Weber and Rinne Tests

The Weber and Rinne tests are both commonly used clinical assessments to evaluate hearing and distinguish between conductive and sensorineural hearing loss. These tests help determine whether hearing loss is due to issues in the outer and middle ear (conductive) or the inner ear or auditory nerve (sensorineural).

1. Weber Test:
The Weber test involves placing a vibrating tuning fork on the midline of the patient's forehead, typically on the glabella (the area between the eyebrows). The patient is asked where they perceive the sound to be louder: in one ear, both ears equally, or in the other ear. The interpretation of the test results depends on the patient's response:

- Normal Hearing: If the sound is perceived equally in both ears or in the middle of the head, the hearing is considered normal or symmetrical.

- Conductive Hearing Loss: If the sound is louder in the ear with hearing loss, it suggests that there is an issue with sound transmission in the ear with less sound perception. This could be due to problems in the outer or middle ear, such as a blocked ear canal, fluid in the middle ear, or issues with the ossicles (small bones) in the middle ear.

- Sensorineural Hearing Loss: If the sound is louder in the ear with better hearing or in the normal ear, it indicates that the ear with less sound perception has sensorineural hearing loss. This could be due to problems in the inner ear or auditory nerve.

2. Rinne Test:
The Rinne test compares air conduction (sound traveling through the air to the eardrum) and bone conduction (sound traveling through the bones of the skull directly to the inner ear). To perform the Rinne test:

- The vibrating tuning fork is initially placed on the mastoid bone behind the ear to assess bone conduction. The patient is asked to signal when they no longer hear the sound.

- The tuning fork is then moved close to the external ear canal (but not touching) to assess air conduction. Again, the patient is asked to signal when they no longer hear the sound.

The interpretation of the Rinne test results depends on the comparison between bone conduction and air conduction:

- Normal Hearing or Sensorineural Hearing Loss: If air conduction is better than bone conduction (AC greater-than BC), the patient has normal hearing or sensorineural hearing loss.

- Conductive Hearing Loss: If bone conduction is better than air conduction (BC greater-than AC) or if there's a significant difference in favor of bone conduction, it suggests conductive hearing loss. This indicates that sound is not effectively reaching the inner ear due to a problem in the outer or middle ear.

Both the Weber and Rinne tests are quick and valuable tools in the initial evaluation of hearing loss, helping healthcare professionals determine the type and potential cause of the hearing impairment. However, they are screening tests and may not provide a complete diagnosis. Further evaluation by an audiologist or medical specialist may be necessary for a comprehensive assessment and treatment plan.

[USMLEpass]

Reuploaded after correcting some wrong information. Thanks to the commenters for pointing it out!

[worldaround]

Since R comes before We Do Rinne before Weber. Bone conduction > Air conduction, why? When sound passes through ear canal through Malleus Incus and Stapes it gets amplified therefore Bone conduction > Air Conduction. First we do Rinne Test if there is a problem in that ear we know that there is a problem but to ascertain if it is Conductive or Sensoneural we do Weber - if Sound is heard more in the ear which is normal it is Sensoneural problem this makes sense but in conductive hearing loss the sound is heard more in damaged ear this is quite counterintuitive - this happens because in damaged ear there is less noise coming from outside through ear canal and also there is less of sound waves leaving through ear canal as the ear canal is damaged - the reasoning is good but it can be confusing so the mnemonic used here is Sensoneural makes sense.

[Kudravets-Diana]

A relative heard that you studied nursing and asks to bring her 17-year-old son for an examination.
The child has been suffering from severe pain and itching in the left ear for two days, a white-yellow discharge and fever
37.5 He rules out hearing loss, disequilibrium or tinnitus.
What is the most likely diagnosis?
1) Meniere's disease
Otitis externa (2
Otitis Media (3
Cerumen Impaction (4

[alexisac]

thank you for the great explanation !!