Diagnostic utility of Stenger test: reappraisal of its value

Nonorganic hearing loss (NOHL) is a lack of consistency in audiological testing. Although NOHL is relatively rare, it is important to identify suspicious patients. This study was designed to evaluate the effectiveness of Stenger test and acoustic reflexes test (ART) in the evaluation of patients with suspicious of unilateral NOHL.

A prospective study Methods: In this study, 474 adult patients with suspicious unilateral profound or total hearing loss were included. Pure tone audiometry (PTA), speech audiometry, Stenger test, ART and click-evoked auditory brainstem response (ABR) measurements were performed. The sensitivity, specificity and predictive values of the Stenger test and ART for unilateral, profound to total NOHL were assessed by comparing these with the results of ABR.

The sensitivity and specificity of the Stenger test in verifying unilateral, profound hearing loss were 99% and 57%, respectively. The positive and negative predictive values of the test were 88% and 97%, respectively. The sensitivity and specificity of the ART in verifying unilateral, profound hearing loss were 96% and 60% at 1000 Hz and 98% and 60% at 2000 Hz, respectively. The positive and negative predictive values of the ART were 50% and 97% at 1000 Hz, and 75% and 97% at 2000 Hz, respectively.

The Stenger test and ART are widely used for the evaluation of unilateral or asymmetrical NOHL. In our opinion, these tests are significantly powerful. More difficult cases require ABR to verify nonorganic hearing loss and to exclude specific diagnoses that may imitate NOHL.