Rinne and Weber tests

Definition

Both the Rinne and the Weber tests employ the use of metal tuning forks to provide a rough assessment of a patient's hearing level at various frequencies. A tuning fork is a metal instrument with a handle and two prongs, or tines. Tuning forks, made of steel, aluminum, or magnesium alloy, will vibrate at a set frequency to produce a musical tone when struck. The vibrations produced can be used to assess a person's ability to hear different sound frequencies.

Purpose

A vibrating tuning fork held next to the ear or placed against the skull will stimulate the inner ear to vibrate, and can help determine if there is hearing loss . The Rinne tuning fork test helps evaluate a patient's hearing ability by air conduction compared to that of bone conduction. The Weber tuning fork test helps determine a patient's hearing ability by bone conduction only, and is useful when hearing loss is asymmetrical.

Precautions

No special patient precautions are necessary when tuning forks are used to conduct hearing tests.

Description

Two types of hearing tests using tuning forks are typically conducted. In the Rinne test, the vibrating tuning fork is held against the skull, usually on the bone behind the ear (mastoid process) to cause vibrations through the bones of the skull and inner ear. It is also held next to, but not touching, the ear, to cause vibrations in

KEY TERMS

Asymmetrical —Unbalanced, disproportionate, or unequal.

Mastoid process —The protrusions of bone behind the ears at the base of the skull.

Rinne test —A hearing test using a vibrating tuning fork that is held near the ear and held at the back of the skull.

Weber test —A hearing test using a vibrating tuning fork that is held at various points along the midline of the skull and face.

the air next to the ear. The patient is asked to determine which sound is louder, the sound heard through the bone or through the air. For the Weber test, the stem or handle of the vibrating tuning fork is placed at various points along the midline of the skull and face. The patient is then asked to identify which ear hears the sound created by the vibrations. Tuning forks of different sizes produce different frequencies of vibrations and can be used to establish the range of hearing for an individual patient.

Preparation

No special patient preparation is required for either of these hearing tests.

Aftercare

No special patient aftercare is required following the hearing tests. If hearing loss is detected using either tuning-fork test, the patient may require further testing to determine the cause and extent of hearing loss.

Complications

There are no known complications associated with the use of tuning forks to screen for hearing loss.

Results

With the Rinne test, a patient with normal hearing will hear the tone of the vibration longer and louder when the tuning fork is held next to the ear, as opposed to when it is held against the mastoid bone. Conversely, the test detects a hearing loss when a patient hears a louder and longer tone when the vibrating tuning fork is held against the mastoid bone, than when it is held next to the ear. This result is often referred to as "reversed Rinne."

For the Weber test, the patient is considered to have normal hearing if the tone produced when the tuning fork is placed along the center of the skull or face sounds about the same volume in each ear. The volume of sound vibrations conducted through parts of the skull and face during the Weber test can indicate which ear may have a hearing loss, if the patient hears louder sound vibrations in one ear compared to sounds picked up by the opposite ear.

If either method of testing reveals abnormal results, the patient will require further evaluation.

Health care team roles

Nurses should explain the procedure to patients and answer any questions.

Patient education

Patients should be instructed to listen carefully to directions for either test and be reassured that there are no pain or complications associated with either test.

Training

No special training is required.

Resources

BOOKS

Baloh, Robert W. Dizziness, Hearing Loss, and Tinnitus. Philadelphia, PA: F.A. Davis Company, 1998, p 93.

The Merck Manual. 17th ed., edited by Mark H. Beers, M.D., and Robert Berkow, M.D. Whitehouse Station, NJ: Merck Research Laboratories, 1999, p 659.

OTHER

Carr, M.M., D.D.S., M.D, M.Ed. "How to Perform and Interpret Weber and Rinne Tests." 1998. <http://icarus.med.utoronto.ca/carr/manual/tuningfork.html> (March 15, 2001).

Susan Joanne Cadwallader