Interpretation of Rinne’s and Weber’s testsĮxternal or middle ear pathology affects the conduction of sound into the inner ear You will notice your voice is louder in the occluded ear. You can demonstrate this by speaking/humming, and then occluding an external auditory meatus. In addition, low-frequency sounds are ‘trapped’ within the inner ear by the obstruction leading to increased loudness in the affected ear. The affected ear has less environmental noise (due to the problem with air conduction). *In conductive hearing loss, there is a relative improvement in bone conduction on the affected side.
Conductive hearing loss: sound is heard louder on the side of the affected ear.*. Sensorineural hearing loss: sound is heard louder on the side of the intact ear. Normal: sound is heard equally in both ears. Weber’s test should be assessed in context with the results of Rinne’s test before any diagnostic assumptions are made: Tap a 512Hz tuning fork and place in the midline of the forehead Ideally, you want a tuning fork that has a long period of decay and cannot be detected by vibration sensation. However, a patient with significant sensorineural hearing loss may have a ‘false negative’ Rinne’s test, as they are unable to hear anything in the affected ear but bone vibrations may be transmitted to the unaffected ear.Įxplain to the patient that you are going to test their hearing using a tuning fork.ġ. Tap a 512Hz tuning fork and place in the midline of the forehead. The tuning fork should be set in motion by striking it on your knee (not the patient’s knee or a table).Ģ. Ask the patient “Where do you hear the sound?”Ī 512Hz tuning fork is used as it gives the best balance between time of decay and tactile vibration. In this situation, the patient will be able to hear the tuning fork for longer when held on the mastoid (testing bone conduction) than when held over the external auditory meatus (testing air conduction). conductive hearing loss), then bone conduction may be better than air conduction. If there is a problem with air conduction (i.e. Therefore, the patient should be able to hear the tuning fork held over the external auditory meatus (which is testing air conduction) for longer than the tuning fork held on the mastoid (testing bone conduction). In healthy patients, air conduction (using the structures in the ear) should be better than bone conduction (conduction of vibrations via bone). Mask the ear not being tested by rubbing the tragus If they can hear the sound, it suggests air conduction is better than bone conduction, which is what would be expected in a healthy individual (this is often confusingly referred to as a “Rinne’s positive” result). When the patient can no longer hear the sound, move the tuning fork in front of the external auditory meatus to test air conduction.Ĥ. Ask the patient if they can now hear the sound again. Confirm the patient can hear the sound of the tuning fork and then ask them to tell you when they can no longer hear it.ģ. Place a vibrating 512 Hz tuning fork firmly on the mastoid process (apply pressure to the opposite side of the head to make sure the contact is firm). It is important to be able to interpret the results of Rinne’s and Weber’s, as these tests frequently appear in OSCEs and written examinations.ġ. 
They are usually performed as part of a comprehensive ear examination. In primary care settings, the Rinne would be most effective as part of a screening program for conductive hearing losses, but not as the sole indicator for referral.Rinne’s and Weber’s tests are simple tuning fork tests used to screen for the presence of conductive and sensorineural hearing loss. Sensitivity for all groups was improved by interpreting equivocal results as indicating a conductive loss.ĭespite reports of poor reliability, the 512-Hz Rinne tuning fork test can be an important tool in an otology practice for the detection of conductive hearing losses and for confirming audiometric findings. Sensitivity was lower when masking was not used and lowest when the Rinne was performed by a less-experienced tester. Results showed the 512-Hz Rinne tuning fork test could be very effective at detecting conductive hearing losses when performed by an experienced tester and when masking was used. Sensitivity of the 512-Hz Rinne tuning fork test was assessed by comparing tuning fork results with the pure-tone average air-bone gap. The effects of tester experience, the use of masking, and the interpretation of equivocal (+/-) Rinne results on test reliability also were examined.ġ,000 adult patients (2,000 ears) seen for their initial otologic evaluation. This study aimed to examine the reliability of the 512-Hz Rinne tuning fork test to detect conductive hearing losses.
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