Stenger’s, Chimani Moos, Teal test

Special Tuning Fork Tests for Malingering and Non-Organic Deafness

1. Stenger’s Test.

Principle: Stenger’s test is based on the principle that when two identical tones are presented simultaneously to both ears, only the louder tone is perceived. If both tones are of equal intensity, the sound is perceived in the midline.

Indications

• Suspected unilateral non-organic (functional) hearing loss
• Suspected malingering
• Medico-legal evaluation
• Inconsistent behavioural audiometric responses

Physiological Basis: When identical tones are presented simultaneously to both ears, the auditory system suppresses the softer tone and perceives only the louder one. Therefore, a patient with normal cochlear function in both ears localises the sound to the ear receiving the louder stimulus. In unilateral functional hearing loss, the patient intentionally withholds the response because acknowledging the louder tone would contradict the claimed deafness.

Tuning Fork Procedure: The patient is blindfolded or instructed to keep the eyes closed. Two identical 512 Hz tuning forks are struck simultaneously. One tuning fork is held near the normal ear, while the other is placed near the ear suspected of non-organic hearing loss. Initially, the tuning fork near the normal ear is louder, so the patient reports hearing the sound in that ear. The tuning fork near the suspected deaf ear is then brought closer (or struck more forcefully) so that it becomes louder than the one near the normal ear. A patient with true unilateral deafness continues to hear the sound in the normal ear. In contrast, a malingerer perceives the louder sound in the supposedly deaf ear but deliberately fails to respond, producing a positive Stenger test.

Audiometric Stenger Test: The Stenger test is now almost always performed with an audiometer.

Procedure: Present identical pure tones simultaneously to both ears using an audiometer. The tone is delivered at 10 dB above the admitted threshold in the suspected deaf ear and 10 dB below the threshold in the normal ear. A patient with unilateral non-organic hearing loss perceives the louder tone in the suspected deaf ear and therefore does not respond, resulting in a positive Stenger test. A patient with true unilateral hearing loss responds to the tone presented to the normal ear, producing a negative Stenger test.

2. Chimani Moos Test. The Chimani Moos test is a modification of the Weber test, designed to identify non-organic hearing loss.

Procedure: When a vibrating tuning fork is placed on the forehead, a malingerer will often report hearing the sound in their better ear, which simulates sensorineural deafness. If the ear canal of the better ear is occluded, a genuinely deaf patient will still hear the sound in the occluded ear, while a malingerer will claim they cannot hear it.

3. Teal Test. The Teal test specifically evaluates the validity of claims where patients assert they can only hear through bone conduction (a pattern highly suspicious of non-organic hearing loss, as pure bone conduction hearing without any air conduction is rare).

Procedure: This test involves presenting a vibrating tuning fork to the mastoid and then alternately to the external ear canal while the patient’s ear is occluded and unoccluded. A malingerer will typically maintain that they only hear the sound via bone conduction, even when conditions are optimal for air conduction.

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Download full PDF Link:

Stenger’s, Chimani Moos, Teal Test Lecture Notes Dr Rahul Bagla ENT Textbook

Reference Textbooks.

• Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
• Glasscock-Shambaugh, Textbook of Surgery of the Ear.
• P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
• Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
• Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery
• Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
• Salah Mansour, Middle Ear Diseases – Advances in Diagnosis and Management.
• Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
• Rob and smith, Textbook of Operative surgery.
• Anirban Biswas, Textbook of Clinical Audio-vestibulometry.
• Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.

Author:

Dr. Rahul Bagla
MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
Fellow Rhinoplasty & Facial Plastic Surgery.
Renowned Teaching Faculty
Mail: msrahulbagla@gmail.com
India

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