Rinne test explained

Rinne test

The Rinne test is used primarily to evaluate loss of hearing in one ear.[1] It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid. Thus, one can quickly screen for the presence of conductive hearing loss.[2]

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.

The Rinne test was named after German otologist Heinrich Adolf Rinne (1819–1868);[3] the Weber test was named after Ernst Heinrich Weber (1795–1878).

Procedure

The Rinne test is performed by placing a 512 Hz vibrating tuning fork against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Once the patient signals they can't hear it, the still vibrating tuning fork is then placed 1–2 cm from the auditory canal. The patient is then asked again to indicate when they are no longer able to hear the tuning fork.

Results

Normal hearing

Abnormal hearing

Air vs. bone conductive hearing loss

Air conduction uses the apparatus of the middle ear (pinna, eardrum and ossicles) to amplify and direct the sound to the cochlea, whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear.

DescriptionPositive/negative
In an ear with normal hearing and an ear with sensorineural hearing loss, air conduction is more than bone conductionPositive
In an ear with conductive hearing loss, bone conduction (BC) is better than air conductionNegative

Note that the words positive and negative are used in a somewhat confusing fashion here, as compared to their typical use in medical tests. Positive or negative in this case means that a certain parameter that was evaluated was present or not. In this case, that parameter is whether air conduction is better than bone conduction. Thus, a "positive" result indicates the healthy state, in contrast to many other medical tests. Therefore, some prefer to avoid using the terms "positive" or "negative", and simply state if the test was normal or abnormal. For example: "Rinne's test was abnormal in the right ear, with bone conduction greater than air conduction".

Weber test
lateralizes to leftno lateralizationlateralizes to right
Condition of ears:leftrightbothleftright
Rinne testNormalSensorineural lossNormalSensorineural lossNormal
Sensorineural loss
Conductive lossNormalCombined lossNormal
NormalCombined lossNormalConductive loss
Conductive lossCombined lossConductive lossCombined lossConductive loss
left earright earCombined loss = conductive and sensorineural loss

Limitations

This test and its complement, the Weber test, are quick screening tests and are not a replacement for formal audiometry. Recently, its value as a screening test has been questioned.[5]

The Rinne test is not reliable in distinguishing sensorineural and conductive loss cases of severe unilateral or total sensorineural loss. In such cases, bone conduction to the contralateral normal ear will be better than air conduction, resulting in a false negative. In such a case, the Weber test will, however, show signs of lateralization, implying some kind of pathology. Formal audiometry testing would be required if any abnormal result is presented.

See also

Internal links

External links

Notes and References

  1. Thijs C, Leffers P . Sensitivity and specificity of Rinne tuning fork test . BMJ . 298 . 6668 . 255 . January 1989 . 2493884 . 1835543 . 10.1136/bmj.298.6668.255.
  2. Book: Betts. J Gordon. Desaix. Peter. Johnson. Eddie. Johnson. Jody E. Korol. Oksana. Kruse. Dean. Poe. Brandon. Wise. James. Womble. Mark D. Young. Kelly A. Anatomy & Physiology. Houston. OpenStax CNX. 978-1-947172-04-3. May 14, 2023. 16.3 The Cranial Nerve Exam.
  3. F. H. A. Rinne. Beiträge zur Physiologie des menschlichen Ohres. Vierteljahrsschrift für die praktische Heilkunde, Prague, 1855, 45: 71-123.
  4. Rogers. J. H.. December 1981. Rinne positive or false Rinne negative. The Journal of Laryngology & Otology. en. 95. 12. 1221. 10.1017/S0022215100092069. 7320618 . 39129883 . 1748-5460.
  5. Bagai A, Thavendiranathan P, Detsky AS . Does this patient have hearing impairment? . JAMA . 295 . 4 . 416–28 . January 2006 . 16434632 . 10.1001/jama.295.4.416 .