Weber and Rinne tests are the two most widely used diagnostic and screening tests for hearing loss. The Rinne hearing test is complementary to the Weber test. It determines the location (left, right, or both) and whether it is a conductive hearing loss or a sensorineural hearing loss. The appropriate management and treatment are then selected based on the type of hearing loss you have.
An audiometry test is performed after the Rinne and Weber tests, which is a sure shot diagnostic test performed in an isolated zero noise environment. A soundproof room or a chamber is usually preferred in which sounds of different intensities and different tones are played.
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What does a positive or negative Rinne and Weber test mean?
A positive Rinne test means that your ossicular chain bone is functioning correctly. This means the bone is acting as an amplifier of external sound to your ear, and there is nothing to worry about.
A negative Rinne test means that your bone conductivity is more than the air conductivity, which means it is abnormal, and further investigation via audiometry is required, whereas the weber test does not give a positive or negative output. It is a generalized test that could only tell which of the two ears hears louder, and then the Rinne test gives conformity.
How Rinne test is performed ?
The first requirement is that it should be performed in a quiet and silent environment
The other thing to be taken into consideration is the tuning fork used should be of 512 Hz, and other forks should be neglected (256,128 Hz)
Rinne test measures your Bone Conduction and air conduction time measurements.
- Before performing the test, make the patient to cover the opposite ear with their hand, then we need to perform vibration of the tuning fork and then place the vibrating fork onto the patient’s mastoid bone to initiate the process of testing the ear.
- Finally, Ask the patient to report when the sound can no longer be heard from his test ear
- After the patient can no longer hear the tuning fork placed on the mastoid bone, move the vibrating tuning fork adjacent to the ear canal. Make sure the folk are oriented in a position perpendicular to the ear.
- At last, the patient should indicate when they can no longer hear the sound conducted via the air.
- Now the doctor will compute the results, which is that the air conduction sound should be prolonged at least twice as much in time when conducted via bone(which is Positive otherwise negative.)
Why can Rinne test be falsely negative?
Consider a patient who is suffering from complete deafness in one ear say left ear. He/she goes to a doctor or ENT specialist for a test, then in Rinne test, the doctor moves the tuning fork to his left ear external auditory meatus, as result, the patient will hear no sound in his left ear, but the sound gets transmitted through their skull to the right ear, and they might not be able to distinguish where they hear sound from. As a result, the patient will state that bone conduction is better/louder than air conduction, Which would be interpreted by the doctor as a negative, but in reality, his/her left ear is non-functional.
Now here the Weber test comes into the role. For instance, it will give the result whether if the left ear hears louder or the right because the tuning folk is put on the middle of the skull and is equidistant from both the ears.
How is Weber test performed?
These two requirements also imply in the Weber test, which should be performed in a quiet and silent environment, and tuning folk used should be of 512 Hz, other forks should be neglected (256,128 Hz).
- Place the vibrating tuning fork on the vertex or the midline of the forehead (from where it is equidistant from both ears) , The vibrations will be conducted through the skull and reach the cochlea of both the ears.
- Now Ask the patient which side of the ear heard loudest left, right or is it midline (same in both ears)
- In conclusion, the ear which heard lower sound is to be examined for further test, which is rinne test.
4 types of hearing loss, and their distinction through the test results.
If you hear normal then
- In Your Weber test, the sound should be heard in the middle and equally on both ears.
- In your Rinne test, positive in both ears (which means AC greater than BC)
If you have Unilateral (one-sided) sensorineural (related to inner ear problem) hearing loss
- Your Weber test will hear louder in the better ear.
- Your Rinne test will be positive on both the problematic ear as well as the normal ear.
If you have unilateral (one-sided) conductive hearing loss
- Then your Weber test is heard louder in the bad ear.
- Rinne test will be negative on the affected ear, positive on the unaffected ear.
If you have symmetrical (both sided) conductive hearing loss
- In your weber test, you will hear no sound in any of the ears.
- In your Rinne test, you will get negative on both the affected ears.
It is important to remember that the Rinne test is only a screening test and does not replace a formal audiometry test. Also, the credibility of the Rinne test as a screening test is doubted by some experts. The test is not precise enough in distinguishing conductive, sensorineural loss, total sensorineural, or severe single-sided hearing loss. It may also show false negatives in some scenarios. In such situations where there is an ambiguity about the Rinne test, the patient is referred to (ENT) specialist for a digital audiometry test.
Secondly, the Rinne test technique is not universal; its placement and orientation of the tuning fork vary from individual to individual. Doctors and physicians who perform the Rinne test must take the orientation of the tines of the tuning fork into consideration to be uniform with reference to the long axis of the external auditory canal when testing for air conduction.
Diseases and other causes which lead to hearing loss.
1. Conductive hearing loss
Outer ear causes
- High amounts of Ear wax
- outer ear infections like otitis externa
- An insect, small object in the external ear canal
- Skin Cancer
- Condition like anotia or an under-developed pinna, microtia formed near the ear region or onto it (Congenital microtia)
Affecting middle ear canal
- Ear injury
- Infection inside the middle ear
- Ear filled with fluid(glue ear)
- Anatomical changes in the middle ear
- Extra skin growth in the middle ear
- Defects by birth
- Temporal bone injury /fracture
2. Sensorineural hearing loss
Caused by inner ear issues which are
- Genetic hearing loss
- Due to Aging
- Inflammed inner ear nerves
- Vertigo hearing loss
- Fluid filling in the inner ear
- A blood clot in the inner ear
- Autoimmune disease
- High-level Noise exposure
- Tumors in ear
- Antibiotic usage
- A profound shock/traumatic event
- Damage to the eardrum
All in all, Rinne and Weber tests are present and have been used since the 1800s and can give a proper screening if you are suffering from a hearing loss. However, further investigation and diagnostic tests are also required to provide a concrete result these results include audiometry and other digital hearing tests. Hearing power is so essential in our lives, and due to this busy lifestyle, we ignore many facts and incidents which can damage our ears. Ear protection is critical and should be taken care of, from time to time wax removal. Early diagnosis and treatment are advised if you are suffering from or have started facing hearing issues.
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