Attunement to the Weber and Rinne hearing tests

Hearing loss can occur at any stage of life for quite a lot of reasons. For example, short-term hearing loss could also be attributable to a standard ear infection, which frequently clears up with treatment and time, while everlasting hearing loss will affect a lot of us as we age. Broadly speaking, hearing loss could be divided into three types (Weber, 2022; Wahid, Hogan, & Attia, 2022):

• Sensorineural: The sound transmitting system that features the inner ear, cochlea, and auditory nerve.
• Conductive: Caused by aspects that limit the quantity of sound entering the inner ear, reminiscent of earwax buildup or fluid in the center ear.
• Mixed hearing loss: is a mix of conductive and sensorineural hearing loss.

Hearing loss is initially assessed by a routine physical examination using easy tools reminiscent of whispering tests, otoscopes and tuning forks. Two quick and simple tests, used together, that may further differentiate between several types of hearing loss are the Weber and Rinne tests.

Weber test (Wahid, Hogan and Attia, 2022; Weber, 2022)

We often hear equally in each ears. The Weber test is primarily used to guage patients with unilateral hearing loss and to characterize conductive and sensorineural hearing loss.

• Using a 512 Hz tuning fork, tap your teeth in your forearm just in front of your elbow and place the fork handle on the highest of your head or on the midline of your brow. Sometimes other areas are used, reminiscent of the chin or bridge of the nose. The vibrations travel through the skull to the cochlea.
• Ask the patient: “Is the sound louder in the right ear, in the left ear, or the same on both sides?”
• Results:
  • is confirmed when the sound is heard within the midline and equally on either side.
  • is observed if the patient hears a sound louder (lateralizes) in the conventional or “healthy” ear.
  • is observed if the patient hears the sound louder (lateralizes) within the damaged or “bad” ear.
  • is observed if the patient doesn’t have lateralization.

Rinne test (Kong and Fowler, 2022; Weber, 2022)

The Rinne test helps distinguish airborne sound from bone-borne sound. This comparison also helps assess unilateral hearing loss.

• Using a 512 Hz tuning fork, tap the prongs in your forearm just in front of the elbow and place the fork shaft on the mastoid bone behind the ear.
• Ask the patient to cover the opposite ear together with his hand and report when the sound stops.
• When the patient not hears the vibrations on the mastoid process, move the vibrating tuning fork near the external auditory canal and ask the patient to point when the sound is not any longer audible.
• Results:
  • the effect is observed when a vibrating fork placed against the ear is louder and lasts twice so long as when placed on the mastoid bone (i.e. air conduction is healthier than bone conduction).
  • the result’s observed when the sound is at the very least as loud or louder when the fork is placed on the bone in comparison with when it’s held next to the ear (i.e. the bone is a greater conductor of air).

Joint evaluation of Weber and Rinne test results (Weber, 2022)

Together, the Weber and Rinne tests can assist determine whether a patient’s hearing loss is conductive or sensorineural.

• An abnormal Rinne test (bone is healthier than air conduction) may indicate lack of conduction if the Weber test also lateralizes to that side.
• If the Weber test is lateralized to an ear during which the Rinne test is normal, the Rinne test needs to be performed within the contralateral ear. A standard Rinne test within the contralateral ear may indicate sensorineural hearing loss. The patient should then be referred for an audiogram examination.

PEARLS (Kong and Fowler, 2022; Wahid, Hogan and Attia, 2022; Weber, 2022)

• Unilateral conductive hearing loss may indicate disease of the outer or middle ear.
• Gradual unilateral sensorineural hearing loss may indicate inner ear disease (e.g. Ménière’s disease or acoustic neuroma).
• The Weber and Rinne tests mustn’t be used to screen for hearing loss, but they could be used to verify audiometric results, especially if the audiogram results are inconsistent with clinical findings.
• The 512 Hz tuning band is the popular tool for assessing hearing loss since it provides the perfect balance of tone and vibration. Lower frequency tuning forks (256 Hz and 128 Hz) are commonly utilized in neurological examinations because they supply higher vibrations.

Kong, E. L., & Fowler, J. B. (2022, February 2). Rinne’s test. . https://www.ncbi.nlm.nih.gov/books/NBK431071/

Wahid, N. B., Hogan, C. J., & Attia, M. (2022, September 14). Weber’s test. ConditionPearls [Internet]. . https://www.ncbi.nlm.nih.gov/books/NBK526135/

Weber, P. C. (2022, March 30). Assessment of hearing loss in adults. .
https://www.uptodate.com/contents/evaluation-of-hearing-loss-in-adults