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WEBER & RINNE TESTS

Lynch

1) Rinne is pronounced Rinn-ah, not Rin-NAY. He was a German Heinrich Adolf Rinne not a
Frenchman. And Rinna is easier to say than RinNAY. 2) What does conductive loss mean? It means that the mechanical apparatus of the middle ear does not vibrate adequately in response to air-born sound waves coming into the ear canal. Loss can be due to such things as build up of cerumen in the canal, otosclerosis, tympanoscerosis, acute otitis media, otitis media with effusion, trauma to the ossicular chain (temporal bone fracture ), glomus tumor of the middle ear, or cholesteatoma. 3) You should all prove to yourselves that conductive loss in an ear will cause the Weber test to lateralize to that ear. To create your own conductive loss, put your finger in one ear. If you block the canal of the left ear, sound will be louder in that ear on Weber testing. The explanation for this is filmy, having something to do with the conductive block eliminating the competition between bone conduction to that ear and ambient noise outside the ear canal. 4) For tests here and for the Board, you have to know how to sort out the Weber & Rinne results and decide whether its conductive or sensorineural loss, and on which side. However, in practice, you can drop it. The Weber and Rinne tests are rarely of any help, and buzzing every patient you see next year with a tuning fork just makes you look like a rookie. I would leave it out of my routine exam, and use it only if there is a complaint somehow related to hearing, balance, vertigo or the head in general. EXAMPLE 1 On Weber test, this ladys hearing lateralizes to the right ear

Louder in the right ear

It could be because she has conductive loss on the right, or..

because she has sensorineural loss on the left.

Mrs. Mafoofski

If the middle ear mechanical apparatus ( TM, ossicles etc ) is operating properly, sound heard by air-conduction is normally heard longer than sound heard by bone conduction, AC > BC. So if we say that on Rinne testing of the right ear, Mrs. Mafoosky has AC > BC, that means her right middle ear is working properly, so the lateralization must be due to sensorineural loss on the left. By the way, sensorineural loss implies an inner ear ( cochlear ) problem, or a problem of the cochlear branch of CN 8, or a lesion of central hearing pathways (ventral & dorsal cochlear nuclei, superior olivary nucleus, lateral lemniscus, inferior colliculus, medial geniculate nucleus and primary auditory cortex in the superior temporal gyrus ) A typical exam question or Board question is written like Example 2 below, as if you just routinely did a Weber test, the patient said it was louder on one side, and then you tested that side with the Rinne test. EXAMPLE 2 A patients hearing lateralizes to the left on Weber, and BC > AC on that side. Whats the problem? Ans. Conductive loss on the left EXAMPLE 3 Suppose the patient tells you her hearing is not so good on the leftor you detect it yourself when doing the whispered word test? What do you do now? You can determine whether its conductive or sensorineural loss by doing the Rinne test. You already know which ear to testthe left one. If the left ear has BC > AC, its conductive loss in this ear. Doing a Weber test would cause lateralization to this ear. If the left ear has AC > BC, its sensorineural loss in this ear. Doing a Weber test would cause lateralization to the other ear. NOTE: Sensorineural loss here is caused by a cochlear or neuronal problem, but both air conduction and bone conduction depend on the same cochlea and same neurons. In sensorineural loss the absolute duration of perception of the tuning fork will be shortened in both bone and air conduction. However, the relationship of AC > BC will still hold.