[The Stenger Test--its use and variations]

Simulation, dissimulation and aggravation of partial hearing loss can refer to bilateral or unilateral hearing loss. Tests for detection can be divided into unilateral and bilateral.

A patient aged 29, came for otolaryngological examination 13 days after hearing impairment and blast injury of the ear following detonation of an airplane-launched missile about 500 meters away. AT the moment of detonation he was not wearing a helmet. Two hours later he noticed bloody discharge and strong tinnitus in the left ear. During examination and audiometric test, we suspected aggravation. The patient was sent for sub-specialist audiological examination. The audiogram made during the first testing showed a perceptive hearing impairment on the right side, while the left ear was without response (Audiogram 1). We asked the patient to concentrate, repeated the test, and got Audiogram 2 (Curve I). After this the patient was informed that we would carry out another testing, using Stenger test, and we got Curve II. The patient was informed that he had done very successfully in the test, and that we would repeat it, Curve III. We got Curve IV by repeating the test reducing the tone volume by 10 dB again. The aggravation was obvious, and the audiogram was shown to the patient, explaining that his intention was detected, and he was asked to cooperate correctly so that adequate therapy could be applied, which he accepted, so that we got Curve V, the real condition of his hearing.

We have shown the case of a patient injured in a missile explosion which caused perforation of the tympanic membrane and a sensorineural hearing loss. Suspecting aggravation, Stenger test was performed. The testing showed unexpected results not described with Stenger test and we simultaneously detected the patient's intention to simulate aggravation.