Rinne and Weber Tests – Tuning Fork (A Complete Guide)

Tuning Fork Test

Tuning ForkThe 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.

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, 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 –

  • 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.

Tuning Fork Test
Tuning Fork Test

Types of Tuning Fork Test

  • Rinne Test
  • Weber Test
  • ABC Test
  • Schwabach Test
  • Gelle’s Test
  • Bing Test

Rinne and Weber Hearing Test

The Rinne and Weber are exams that test 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.

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 the certain hearing impairment.

A sensorineural hearing loss occurs from the gradual damage to the hair cells in the cochlea. Hair loss damage can occur because of many reasons such as –

  • Excessive noise
  • 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.

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-

Benefits of Rinne and Weber tests

Between Rinne and Weber,if we compare 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.

Rinne Test

""BC</tdThe normal sensorineural loss in the right earSensorineural loss in the left earRinne left BC>AC
A conductive hearing loss in the left ear combined loss in left earRinne Right BC>AC
Combined loss in right ear Conductive hearing loss in the right earRinne both ears BC>ACConductive loss in both earsCombined loss in right and conductive loss in left combined loss in left and conductive loss in rightAC= Air ConductionBC=Bone ConductionCombined loss= Sensorineural loss+Conductive loss

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 a 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.

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.

Weber Vs Rinne Tests

Weber TestRinne Test
NormalSound perceived as coming from midlineAir conduction > Bone conduction
Conduction DeafnessSound perceived as coming from affected earBone conduction > Air conduction on the affected ear
Sensorineural DeafnessSound perceived as coming from normal earAir conduction > Bone conduction

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. Always, try to wash your hands before the test. No other required is necessary for these test as they are very simple to perform.

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 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

Hearing Test (Rinne and Weber Examinations) – ENT

This 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 any 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 Tests – Tuning Fork (A Complete Guide)
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