#128 tuning fork medical how to
#128 tuning fork medical full

For example, imagine the right ear is ‘dead’.

The difficulty in interpreting Rinne’s test is in total unilateral sensorineural hearing loss (i.e.

2) If the patient can hear best when the tuning fork is on the mastoid (negative Rinne’s) bone conduction is better than than air conduction, demonstrating a conductive hearing loss.

Therefore in sensorineural hearing loss on the right, for example, Rinne’s test should be positive on the right.

1) If a patient can hear best when the tuning fork is in the air (positive Rinne’s) then air conduction is better than bone conduction so there is no significant conductive hearing loss.

In a normal ear sound is conducted to the cochlear most efficiently via air conduction. Sound can also be transmitted to the cochlea, less efficiently, via bone.

A patient who hears the fork loudest when it is held against the mastoid process has a negative Rinne’s test.

A patient who hears the tuning fork loudest when held 1cm from the external auditory meatus has a positive Rinne’s test.

What is a positive and negative Rinne’s Test?

Ask the patient in which of the positions they were able to hear the note the loudest in.

Leave it there again for a few seconds before taking the tuning fork away from their ear.

Then promptly lift the fork off the mastoid process and place the vibrating tips about 1cm from their external auditory meatus.

Allow it to stay there for 2-3 seconds to allow them to appreciate the intensity of the sound.

Hold the tuning fork in one hand and place the base against the patient’s mastoid process ( see video).

Begin by striking the tuning fork against your knee or elbow.

I want you to tell me which position you hear the tuning fork loudest in”

“I’m going to put this vibrating tuning fork in two positions, one touching the bone near you ear, one a short distance from the ear.

Rinne’s test can only detect a conductive hearing loss of at least 30dB.

Rinne’s test has a high sensitivity (0.84) though this varies with the skill of the examiner.

This test aims compare air conduction with bone conduction.

Interpretation of Rinne’s and Weber’s tests Test

The various outcomes of Rinne and Weber tests are shown below.

In bilateral and symmetrical hearing loss of either type Weber’s test will be normal.

If a patient has a unilateral sensorineural hearing loss, the tuning fork sound will be heard louder in the normal ear.

If a patient has a unilateral conductive hearing loss, the tuning fork sound will be heard louder in the deaf ear.

move to one side, with a relatively small amount of hearing loss (5dB)

If the patient is unclear, you may ask if they hear it “everywhere.” Be careful not to ask the question in a leading manner.

Then ask the patient: “Do you hear the sound louder in one ear than the other?”.

It is important to steady the patient’s head with your other hand so that reasonably firm pressure can be applied.

To perform Weber’s test strike the fork against your knee or elbow, then place the base of the fork in the midline, high on the patient’s forehead.

Note you should ideally be in a completely silent room for Rinne and Weber tests.

Permission (consent and explain examination: “I’m going to examine your hearing using this tuning fork now, is that OK?”).

Identity of patient (confirm name and date of birth).

Video on Rinne and Weber tests by Oxford Medical Education

Other tuning fork tests include the Schwabach and Bing tests, though these are not used in routine practice.

The Rinne and Weber tests help distinguish between a conductive hearing loss (CHL) and sensorineural Hearing Loss (SHL).

#128 tuning fork medical full

These tests should be carried out with a full examination of the cranial nerves or the ear.Patients with bilateral loss or mixed losses are better assessed with formal pure tone audiometry.They are most useful in patients with unilateral hearing loss which is purely conductive or purely sensorineural.The tuning fork tests provide a reliable clinical method for assessing hearing loss.

#128 tuning fork medical how to

How to do Rinne and Weber tuning fork tests for doctors, medical student finals, OSCEs and MRCP PACES Tuning Fork Tests (Rinne’s and Weber’s tests)