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Author: admin | 17.01.2014 | Category: Tinnitus Hearing Loss

There may be a natural tendency for dispensing professionals to recoil at the idea of a tuning fork test; it seems dusty and archaic in the face of all of our excellent electronic screening options. Prior to the introduction of electronic audiological testing equipment, clinicians relied heavily on tuning fork tests (TFT) along with some other rudimentary tests, such as the “Whisper Voice.” Even with all of the electronic and computerized test equipment available today, TFTs play a critical role as an adjunct for clinicians to determine the type of hearing loss in patients. Although some of the TFTs have lost their value, two tests—the Weber and Rinne—have stood the test of time and are still important for clinicians in diagnosing hearing loss. Tonndorf and others10-12 have pointed out the important contribution that TFTs make for clinicians in developing their otologic diagnosis. Tonndorf and colleagues11,12 offered the most detailed and complete explanations of how bone conduction (BC) works. 1) Middle ear inertia, 2) Middle ear compliance, 3) Inner ear compression, and 4) Round window release. 5) Inner ear fluid inertia, 6) Oval window release, and 7) Release through the “third window” (cochlear aqueduct). Tonndorf12 comments, “All three anatomical parts of the ear, the outer ear canal, the middle ear, and the inner ear, contribute independently to bone conduction [transmission].” He went on in a later paper11 to further clarify his theory of bone conduction. Tonndorf stated that 500 Hz and 1000 Hz are the frequencies that are most affected by middle ear inertia.10 With the Rinne test, at frequencies above 1000 Hz, the air-bone gap has to be larger in order to observe the fork being louder behind the ear compared to at the opening of the meatus.
Clinically speaking, we know quite a lot about tuning fork tests; however, the mechanisms explaining the interaction of the components can be confusing. The Weber and Rinne should be administered at a BC level of 40 to 50 dB HTL (hearing threshold level) using a bone oscillator at 500 Hz or 1000 Hz.11 When a tuning fork or bone oscillator is overdriven and made so loud it deviates from its fundamental frequency, it will produce distortion. It should be noted that it is common to use the term 512 Hz and 1024 Hz when referring to a tuning fork test.
In the Weber test, the tuning fork tines are set into vibration and the stem of the fork is pressed against the middle of the forehead. If a conductive, mixed, or sensorineural hearing loss is present in only one ear and the other ear is normal or has better sensorineural hearing, the patient will report hearing the fork in that ear with the conductive loss or the ear with greatest sensorineural loss. In administering tuning fork tests, we have found that patients have no difficulty reporting their observations to the clinician.
This paper was written with the intention of communicating to hearing care clinicians an explanation of two tuning fork tests, the Weber and Rinne. The Weber and Rinne can be administered and communicated in only a few minutes and can be valuable in assisting hearing care professionals in interpreting and verifying their own test results.
Movement of the stapes on the oval window creates a wave or vibration in the perilymph fluid of the cochlea. Thousands of nerves representing more than 20,000 frequencies are located along the length of the cochlea; these nerves account for the hearing range. Conductive hearing loss results from anything that decreases the transmission of sound from the outside world to the cochlea.
Differentiation between sensory (cochlear) and neural (cranial nerve VIII) sensorineural hearing loss is important.
Lateralization of the sound to one ear indicates a conductive loss on the same side, or a perceptive loss on the other side. The patient is asked to indicate whether the tone is louder by air conduction or bone conduction. The combined information from the Weber and Rinne tests will tell you whether a conductive or sensorineural hearing loss is present.
If you have conductive hearing loss, bone conduction test is better because the vibrations are traveling through the bone to the cochlea.
Once your physician has determined the cause of your hearing loss, hearing aid may be recommended.
This information is collected if you request information from us, participate in a contest or sweepstakes, and sign up to join our email list or request some other service or information from us. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. However, two tuning fork tests—the Rinne and Weber—have stood the test of time and retain their importance for clinicians in diagnosing hearing loss.
In this paper, we review the basic principles involved in the use, theory, and interpretation of the Rinne and the Weber. Michael Hall, AuD, is a clinical audiologist who lives in Walnut Creek, Calif, and is now retired from private practice.


Although there are quite a few TFTs that were developed prior to the widespread use of audiometers, TFTs other than the Weber and Rinne are not of the same clinical value they were prior to the introduction of audiometers and immittance bridges. He and other researchers did an excellent job explaining the rationale for 512 Hz and 1024 Hz as the preferred frequencies for administering the Weber and Rinne.
The rationale for using lower frequencies is that the tuning fork is more subtle in terms of identifying conductive hearing loss at these frequencies.
The factors that explain why the fork lateralizes to the ear with a conductive pathology when the other ear is normal or has some degree of sensorineural hearing loss are the same four primary factors previously noted for BC: middle ear inertia, middle ear compliance, inner ear compression, and round window release. Technically, 500 Hz means a 500 Hz tone via the audiometer’s bone oscillator, while 512 Hz is the tuning fork frequency.
A useful method of recording the results of TFT is shown in Figure 1 where the Latin origin of these letters is defined.
If a conductive loss is present in only one ear and the other ear has a sensorineural loss, the patient will still report the fork being louder in the ear with the middle ear pathology.
The tuning fork tines are put into vibration in the same manner as when conducting the Weber Test. Audiometric puretone and tuning fork test results for a patient with a unilateral mixed hearing loss.
Audiometric puretone and tuning fork test results for a patient with a bilateral sensorineural hearing loss. These tests, in our opinion, offer support to more modern audiometric tests in assisting all professionals involved in administering hearing tests.
This may be useful, for example, in cases of conductive hearing loss with normal tympanograms where an air-bone gap is present on the audiogram, but the patient does not have otitis media.
Examination should include otoscopic inspection of the auditory canals and tympanic membranes, assessment of auditory acuity in each ear, and Weber and Rinne tests performed with a 512-Hz tuning fork.
When they strike the tympanic membrane, the waves cause it to vibrate, setting off a chain of vibrations along the ossicles (malleus, incus, and stapes) to the membrane of the oval window at the entrance to the cochlea. This fluid movement displaces the hair cells, triggering an action potential and causing a nerve in the cochlea to fire to the brain.
It occurs after damage to the inner ear (hair cell destruction in the cochlea) or vestibulocochlear nerve (cranial nerve VIII). Evaluating hearing with a tuning fork can be a useful clinical screening tool to differentiate between conductive and sensorineural hearing loss. The stem of a vibrating tuning fork is placed on the head in the midline, and the patient is asked whether the tone is heard in both ears or in one ear better than in the other. When neurosensory hearing is intact bilaterally, the sound will lateralize to the side of conductive loss, which loses the masking effect of background noises. If there is conductive hearing loss of right ear, the vibration of the tuning fork is heard better in the right ear. If there is sensorineural hearing loss of right ear, the vibration of the tuning fork is heard better in the left ear. A Rinne test compares the ability to hear by air conduction with the ability to hear by bone conduction.
Normally and in sensorineural hearing loss, the tone of the vibrating tuning fork is heard louder by air conduction than by bone conduction. However, these tests are associated with significant false-positive and -negative responses and therefore should be used only as screening tools and not as a definitive evaluation of auditory function. An ear with sensorineural hearing loss, the air conduction is the best test of the tuning fork because sound is transmitted efficiently through the healthy apparatus of the middle ear than through bone.
Infection can be treated with antibiotics, although sometimes the infection must be drained and the pressure relieved by myringotomy, a tiny opening is made in the eardrum.
It produces periods of vertigo, a spinning sensation, dizziness, nausea, vomiting, and fluctuating hearing loss, also noise in the ear.This disease can be dramatic and disabling. The information collected is internally reviewed, used to improve the content of our website, notify our visitors of updates, and respond to visitor inquiries. We will also provide a discussion of how to interpret the results, as well as the AC and BC phenomenon that determines the various results seen with these two tests. Carl Croutch, AuD, is an audiologist at Kaiser Permanente Hearing Center in Daly City, Calif.
For example, at frequencies 2 to 3 octaves lower than 2000 Hz, an air-bone gap one-half or less the size than at 2000 Hz is typically needed to indicate a conductive loss.


The effect of all of these various components results in producing in-phase and out-of-phase traveling waves in the cochlea.11 The in-phase condition results in an increase in amplitude, which creates a perception that the Weber is louder in the ear with the middle ear pathology.
The stem is placed on the mastoid prominence on one side, and then transferred to the opening of the same ear while keeping the tuning fork from actually touching the patient’s ear.
Looking at Figure 1 will acquaint the reader to a quick and easy method to report TFT results. When conducting the Rinne, where there is a 30 dB or more difference between ears, it is advised to mask the better ear when conducting the test. Auditory acuity can be tested crudely by rubbing thumb and forefinger together approximately 2 in from each ear.
The location of the vibration in the cochlea correlates with the frequency of the original pitch. By comparing the threshold of hearing by air conduction with that elicited by bone conduction with a 512-Hz tuning fork, one can infer the site of the lesion responsible for hearing loss.
As a general rule, a 5-dB difference in hearing between the two ears is required for lateralization (see figure below). The vibrating tuning fork is held near the opening of the external auditory canal, and then the stem is placed on the mastoid process. However, with a 30-dB or greater conductive hearing loss, the bone-conduction stimulus is perceived as louder than the air-conduction stimulus. When middle ear pathologies are present, there is an increase in impedance at the footplate and oval window, which create in- and out-of-phase traveling waves in the cochlea. When the middle ears are normal, the Weber lateralizes to the better cochlea simply because it is the better-hearing ear.
Normally, we instruct the patient that they will hear two sounds: one at the bone behind their ear and the other in their ear.
If the patient’s hearing loss is severe, the clinician may rely on sign signals such as having the patient hold up one or two fingers to indicate which sound is the loudest. If the patient complains of hearing loss or cannot hear the finger rub, the type of the hearing deficit should be determined. The Rinne and Weber tuning fork tests are used widely both to differentiate conductive from sensorineural hearing losses and to confirm the audiologic evaluation results. An abnormal result is when the patient can hear the tuning fork tone in one ear more than the other.
Go to chemobrainIn the weber test which is used to diagnose one side of hearing loss, the vibrating tuning fork is held against the middle of your forehead.
The patient will report they either cannot tell if it is louder in one ear or the other, or will report hearing it at their forehead.
They are cautioned not to think about what the correct answer should be, but to merely say whether number 1 (mastoid prominence) or number 2 (the opening of the ear) is louder. However, in a severe loss with no conductive component present, it is unlikely the tuning fork will be heard. Rinne-negative test is abnormal and means that bone conduction is greater than air conduction. If you are a victim of conductive hearing loss, you hear the sound better in the hearing loss ear, because the ear is not distracted by environmental sounds, which means the noise is barely heard due to the abnormalities in the outer and middle ear.It is possible that your physician will order a more trained physician namely a specialist who conduct audiometric testing. The symptoms are vertigo, a spinning sensation, loss of balance, nausea, vomiting, involuntary movements of the eyes, and hearing loss in one ear.The symptoms do not last more than a few days and there are treatments that help. The most successful operations are destructive, which means they purposely change the structures in the ear to bring deafness to prevent vertigo.This type of surgery is usually used on an individual who experience severe dizziness and have little or no hearing in the affected ear.
Middle ear infection is also called otitis media.This infection is very common in children, it can cause severe pain in the affected ear.
Impedance testing measures your eardrum's ability to reflect sound waves and can indicate whether a middle ear problem is causing hearing loss. The surgeon cuts the nerve that carries the body's balance signal from the inner ear to the brain.A newer procedure called an ENDOLYMPHATIC SHUNT a small hole is produce in the inner ear to drain out the excess fluid. Another procedure is to install the antibiotics gentcomicin or streptomycin into the middle ear through the eardrum; these drugs selectively destroys the balance organ and the chaotic signal it send to the brain while preserving hearing.



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