The positive Stengers and elevated unmasked bone AD are strongly
supportive of what Raymond Carhart liked to call, "Pseudohypacusis." The
pure-tone Stenger, properly used, can sometimes give you an idea of
sensitivity at least up to the lowest interference levels observed,.but
the pure-tone Stenger should be used sparingly because some individuals
can learn to "beat it" if given enough exposure. This is an argument for
using the speech Stenger, which, I presume you might have tried since you
report SRTs. I hope you have been taught always to start testing with SRTs
rather than tones, using an ascending pattern, and introducing the speech
Stenger unobtrusively whenever SRT approaches the limits of interaural
attenuation. This approach pays big dividends in allerting you early to
the existence and nature of the problem of pseudohypacusis.
Despite the positive indicators, I would strongly advise you not to
report that, "Your patient is faking this." The tests that you performed,
the information that your obtained, and the limited inferences that you
can draw from the results do not permit you to rule out an underlying
organic problem. You might indicate that there appears to be an unresolved
nonorganic component. It makes sense to me to try further to resolve the
problem, or, perhaps, have someone more experienced with this kind of
problem try to resolve it before indulging in the "hope" that other,
potentially inappropriate and costly procedures, will bail tyou out.
Sounds like you are embracing Audiology and enjoying some of the
puzzles it sometimes poses. Good Luck!