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Clinical Tests for Hearing

Dr. Vishal Sharma

Tuning Fork (Gardiner Brown)


Parts:
1. Prongs or tines

2. Shoulder
3. Stem or handle 4. Base or footplate

Tuning Forks
Frequencies used in E.N.T.: 256, 512, 1024 Hz

128 Hz produces more of vibration sense

more than 1024 short sound decay time

Striking Surfaces
Hard: Olecranon, radial styloid process, patella Soft: Thenar & hypothenar eminences, thick rubber strip Tuning fork is allowed to fall by its own weight

Impact area is b/w proximal two-thirds & distal


one-thirds of its prongs

Rinne Test

Rinne Test
Duration comparison technique:

Vibrating tuning fork kept on pt's mastoid Pt


signals when sound ceases Move vibrating tuning fork over opening of ear canal (2 cm away & axis parallel to it) Patient indicates if sound is still heard

Rinne Test
Loudness comparison technique (better): Vibrating tuning fork kept on pt's mastoid Pt signals if sound is heard Move vibrating tuning fork immediately over opening of ear canal If sound is heard patient asked which sound is louder

Results of Rinne Test


Better response:

sound heard longer or louder

A.C. > B.C. (positive test):

Normal hearing or Sensorineural deafness

B.C. > A.C. (negative test):

Conductive deafness

Rinne Negative

256 Hz = 15 - 30 dB HL = mild conductive deafness

512 Hz = 31 - 45 dB HL = moderate conductive deafness

1024 Hz = 46 - 60 dB HL
= severe conductive deafness

Weber Test
Procedure: Vibrating 512 Hz tuning fork placed in midline of pts skull at

forehead / vertex /
central incisor

Results of Weber test


Sound heard equally (central):

Normal hearing or B/L equal deafness

Sound lateralizes to deafer ear:

Conductive deafness

Sound lateralizes to better hearing ear:

Sensorineural deafness

Why Weber lateralizes to deafer ear in Conductive HL ?


1. Lack of masking effect of surrounding noise
on tuning fork sound, as air conduction is reduced in conductive deafness 2. Lack of dispersion of sound energy due to ossicular break

Absolute Bone Conduction Test

Absolute Bone Conduction Test


Pt's B.C. compared vs. examiner's normal B.C. Vibrating tuning fork kept on pt's mastoid with pts E.A.C. occluded (to prevent A.C.) pt signals when sound ceases vibrating tuning

fork kept on examiner's mastoid with


examiner's E.A.C. occluded

Results of Absolute Bone Conduction Test


Pt stops hearing before examiner:

sensorineural deafness

Both hear for same duration:

normal hearing / conductive deafness

Schwabach Test

Schwabach Test
Same as A.B.C. but E.A.C. is not occluded Pt stops hearing before examiner:

sensorineural deafness

Both hear for same duration:

normal hearing

Pt hears longer than examiner:

conductive deafness

False Negative Rinne


Etiology: U/L severe Sensorineural deafness Detection: Rinne negative, Weber lateralized to better hearing ear

Confirmation: A.B.C. reduced in deaf ear

Correction: Repeat Rinne test with masking of


better ear with Barany's noise box

False Negative Rinne


Mechanism: In deaf ear, air conduction & bone conduction are absent. Trans-cranial transmission of sound to opposite cochlea is perceived as I/L bone

conduction. Reported as bone conduction > air


conduction in deaf ear (Rinne Negative)

Gelle Test

Vibrating tuning fork placed on pt's mastoid & examiner increases pt's E.A.C. pressure with Siegel's speculum

Softer sound:

normal hearing or sensorineural deafness

No change in sound:

conductive deafness

Bing Test

Vibrating tuning fork placed on pt's mastoid & examiner blocks pt's E.A.C.

Louder sound:

normal hearing or sensorineural deafness

No change in sound:

conductive deafness

Thank You