Evaluation of auditory function using Rinne and Weber tests
Tony Brune, DO, Departments of Neurology, The Johns Hopkins School of Medicine; Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
The Rinne test is an assessment of auditory thresholds to air and bone conduction of sound. The Weber test is a comparison of bone conducted sound of either ear. Conductive hearing loss results in a loss of air conducted greater than bone conducted sound, whereas sensorineural hearing loss results in the loss of both air and bone conducted sound. Peripheral vestibular disease affecting the labyrinth or the 8th cranial nerve can be associated with sensorineural hearing loss. In these cases, the sensitivity to air conduction will remain greater than to bone conduction. Weber will lateralize away from the side of sensorineural hearing loss. As an example, destruction of the right labyrinth (e.g., bacterial labyrinthitis) will cause decreased hearing in the right ear, and air conduction will be greater than bone conduction in the right (affected) and left (unaffected) ears. Weber will lateralize to the left (unaffected) ear. In the case of superior semicircular canal dehiscence (SCDS), there may be increased sensitivity to bony transmission of sound through a (third mobile window) as well as conductive hearing loss, with bone conduction greater than air conduction and Weber lateralizing to the side of the dehiscence. A bedside test used for SCDS that highlights this increased sensitivity to bony transmission of sound involves placing a tuning fork on the malleolus, and in patients with SCDS, it may be heard in the affected ear.
Spencer S. Eccles Health Sciences Library, University of Utah