Tag: Tuning Fork Tests

Tuning Fork Tests

Tuning Fork Tests


TUNING FORK TESTS

  • Tuning fork frequency used most commonly in the ENT clinic is of 512Hz.
  • Ideally 3 frequencies are used 256 Hz, 512 Hz, and 1024 Hz. These three frequencies are used because they fall within speech frequency range.
  • The most preferred and commonly used is 512 Hz frequency because it is better felt since tuning forks of higher frequency have shorter decay time and those with lower frequency produce a sense of bone vibration.
  •  It is a frequency common in human speech.
  • Tuning fork tests used to differentiate hearing loss are:Rinne’s test,Weber test,Absolute bone conduction (ABC) test,Schwabach’s test,Bing test,Gelle’s test.

RINNE’S TEST

  • It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid.
  • Frequency of tuning fork commonly used for performing Rinne’s test is 512 Hz.

INTERPRETATIONS:

  • (AC= Air Conduction and BC= Bone Conduction)
  • Normal:AC > BC (Rinne’s Positive)
    Conductive Hearing Loss:BC > AC (Rinne’s Negative).
  • Sensorineural Hearing Loss:AC>BC.
    The procedure is done by all three tuning forks. (256 Hz, 512 Hz, 1024 Hz).For routine clinical practice, tuning fork of 512 Hz is ideal.
  • Negative Rinne’s test of 256 Tuning Fork Frquency suggests Mild Conductive hearing loss of 10-15 dB.
  • Negative Rinne’s test of 512 Tuning Fork Frquency suggests Moderate Conductive hearing loss of 25 dB.
  • Negative Rinne’s test of 1024 Tuning Fork Frquency suggests Severe Conductive hearing loss of 20-35 dB. 
  • A Rinne test should always be accompanied by a Weber test to also detect sensorineural hearing loss and thus confirm the nature of hearing loss. 

False Negative Rinne’s Test:

  • When a patient has unilateral sensori-neural deafness in the test ear, the bone conduction stimulus may be perceived by the opposite ear. Hence it can be interpreted as Rinne’s Negative.
  • In such cases,Weber’s test will be lateralised to the normal ear thus confirming false negative Rinne’s result. The above can also be avoided by giving a masking sound to the non-test ear.

WEBER’S TEST

  • Weber’s test best elicited by placing tuning fork  on the middle of the patient’s forehead and he is asked to say in which ear he hears the sound better.

Interpretations:

  • Normal – He hears the sound equally in both ears
  • Conductive deafness – He hears the sound better in the diseased ear
  • Sensorineural deafness – He hears better in the normal ear.

SCHWABACH TEST

  • It compares the patient’s bone conduction to that of the examiner’s(assuming that Examiner has Normal Hearing)

INTERPRETATIONS:

  • Normal:Patient’s Bone Conduction is equal to that of examiner.
  • Sensorineural loss:If the patient stops hearing before the examiner.
  • Conductive loss.If the patient hears it longer than the examiner.

ABSOLUTE BONE CONDUCTION TEST

  • This is a modified Schwabach’s test where, the bone conduction level of patient is compared to that of the clinician with inclusion occlusion of the External Auditory Canal(assuming that Examiner has Normal Hearing).

INTERPRETATIONS:

  • Normal:Patient’s Bone Conduction is equal to that of examiner.
  • Sensorineural loss:Bone Conduction is reduced as compared to Examiner’s.
  • Conductive loss:Bone Conduction is equal to that of examiner.

BING TEST

  • This is like ABC test, but the external ear canal is alternately closed and opened by pressing and releasing the tragus.

Interpretations:

  • Normal: Hears louder when ear canal is closed (Positive)
  • Sensorineual Hearing loss:hears louder when ear canal is open(Positive)
  • Conductive Hearing Loss:No change in hearing(Negative)

 GELLE’S TEST

  • Tuning fork is placed on mastoid and the pressure in the ear canal is increased using the Siegle’s speculum.

INTERPRETATION:

  • Normal:Positive test result(Decreased hearing).
  • Conductive hearing loss:Negative test result(Normal hearing).
  • Sensorineural hearing loss:Positive test result (Decreased hearing).

Exam Question

  • Tuning fork frequency used most commonly in the ENT clinic is of 512Hz.
  • Weber’s test best elicited by placing tuning fork  on the middle of the patient’s forehead and he is asked to say in which ear he hears the sound better. 
  • Tuning fork tests used to differentiate hearing loss are:Rinne’s test,Weber test,Absolute bone conduction (ABC) test,Schwabach’s test,Bing test,Gelle’s test. 

False Negative Rinne’s Test: 

  • When a patient has unilateral sensori-neural deafness in the test ear, the bone conduction stimulus may be perceived by the opposite ear. Hence it can be interpreted as Rinne’s Negative.
  • In such cases,Weber’s test will be lateralised to the normal ear thus confirming false negative Rinne’s result. The above can also be avoided by giving a masking sound to the non-test ear.
  • Frequency of tuning fork commonly used for performing Rinne’s test is 512Hz.
  • The most preferred and commonly used is 512 Hz frequency  tuning fork because it is better felt.
  • Negative Rinne’s test for 256 Hz tuning fork indicates a minimum air-bone gap of 15dB.
Don’t Forget to Solve all the previous Year Question asked on Tuning Fork Tests

Tuning Fork Tests

Tuning Fork Tests

Q. 1

How is Weber’s test best elicited?

 A

Placing the tuning fork on the mastoid process and comparing the bone conduction of the patient with that of the examiner

 B

Placing the tuning fork on the vertex of the skull and determining the effect of gently occluding the auditory canal on the threshold of low frequencies

 C

Placing the tuning fork on the mastoid process and comparing the bone conduction in the patient

 D

Placing the tuning fork on the forehead and asking him to report in which ear he hears it better

Q. 1

How is Weber’s test best elicited?

 A

Placing the tuning fork on the mastoid process and comparing the bone conduction of the patient with that of the examiner

 B

Placing the tuning fork on the vertex of the skull and determining the effect of gently occluding the auditory canal on the threshold of low frequencies

 C

Placing the tuning fork on the mastoid process and comparing the bone conduction in the patient

 D

Placing the tuning fork on the forehead and asking him to report in which ear he hears it better

Ans. D

Explanation:

Here the tuning fork is placed on the middle of the patient’s forehead and he is asked to say in which ear he hears the sound better.

Interpretations:

Normal – He hears the sound equally in both ears

Conductive deafness – He hears the sound better in the diseased ear

Sensorineural deafness – He hears better in the normal ear


Q. 2

Tuning fork frequency used MOST commonly in the ENT clinic is likely to be which of the following?

 A

256 Hz

 B

512 Hz

 C

1024 Hz

 D

2048 Hz

Q. 2

Tuning fork frequency used MOST commonly in the ENT clinic is likely to be which of the following?

 A

256 Hz

 B

512 Hz

 C

1024 Hz

 D

2048 Hz

Ans. B

Explanation:

Ideally 3 frequencies are used 256 Hz, 512 Hz, and 1024 Hz. These three frequencies are used because they fall within speech frequency range.

The most preferred and commonly used is 512 Hz since tuning forks of higher frequency have shorter decay time and those with lower frequency produce a sense of bone vibration. It is a frequency common in human speech.


Q. 3

All of the following are tuning fork tests to differentiate hearing loss, EXCEPT:

 A

Schwabach test

 B

Gelles test

 C

Burn’s test

 D

Rinne test

Q. 3

All of the following are tuning fork tests to differentiate hearing loss, EXCEPT:

 A

Schwabach test

 B

Gelles test

 C

Burn’s test

 D

Rinne test

Ans. C

Explanation:

Tuning fork tests:

  • Rinne’s test
  • Weber test
  • Absolute bone conduction (ABC) test
  • Schwabach’s test
  • Bing test
  • Gelle’s test
     
Common tuning fork tests and their interpretation:
 
Test
Normal
Conductive deafness
SN deafness
Rinne
AC>BC (Rinne positive) BC>AC (Rinne negative) AC>BC
Weber
Not laterized Laterized to poorer ear Laterized to better ear
ABC
Same as examiner’s Same as examiner’s Reduced
Schwabach’s
Equal Lengthened Shortened

Q. 4

A 38 year old gentleman reports of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork the Rinne’s test without masking is negative on the right ear and positive on the left ear. With the Weber’s test the tone is perceived as louder in the left ear. This patient MOST likely has:

 A

Right conductive hearing loss

 B

Right sensorineural hearing loss

 C

Left sensorineural hearing loss

 D

Left conductive hearing loss

Q. 4

A 38 year old gentleman reports of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork the Rinne’s test without masking is negative on the right ear and positive on the left ear. With the Weber’s test the tone is perceived as louder in the left ear. This patient MOST likely has:

 A

Right conductive hearing loss

 B

Right sensorineural hearing loss

 C

Left sensorineural hearing loss

 D

Left conductive hearing loss

Ans. B

Explanation:

In unilateral sensorineural hearing loss, when hearing test is conducted with 512Hz tuning fork, the Rinnie’s test (without masking) may be false or negative but Weber’s test will be lateralized to the normal ear. In this patient with right sided hearing loss, Weber’s test was lateralized to the left ear so this ear is normal and patient has right sided sensorineural hearing loss. 
 
When unilateral conductive deafness is present in the and the other ear is normal, sound of the tuning fork lateralizes in the ear with the conductive hearing loss.
 
Rinnie’s test is positive when air conduction is greater than bone conduction and it is negative when bone conduction is greater than air conduction.  Negative Rinnie’s test indicate conductive deafness. An exception is when one ear is not hearing at all, when we get a false negative Rinnie’s test.
 

Q. 5

Weber test is best elicited by:

 A

Placing the tuning fork on the mastoid process and com­paring the bone conduction of the patient with that of the examiner

 B

Placing the tunning fork on the vertex of the skull and determining the effect of gently occluding the audtitory canal on the thereshold of low frequencies

 C

Placing the tuning fork on the mastoid process and comparing the bone conduction in the patient

 D

Placing the tuning fork on the forehead and asking him to report in which ear he hears it better

Q. 5

Weber test is best elicited by:

 A

Placing the tuning fork on the mastoid process and com­paring the bone conduction of the patient with that of the examiner

 B

Placing the tunning fork on the vertex of the skull and determining the effect of gently occluding the audtitory canal on the thereshold of low frequencies

 C

Placing the tuning fork on the mastoid process and comparing the bone conduction in the patient

 D

Placing the tuning fork on the forehead and asking him to report in which ear he hears it better

Ans. D

Explanation:

Q. 6

A 38-year-old gentleman reports of decreased hearing in the right ear for the last two years. On testing with a 512Hz tuning fork the Rinne’s test without masking is negative on the right ear and positive on the left ear. With the Weber’s test, the tone is perceived as louder in the left ear. The most likely patient has: 

 A

Right conductive hearing loss

 B

Right sensorineural hearing loss

 C

Left sensorineural hearing loss

 D

Left conductive hearing loss

Q. 6

A 38-year-old gentleman reports of decreased hearing in the right ear for the last two years. On testing with a 512Hz tuning fork the Rinne’s test without masking is negative on the right ear and positive on the left ear. With the Weber’s test, the tone is perceived as louder in the left ear. The most likely patient has: 

 A

Right conductive hearing loss

 B

Right sensorineural hearing loss

 C

Left sensorineural hearing loss

 D

Left conductive hearing loss

Ans. B

Explanation:

Q. 7

Frequency of tuning fork commonly used for performing Rinne’s test is:   

 A

256 Hz

 B

512 Hz

 C

1024 Hz

 D

2048 Hz

Q. 7

Frequency of tuning fork commonly used for performing Rinne’s test is:   

 A

256 Hz

 B

512 Hz

 C

1024 Hz

 D

2048 Hz

Ans. B

Explanation:

 

Tuning fork tests are performed with tuning forks of different frequencies such as 128, 256, 512, 1024, 2048 & 4096 Hz, but for routine clinical practice, tuning fork of 512 Hz is ideal.


Q. 8

Tuning fork of 512 FPS is used to test the hearing because it is:  

 A

Better heard

 B

Better felt

 C

Produces overtones

 D

NOT heard

Q. 8

Tuning fork of 512 FPS is used to test the hearing because it is:  

 A

Better heard

 B

Better felt

 C

Produces overtones

 D

NOT heard

Ans. B

Explanation:

Q. 9

Negative Rinne’s test for 256 Hz tuning fork indicates a minimum air-bone gap of         

 

 A

10dB

 B

15dB

 C

20dB

 D

25dB

Q. 9

Negative Rinne’s test for 256 Hz tuning fork indicates a minimum air-bone gap of         

 

 A

10dB

 B

15dB

 C

20dB

 D

25dB

Ans. B

Explanation:

 

Rinne’s test:

  • Is named after Adolf Rinne of Gottingen, who described this test in 1855
  • It compares the patient ability to hear a tone conducted via air and bone – the mastoid process.
  • The base of a vibrating tuning fork is first placed on the mastoid process and then after the sound is no longer appreciated the vibrating top is held one inch from the external auditory meatus
  • The patient is asked whether the sound is louder behind or in front – referring to bone and air conduction respectively
  • Normally the note is audible at the external meatus
  • When nerve deafness is present then the note is audible at the external meatus, as air and bone conduction are reduced equally, so that the air conduction is better (as is normal) than bone conduction – this is termed Rinne-positive (AC is longer/louder than BC). It is seen in normal person or those having sensorineural deafness.
  • Rinne-negative occurs with a conductive hearing loss – no note is audible at the external meatus (i.e. bone conduction is better than air conduction).
  • A prediction of the air-bone gap can be made if tuning forks of 256, 512 and 1024 are used.
  • A negative Rinne test for 256, 512 and 1024 Hz indicates a minimum air-bone gap of 15, 30 and 45 dB respectively.

Q. 10

Tuning fork frequency used for testing is:

 A

512 Hz

 B

1048 Hz

 C

248 Hz

 D

All of the above

Q. 10

Tuning fork frequency used for testing is:

 A

512 Hz

 B

1048 Hz

 C

248 Hz

 D

All of the above

Ans. A

Explanation:

 

Test are performed with tuning forks of different frequencies such as 128, 256, 512, 1024, 2048 and 4096 Hz. The higher pitched forks (such as the 512 hz fork) are more appropriate for hearing testing

  • The single most common office test is a tuning fork test called the Rinne, named after Adolf Rinne of Gottingen, who described this test in 1855.
  • In the Weber test, a 512 Hz tuning fork is placed on the patient’s forehead. If the sound lateralizes (is louder on one side than the other), the patient may have either an ipsilateral conductive hearing loss or a contralateral sensorineural hearing loss.
  • The Schwabach test compares the patient’s bone conduction to that of the examiner’s. If the patient stops hearing before the examiner, this suggests a sensorineural loss.

If the patient hears it longer than the examiner, this suggests a conductive loss.

Of course, this test is contingent on the examiner having normal hearing.


Q. 11

A 38 year old female complaining of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork, the rinne’s test without masking is negative on the right ear and positive on the left ear. With the weber’s test, the tone is perceived as louder in the left ear. The most likely problem the patient has is

 A

Right conductive hearing loss

 B

Right sensorineural hearing loss

 C

Left sensorineural hearing loss

 D

Left conductive hearing loss

Q. 11

A 38 year old female complaining of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork, the rinne’s test without masking is negative on the right ear and positive on the left ear. With the weber’s test, the tone is perceived as louder in the left ear. The most likely problem the patient has is

 A

Right conductive hearing loss

 B

Right sensorineural hearing loss

 C

Left sensorineural hearing loss

 D

Left conductive hearing loss

Ans. B

Explanation:

 

Patient is presenting with right sided deafness.

Interpretation of Rinne’s test in this patient

Right side negative means : –

i) Right sided conductive deafness.

or

ii) Right sided severe sensorineural hearing loss which gives false negative results.

Left side positive test means : –

  • Normal left ear
  • Left sided sensorineural hearing loss (However this is not the case in this patient as the patient is presenting with right sided hearing loss).
  • Interpretation of Weber test in this patient
  • Weber is lateralized to left ear. That means : –
  • Right sided sensorineural hearing loss.
  • Left sided conductive deafness (However, this is not the case as patient is presenting with right sided hearing loss).
  • Thus , this patient is suffering from severe right side sensorineural hearing loss in which the Rinne’s test is false negative and weber is lateralized to left ear.


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