Station Progress:

[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“Please check this patient’s hearing.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][no_counter type=”zero” box=”no” position=”center” underline_digit=”no” separator=”yes” digit=”20″ title=”Minutes” text=”Station time”][/vc_column_inner][vc_column_inner width=”1/4″][no_counter type=”zero” box=”no” position=”center” separator=”yes” digit=”10″ title=”Minutes” text=”Time for this encounter”][/vc_column_inner][vc_column_inner width=”1/4″][no_counter type=”zero” position=”center” separator=”yes” digit=”6″ title=”Minutes” text=”Maximum time to examine your patient”][/vc_column_inner][vc_column_inner width=”1/4″][no_counter type=”zero” position=”center” separator=”yes” digit=”4″ title=”Minutes” text=”Minimum time for discussion and questions”][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has conductive hearing loss on the right.  There is impaired hearing on the left.  Weber’s test lateralises to the right and Rinne’s test is negative (or abnormal).[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Masterclass: Rinne and Weber’s Tests

Rinne’s and Weber’s tests are by now largely historic and deprecated techniques that have been superseded by the advent of modern technology – particularly readily available audiometry.

Despite their place in the history books as an outmoded and flawed means of assessing hearing it is still advisable to have an understanding of these tests for the MRCP PACES.

The use of Rinne’s and Weber’s tests can be used by a clinical examiner to gain an impression of the presence of a hearing deficit and to provide some crude diagnostic information of value in determining the underlying cause. They are an adjunct to, but not a replacement for, audiometry in the assessment of your patient’s hearing.

Rinne’s test

Perhaps the most confusing thing about Rinne’s test is that it is referred to as positive in normality. This is in contrast to most other tests (Murphy’s, Corrigan’s, de Musset’s etc.) which are usually referred to as negative in normality. Given that this particular quirk has persisted in clinical practice for over a hundred years now it’s probably best just to accept the fact that it is needlessly confusing and try to live with it.

Method for conducting Rinne’s test:

  • vibrate the tuning fork and place on the mastoid bone for bone conduction;
  • vibrate the tuning fork and place next to the external auditory canal for air conduction.

This test compares and contrasts the audible sound from a vibrating tuning fork (at 512 hertz) upon the mastoid bone (i.e. bone conduction) with the external auditory canal (i.e. air conduction). In air conduction, the sound is transmitted though the external canal, through to the middle and then inner ear.

Air conduction, in healthy individuals, should be better than bone conduction. While bone is a better medium for sound conduction, the terminology can be misleading, because the term ‘conduction’ refers to the passage of sound through the air, and as such, if air conduction is better than bone conduction, the Rinne’s test is counterintuitively positive.

A Rinne’s negative (i.e. abnormal, with bone conduction better than air conduction) test is most commonly caused by ear wax build up or middle ear disease.

Weber’s test

Method for conducting Weber’s test:

  • vibrate the tuning fork and place in the centre of the forehead or on the occiput and ask whether one side is louder than the other

The test compares bone conduction in both ears at the same time. It has no role in testing air conduction. If normal, the sound should be heard at the same level in both ears when the tuning fork is placed in the middle of the forehead.

If there is sensorineural deafness, the sound will be louder on the affected side.

Key patterns:

Conductive deafness: Rinne’s test negative on the affected side, Weber’s test does not lateralise in either direction.

Sensorineural deafness: Rinne’s test positive both sides, Weber’s test lateralises away from the affected side.

Notably, Weber’s may not lateralise in deafness which is symmetrical.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has a conductive hearing deficit on the right.  Weber’s lateralises to the right and Rinne’s test is negative in that ear.  I would like to confirm my findings with formal audiometry.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]