspect. Am J Otol 1997;18:
tional hearing loss. Special testing may also be 361–7
20 Gorga MP, Johnson TA, Kaminski JR, Beauchaine KL,
required to exclude specific diagnoses that may Garner CA, Neely ST. Using a combination of click- and
imitate pseudohypacusis. The clinician should be tone burst-evoked auditory brain stem response measure-
aware of these objective tests and apply them effi- ments to estimate pure-tone thresholds. Ear Hear 2006;
ciently in order to identify or exclude pseudohypacusis. 27:60 –74
21 Sanders JW, Lazenby BB. Auditory brain stem response
measurement in the assessment of pseudohypoacusis. Am
Conclusion J Otol 1983;4:292– 9
22 Coles RR, Mason SM. The results of cortical electric
Pseudohypacusis refers to conscious and deceptive response audiometry in medico-legal investigations. Br J
exaggeration of hearing loss. Although the Stenger Audiol 1984;18:71 –8
test has been used for almost a century in the man- 23 Altman DG, Bland JM. Diagnostic tests 1: sensitivity and
agement of pseudohypacusis, its sensitivity, speci- specificity. BMJ 1994;308:1552
ficity and predictive values for unilateral
pseudohypacusis have not previously been reported, Address for correspondence:
to our best knowledge. We investigated the efficiency Dr Abdullah Durmaz,
of the Stenger test in detecting unilateral pseudohy- Assistant Professor,
Dept of ORL & HNS,
pacusis, within a particular patient population and GATA Etlik 06018,
using a conventional auditory testing battery, accept- Ankara, Turkey.
ing ABR testing as the gold standard.
Fax: þ90 (312) 3045700
References E-mail: [email protected]
1 Rintelmann WF, Schwan SA, Blakley BW. Pseudohypacu-
sis. Otolaryngol Clin North Am 1991;24:381– 90 Dr A Durmaz takes responsibility for the integrity of the
2 Austen S, Lynch C. Non-organic hearing loss redefined: content of the paper.
understanding, categorizing and managing non-organic Competing interests: None declared
behaviour. Int J Audiol 2004;43:449– 57

Downloaded from https://www.cambridge.org/core. Pontificia Universidad Catolica de Chile, on 13 Mar 2020 at 16:40:12, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0022215109004769