The hearing test is very important in order to identify the relying cause behind your hearing problems. Audiologist performs these tests to satisfy the conditions of hearing loss.
As your overall treatment depends on your particular hearing problems. Today our topic is going to deal with Rinne and Weber Test, a type of tuning fork test.
With the help of Rinne and Weber test, a doctor determines hearing loss and come up with a treatment plan for your hearing changes.
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It evaluates the level of hearing loss by comparing air conduction to bone conduction. Early evaluation allows you to get early treatment which can prevent from total hearing loss.
Before discussing the Rinne and Weber test, first, we will discuss some points about Tuning Fork Test as it has a huge contribution in both of these tests.
How And Why Rinne & Weber Test is Done
- 1. Tuning Fork Test
- 2. Rinne and Weber Test
- 3. Inference
Tuning Fork Test
The tuning fork tests are useful in assessing hearing loss. It is used to differentiate between sensorineural or conductive hearing loss. The patient who has over eight years old can go for conductive loss test or
asymmetric hearing in the low frequencies. The frequencies range from 128, 256, 512, 1024, 2048 Hz.
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Usually, a frequency of less than 254 Hz is not used as is better felt than heard by a patient. Whereas the frequency greater than 1024 Hz is not used as is extremely poor.
In this test, a larger fork vibrates at the lower frequency. The tuning fork is activated by striking against examiner’s elbow, the heel of the hand and placed 2 cm away from EAC for Air conduction and on mastoid for Bone conduction.
Conditions for ideal tuning fork test
- Professional uses fork made from good alloy.
- It is good to use a tuning fork which vibrates at a certain frequency.
- The vibration capacity should be of at least one minute.
- Those are not used which produce any kind of overtones.
How to Use a Tuning Fork?
Struck the tuning fork against a firm surface which can be the elbow of the examiner or any rubber pad. Then struck the tuning fork at an intersection of lower 2/3 and upper 1/3 of the fork.
A vibrating fork of 512 Hz frequency is set in the center of the skull. And the person is then asked regarding sound that is heard more at the place where it is produced which is the middle of the skull or only in one specific ear.
A good examiner always tries to hold the vibrating fork parallel to the acoustic axis of the ear of the patient.
Types of Tuning Fork Test
- Rinne Test
- Weber Test
- ABC Test
- Schwabach Test
- Gelle’s Test
- Bing Test
Rinne and Weber Test
Interpretation of Rinne and Weber test is the hearing disability of a person. They help in determining the type of unilateral hearing loss such as sensorineural or conductive hearing loss. By determining the type of hearing loss, it helps the doctor to start a treatment plan related to the hearing impairment. These tests require a full examination of the cranial nerves or the ear.
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The Rinne and Weber tests are usually performed together. Therefore, combining the result of each other test together helps in finding out the nature and location of certain hearing impairment.
A Sensorineural hearing loss occurs from the gradual damage to the hair cells in the cochlea. This damage can occur because of many reasons such as –
- Exposure to diseases such as Meniere’s disease, meningitis, mumps, and multiple sclerosis.
- Usage of certain drugs such as quinine, aspirin, cisplatin or some antibiotics like gentamicin or streptomycin.
- It also can be inherited or can occur in case the mother has had rubella during the pregnancy period.
- Exposure to Excessive noise and loudspeakers or music.
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A Conductive hearing loss results from a difficulty in conducting sound waves through the outer ear, eardrum or ossicles( middle ear). It can also occur in combination with a sensorineural hearing loss(mixed hearing loss). There are many causes of conductive hearing loss such as-
- Fluid accumulation in the middle ear,
- Malfunction of the ear canal, outer canal, or middle ear
- Ear canal infection
- Perforated eardrum
- Otitis media or Ear infection
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Difference Between Rinne and Weber
Difference Between Rinne and Weber, if we compare the Rinne test is performed first. They help in determining the difference between sensorineural and conductive hearing loss.
Therefore, these tests guide the doctor in further examination and investigation of the treatment process. These tests can be done in the office, and are easy to perform.
Also called as Rhinne Test by some people, is used in cases of unilateral hearing loss and establishes which ear has the greater bone conduction. It is combined with the patient’s perceived hearing loss. As a result, it can be determined if the cause is sensorineural or conductive.
A normal or positive Rinne test is when sound is still heard when the tuning fork is moved to air near the ear (air conduction or AC), indicating that AC is equal or greater than (bone conduction or BC). Therefore, AC > BC; which is how it is reported clinically for a normal or positive Rinne result.
In the conductive hearing loss, bone conduction is better than air or BC > AC, a negative Rinne, and the patient will report that they do not hear the fork once it is moved.
This test is conducted by placing a tuning fork on the mastoid bone:
- Air conduction uses the apparatus of the ear to amplify and direct the sound.
- Bone conduction allows the vibration sound to be transmitted to the inner ear. There is reduced volume transmitted by to the bones of the skull to the other ear.
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Weber test is a quick screening test for hearing. It helps to detect unilateral conductive hearing loss and unilateral sensorineural hearing loss. Generally, 256 Hz or 512 Hz is used for performing Weber Test.
It is a test for lateralization in which you have to tap the tuning fork on your palm and then press the butt of the instrument on the top of the patient’s head in the midline and ask the patient where they hear the sound. Patients heard the sound in the center of the head or equally in both the ears.
If you are suffering from a conductive hearing loss the vibration will be louder with the conductive hearing loss side. But if the patients do not hear the vibration at all, attempt again, but press the butt harder on the patient’s head.
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Following table shows a direct difference between Weber & Rinne test
|Condition||Weber Test||Rinne Test|
|Normal||The sound perceived as coming from the midline||Air conduction > Bone conduction|
|Conduction Deafness||The sound perceived as coming from the affected ear||Bone conduction > Air conduction on the affected ear|
|Sensorineural Deafness||The sound perceived as coming from the normal ear||Air conduction > Bone conduction|
In this table, 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 a 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.
Benefits of Rinne and Weber tests
These tests are noninvasive and cause no pain and no associated risks. The information they provide determines the type of hearing loss you may have, especially when the results of both tests are used together.
These tests help to discuss any necessary treatment options with your doctor. Further examinations and tests will help determine the exact location and cause of the type of hearing loss you have. Your doctor will suggest ways to reverse, correct, improve, or manage your particular hearing problem.
Rinne and Weber’s test is performed due to the following reasons. It means these tests are beneficial in the following conditions:
- Eardrum perforation
- Center ear fluid
- Otosclerosis (the incapacity of the little bones within the middle ear to move appropriately)
- Nerve damage to the ears
- Ear infection
- Wax in the ear canal
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Limitations of Rinne and Weber test
In some cases of unilateral or total sensorineural hearing loss, the Rinne test is not dependable in distinguishing conductive and sensorineural hearing impairment. These cases result in a false negative, therefore, bone conduction will be more than air conduction.
In some cases, the Weber test will show signs of lateralization which indicating some kind of pathology guide.
How Does a Person Prepare for Rinne and Weber Tests?
A person needs to be in a completely quiet room for Rinne and Weber tests. Test are easy to perform and does not cause any pain to you. So don`t panic.
The practitioner shall instruct the patient on each of the tests. Tuning fork tests are particularly.
subjective and response bias must be accounted for when determining their validity as diagnostic tools.
Clear and concise instructions will limit misinterpretation by the patient.
When undertaking this test on young children it may be necessary to have the child sat on the parent’s
knee and the tuning fork should be held in plain sight. The practitioner may wish to prime the tuning
fork and hold it on a surface so the sound can be heard to prepare the child for the test, it can also be
helpful to get the child to close their eyes whilst they listen to help them concentrate.
How do Doctors Conduct Rinne and Weber test?
512-Hz tuning forks are used to perform the test on how you respond to sounds and vibrations near your ears. The tests are completed in the following steps which are as follows :
Rinne Hearing Test
The doctor strikes the tuning fork and holds the tines of the tuning fork approximately 25mm from the ear canal entrance. The vibrating fork should be held parallel to the acoustic axis. The orientation of the tuning fork is critical to ensure the acoustic axis is pointing towards the ear canal.
Without any interruption and without touching the tines press the footplate firmly against the mastoid (without any hair getting between the footplate and the mastoid). Place your other hand gently, but firmly on the opposite side of the patients head to ensure enough counter-pressure is applied. Hold the tuning fork in place for another 2 seconds.
Thus it is performed in the following steps :
- The specialist strikes a tuning fork and places it on the mastoid bone behind one ear.
- If you cannot hear the sound, you can flag the signal to the specialist.
- Then, the specialist moves the tuning fork alongside your ear canal.
- When you cannot hear that sound for a longer period of time, you once again flag the signal to the specialist.
- The specialist records the span of time when you hear each and every sound.
Weber Hearing Test
Strike the tuning fork and place it on the midline, typically on the patient’s forehead, (but it can also go on the vertex, bridge of the nose or chin).
Place your other hand gently, but firmly on the back of the patients head to ensure enough counter-pressure is applied.
Hold the tuning fork in place for up to 4 seconds. You note where the sound is best heard: the left ear, the right ear, or both equally.
Following video describes how to perform the Rinne and Weber test which produced by students at Oxford University Medical School in conjunction with the ENT faculty:
There is no outlook effect of Rinne and Weber tests. The test will help to find the exact type of hearing disability you are suffering from. For any further help or guidance, you may visit our hearing clinic or contact us.
Rinne and Weber Test Results
Rinne Test Results
- Normal hearing – Air conduction will be more than bone conduction. Therefore, the person is able to hear the tuning fork sound close to the outer ear(pinna). However, the person will not hear the sound afterward when held against mastoid.
- Abnormal Hearing – A person with hearing difficulty will not hear the tuning fork sound after it changed from mastoid to pinna. Therefore, the bone conduction is more than air conduction, up to twice more than air conduction. This is also known as negative Rinne. In both the ears, this test is performed. This result is shown in the Conductive hearing loss.
In case of sensorineural hearing loss, a person will hear the tuning fork by air conduction. However, after that sound, an individual will not hear any further sound through bone conduction.
This pattern is similar to normal hearing. Therefore, air conduction will be more than bone conduction. However, it will not be twice. This is all about Rinne’s false positive.
Weber’s Test Results
In a Normal hearing, a person hears the sound of a tuning fork in both the ear equally. An individual with one-sided conductive deafness(unilateral) will hear the sound of tuning fork louder in the affected ear. As the conduction difficulty covers the surrounding noise of the room.
In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear. In an affected patient, if the normal ear hears the tuning fork sound better, there is sensorineural hearing loss on the other (defective) ear.
Whereas in the sensorineural deafness, the normal inner ear picks the sound through the skull bone and the sound is heard louder than in the normal ear.
The Rennin and Weber test is used to diagnose the unilateral hearing loss. They are easy to perform with tuning forks via a specialist. As soon as you see the sign of hearing loss. Concerned your doctor for further process.