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512 hz tuning fork medical8/17/2023 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).These tests should be carried out with a full examination of the cranial nerves or the ear.
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