Rinne and Weber Tests

The Rinne and Weber tests are simple clinical tests used to differentiate between conductive and sensorineural hearing loss. Both tests use a tuning fork to compare air conduction (AC) and bone conduction (BC) of sound.

Rinne Test

Purpose: To compare air conduction and bone conduction hearing in each ear.

Procedure:

. Strike a tuning fork and place it on the mastoid process (bone behind the ear).

. Ask the patient to indicate when they no longer hear the sound.

. Move the still-vibrating tuning fork next to the ear canal.

. Ask the patient if they can hear the sound again.

Interpretation:

. Normal (Positive Rinne): Air conduction is better than bone conduction (AC > BC). The patient hears the sound longer through air than bone.

. Conductive Hearing Loss (Negative Rinne): Bone conduction is better than air conduction (BC > AC). The patient hears the sound longer through bone than air.

. Sensorineural Hearing Loss: Air conduction is better than bone conduction (AC > BC), but both are diminished compared to normal hearing.

Weber Test

Purpose: To assess the relative difference in hearing between the two ears.

Procedure:

. Strike a tuning fork and place it in the midline of the patient’s forehead or on the vertex of the skull.

. Ask the patient where they hear the sound: in the left ear, right ear, or both equally.

Interpretation:

. Normal: The sound is heard equally in both ears.

. Conductive Hearing Loss: The sound lateralizes to the affected ear. The affected ear perceives the sound as louder because the external noise is reduced, and bone conduction is enhanced.

. Sensorineural Hearing Loss: The sound lateralizes to the normal or better-hearing ear. The affected ear perceives the sound as quieter due to impaired cochlear or auditory nerve function.

Summary

Rinne Test:

i. Positive (Normal): AC > BC

ii. Negative (Conductive Loss): BC > AC

iii. Sensorineural Loss: AC > BC (both diminished)

Weber Test:

i. Normal: Sound heard equally in both ears

ii. Conductive Loss: Sound louder in affected ear

iii. Sensorineural Loss: Sound louder in unaffected ear