Rinne test

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The Rinne test (RIN-ə) is a hearing test.[1] It compares perception of sounds, as transmitted by air or by
bone conduction through the mastoid. Thus, one can quickly suspect conductive hearing loss.

A Rinne test should always be accompanied by a Weber test to also detect sensorineural hearing loss and
thus confirm the nature of hearing loss.

The Rinne test was named after German otologist Heinrich Adolf Rinne (1819-1868);[2][3] the Weber test
was named after Ernst Heinrich Weber (1795 – 1878).

Its value as a screening test has been questioned.[4]

[edit] Procedure
The Rinne test is performed by placing a vibrating tuning fork (512 or 256 Hz) initially on the mastoid
process until sound is no longer heard, the fork is then immediately placed just outside the ear. Normally,
the sound is audible at the ear.

Air conduction uses the apparatus of the ear (pinna, eardrum and ossicles) to amplify and direct the sound
whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to
the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear.

Description Relative Positive/negative

In a normal ear, air conduction (AC) is better than bone this is called a positive
AC > BC
conduction (BC) Rinne

In conductive hearing loss, bone conduction is better than air AC < BC negative Rinne

In sensorineural hearing loss, bone conduction and air conduction

are both equally depreciated, maintaining the relative difference AC > BC positive Rinne
of

In sensorineural hearing loss patients there may be a false

AC < BC negative Rinne
negative Rinne

Note that the words positive and negative are used in a somewhat confusing fashion here, other than their
normal use in medical tests. Positive or negative means that a certain parameter that was evaluated was
present or not. In this case, that parameter is if air conduction (AC) is better than bone conduction (BC).
Thus, a "positive" result indicates the healthy state, in contrast to many other medical tests.

[edit] Hazards
This test, and its complement the Weber test, are quick screening tests and are no replacement for formal
audiometry.

[edit] Effect on opposite ear

The effect on the opposite ear, relative to the tuning fork, is reverse to the ear being tested. Here,
conduction through the skull to the opposite side is more effective than conduction through room air
around the head. Thus, if the normal ear is not masked, bone conduction could be reported as louder by the
patient, even if both ears are normal.

Weber test
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The Weber test is a quick screening test for hearing. It can detect unilateral (one-sided) conductive hearing
loss and unilateral sensorineural hearing loss. The test is named after Ernst Heinrich Weber (1795–1878).

Its value as a screening test has been questioned.[1]

Contents
[hide]

• 1 Performance
• 2 Detection of conductive hearing loss
• 3 Detection of sensorineural hearing loss
• 4 Incompleteness
o 4.1 Additional Rinne test

• 5 References

[edit] Performance
In the Weber test a vibrating tuning fork (either 256 or 512 Hz) is placed in the middle of the forehead
equidistant from the patient's ears. The patient is asked to report in which ear the sound is heard louder. In a
normal patient, the sound is heard equally loud in both ears (no lateralization). However a patient with
symmetrical hearing loss will have the same findings. Thus, there is diagnostic utility only in asymmetric
hearing losses.

[edit] Detection of conductive hearing loss

A patient with a unilateral conductive hearing loss would hear the tuning fork loudest in the affected ear.
This is because the conduction problem masks the ambient noise of the room, whilst the well-functioning
inner ear picks the sound up via the bones of the skull causing it to be perceived as a louder sound than in
the unaffected ear. Another theory, however, is based on the occlusion effect described by Tonndorf et al.
in 1966. Lower frequency sounds (as made by the 512Hz fork) that are transferred through the bone to the
ear canal escapes from the canal. If an occlusion is present, the sound cannot escape and appears louder on
the ear with the conductive hearing loss.[2] Occlusion won't happen as a result of conductive hearing loss. It
is not correct to say that the sound to the ear with conductive loss appears louder because of occulusion
effect. This is not correct.

Conductive hearing loss can be mimicked by plugging one ear with a finger and performing the Rinne and
Weber tests, which will help clarify the above. The simulation of the Weber test is the basis for the Bing
test.

[edit] Detection of sensorineural hearing loss

A patient with a unilateral sensorineural hearing loss would hear the sound louder in the unaffected ear,
because the affected ear is less effective at picking up sound even if it is transmitted directly by conduction
into the inner ear.

[edit] Incompleteness
This test is most useful in individuals with hearing that is different between the two ears. It cannot confirm
normal hearing because it does not measure sound sensitivity in a quantitative manner. Hearing defects
affecting both ears equally, as in Presbycusis will produce an apparently normal test result.

[edit] Additional Rinne test

Although no replacement for formal audiometry, a quick screening test can be made by complementing the
Weber test with the Rinne test.

The Rinne test is used in cases of unilateral hearing loss and establishes which ear has the greater bone
conduction. Combined with the patient's perceived hearing loss, it can be determined if the cause is
sensorineural or conductive.

For example, if the Rinne test shows that air conduction (AC) is greater than bone conduction (BC) in both
ears and the Weber test lateralizes to a particular ear, then there is sensorineural hearing loss in the opposite
(weaker) ear. Conductive hearing loss is confirmed in the weaker ear if bone conduction is greater than air
conduction and the Weber test lateralizes to that side. Combined hearing loss is likely if the Weber test
lateralizes to the stronger ear and bone conduction is greater than air conduction in the weaker ear.

Weber without
Weber lateralizes left Weber lateralizes right
lateralization

Rinne both
Normal Sensorineural loss in right Sensorineural loss in left
ears AC>BC

Rinne left Combined loss : conductive and

Conductive loss in left
BC>AC sensorineural loss in left

Rinne right Combined loss : conductive and

Conductive loss in right
BC>AC sensorineural loss in right