TUNING FORK TESTS
USE: Qualitative
assessment of hearing by
performing Rinne test,
Weber test and Absolute
Bone Conduction test.
Gardiner
Brown
Tuning Fork
TUNING FORK TESTS
Tuning fork test can distinguish
between conductive and sensorineural
hearing loss.
The tests are carried out by vibrating of
tuning forks of varying frequency 256,
512, 1024 etc.
The most useful fork is 512 cps
TUNING FORK TESTS
In air conduction the sound waves are
transmitted through external auditory canal,
tympanic membrane, middle ear and
ossicles to the inner ear.
Thus, by the air conduction test, the
function of both the conductive mechanism
and cochlea are tested.
TUNING FORK TESTS
In bone conduction, sound waves
are transmitted through the skull
bones and directly stimulated the
inner ear.
So, bone conduction is a measure
of cochlear function only.
RINNE TEST
Principle:
Comparison of air conduction with
bone conduction of same ear of
same individual.
RINNE TEST
How to perform:
A vibrating tuning fork is placed on the
patient’s mastoid and when he stops
hearing, it is brought beside the
meatus. If he still hears, AC is more
than BC.
RINNE TEST
INTERPRETATION:
1. Rinne’s positive: Air conduction is better
than bone conduction. In normal hearing
person.
2. Reduced/low Rinne’s positive: Air
conduction is still better than bone
conduction but short duration or short
volume. In patient with partial
sensoryneural hearing loss.
RINNE TEST
INTERPRETATION:
3. Rinne’s negative: Bone conduction is
better than air conduction in conductive
deafness.
4. False Rinne’s negative: In patient with
severe unilateral sensorineural hearing loss.
This is confirmed by masking the non-test
ear and Weber test.
WEBER TEST
Principle:
Comparison of bone conduction
between two ears of same
individual.
WEBER TEST
How to perform:
In this test, a vibrating tuning fork is
placed in the middle of the forehead
and the patient is asked in which ear
the sound is heard.
WEBER TEST
INTERPRETATION:
1. In conductive deafness Weber lateralized
to same ear.
2. In sensorineural deafness Weber
lateralized to opposite ear.
ABSOLUTE BONE CONDUCTION TEST
Principle:
Comparison of bone conduction
between the patient and the examiner,
assumed that examiner’s hearing is
normal
ABSOLUTE BONE CONDUCTION TEST
How to perform:
The vibrating tuning fork is held on the
mastoid of the patient, closing the external
auditory canal firmly with the tragus, the
patient is asked to signal when he no longer
hear the sound.
The fork is then transferred by the examiner
to his won mastoid closing the external
meatus.
ABSOLUTE BONE CONDUCTION TEST
Interpretation:
If the examiner still hears the sound, then
patient is said to be reduced/ shortened. This
is found in sensoryneural deafness.
If the examiner also does not hear the sound
then the result is normal. This is found in
normal hearing person or with conductive
deafness.
PURE TONE AUDIOMETRY
Pure tone audiometer is an electronic device
which produce pure tone in desired
frequency and intensity.
Usually air conduction thresholds are
measured for tones of 125, 250, 500, 1000,
2000, 4000 and 8000 Hz and bone
conduction thresholds for 250, 500, 1000,
2000 and 4000Hz.
PURE TONE AUDIOMETRY
Using head phone and bone vibrator, each
ear is tested individually for air conduction
and bone conduction thresholds.
The results are plotted as a graph called
audiogram.
PURE TONE AUDIOMETRY
PTA will give a graphical
representation of different hearing loss.
Both quantity and quality can be
studied.
Normal hearing threshold is 0 dB
(range -10 to 25 dB)
PURE TONE AUDIOMETRY
WHO classification of degree of hearing loss
Normal hearing (0-25dB)
Mild hearing loss (26-40 dB)
Moderate hearing loss (41-55 dB)
Moderate-severe hearing loss (56-70 dB)
Severe hearing loss (71-90 dB)
Profound hearing loss (>90 dB)
Audiogram
PURE TONE AUDIOMETRY
Interpretation:
Normal hearing: Both air conduction
and bone conduction threshold are
within 25 dB.
Normal
hearing
person
PURE TONE AUDIOMETRY
Conductive deafness:
Bone conduction threshold within 25
dB.
Increased air conduction threshold.
Air-Bone gap present (10 dB or more)
PURE TONE AUDIOMETRY
Sensorineural hearing loss:
Both air conduction and bone
conduction threshold are raised.
No air-bone gap.
Sensori-
neural
hearing
loss
Moderate
sensorineural
hearing loss
PURE TONE AUDIOMETRY
Mixed hearing loss:
Both air conduction and bone
conduction threshold are raised.
Air-bone gap is present.
TYMPANOMETRY
It is an objective test, widely
used in clinical practice for
diagnosis of middle ear
diseases.
A tympanogram is a graphic
presentation of the relationship
between the air pressure in the
external auditory canal and the
movement of the tympanic
membrane.
Tympanometry measure the air
pressure in the middle ear and
compliance of the ear drum.
The compliance will be greatest when
the air pressure in the meatus is equal
to the air pressure in the middle ear.
TYMPANOMETRY
It is based on simple principle:
When a sound strikes tympanic membrane,
some of the sound energy is absorbed while
the rest is reflected. A stiffer/stretched
tympanic membrane would reflect more of
sound energy than a compliant one.
TYMPANOMETRY
How to perform:
A probe is inserted in external auditory canal
which seal the canal. Probe has three channels-
A) Oscillator to produce a tone of 220 Hz.
B) Microphone to pick up the reflected sound.
C) Air pump to increase or decrease air pressure in
the external auditory canal.
Ear probe has
three channels
TYMPANOMETRY
By varying the pressure in the external ear
canal, the compliance of ear drum may be
calculated by the degree of sound reflected back.
Normal middle ear pressure: -100 to +50 mm
H2O (daPa). Average 0 mm H2o.
Normal compliance: 0.3 to 1.7 cc. Average .6 cc.
TYMPANOMETRY
The graphic recording of these information is called
tympanogram. There are three basic types:
Type A: Normal pressure and normal compliance.
Type B: It is a flat curve denoting that pressure
change do not have much effect on the compliance.
Example - OME
Type C: Normal compliance in negative middle ear
pressure. Example- Eustachian tube dysfunction.
Type A curve
Type B flat curve
Type C curve:
Normal
compliance at
negative middle
ear pressure
CALOTIC TEST
The basis of this test is to induce
nystagmus by thermal stimulation
of vestibular system.
CALOTIC TEST
In this test, patient lies supine with head tilted 30
degree forward so that horizontal canal is vertical.
Each ear is irrigated for 40 seconds alternatively
with water at 30 degree and 44 degree and eyes
observed for appearance of nystagmus till its end
point.
Normally the nystagmus lasts for about 90 seconds
to 150 seconds (average 120 seconds)
CALOTIC TEST
Cold water induces nystagmus to
opposite side and warm water to the
same side.
The result is recorded on a calorigram
CALOTIC TEST
Applied importance:
Canal paresis: is present, if the
duration of nystagmus is reduced for
both hot and cold water. This signifies
peripheral vestibular lesion.
Normal
caloric
responses
Right canal
paresis
