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“This patient has complained of hearing loss. Please examine their hearing clinically.”
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Neurology quiz eight
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Testing hearing and vestibular function assesses the vestibulocochlear (VIIIth cranial) nerve. Hearing can only be definitively assessed using audiometry, but a clinical determination of the severity of the hearing loss may be gained by determining how the patient responds to normal speech in each ear, and if there is some evidence of hearing loss, bed side tests can be carried out to elucidate further.
A Weber test determines whether an issue is conductive or sensorineural hearing loss in origin, and hence can help determine further investigations as required. Conductive hearing loss occurs when sound waves are not able to pass through the inner ear, such as when there is a blockage from earwax. This can be also caused by an infection, a punctured eardrum, and/or fluid in the middle ear. Sensorineural hearing loss occurs when auditory nerves or hair cells are damaged in the inner ear. This is also known as “nerve deafness,” and it is most commonly caused by the natural ageing process as well as exposure to loud noise for prolonged periods of time during earlier life.
Both tests are used to evaluate a patient’s hearing. Early identification allows patients to access definitive treatment or management strategies before problems progress to total hearing loss.
Tuning fork tests- Rinne’s and Weber’s:
Both Rinne’s and Weber’s test use a tuning fork to help differentiate conductive from sensorineural hearing loss. A Rinne test compares air- and bone-conduction hearing.
Rinne’s test: Rinne’s is a hearing test that uses tuning fork. Following steps are followed to evaluate the patient’s hearing: Hit the prongs of the tuning fork against a hard surface to make it vibrate. Place the vibrating prongs at the patient’s external auditory meatus; ask if they can hear it. Place the still-vibrating base on the mastoid process and ask whether it is louder in front of or behind the ear.
Abnormal findings: if the sound is louder at the ear canal, the test is positive and air conduction is better than bone conduction. If the sound is louder on the mastoid process, the test is negative; bone conduction is better than air conduction. Rinne’s test is negative in conductive deafness. An exception is when one ear has no hearing at all. The test may be negative because sound is conducted through the skull bones to “good” ear, which indicates that it’s a false negative Rinne’s test.
The Weber’s test is more sensitive than Rinne’s test in unilateral conductive deafness.
Weber’s test: Following are the steps followed in a Weber’s test to evaluate hearing: Hit the prongs of the fork against a hard surface to make it vibrate. Place the base of the vibrating tuning fork on top of the patient’s head or in the middle of the forehead. Ask the patient where they hear the sound; normally this is in the middle or equally in both ears. Note to which side Weber’s test lateralizes.
Abnormal findings: In symmetrical hearing loss, the sound is also heard in the middle. It is heard loudest in the ear with conductive deafness, since there is no interference from extraneous noise. In unilateral sensorineural deafness the sound is loudest in the unaffected ear.
Question 1 of 3
On which side does the patient report hearing loss?CorrectIncorrect
Question 2 of 3
Is Rinne’s test positive or negative?CorrectIncorrect
Question 3 of 3
What hearing deficits are consistent with these findings?CorrectIncorrect