Rinne Test Research Articles

ОЦЕНКА СОСТОЯНИЯ СЛУХОВОГО АНАЛИЗАТОРА И АНАЛИЗ ФАКТОРОВ РИСКА У СТУДЕНТОВ

The modern lifestyle of young people is reflected in the state of hearing. Using gadgets and listening to loud music leads to the early development of hearing loss. The purpose of the study is to assess the condition of the auditory analyzer in students. The results of our own research allowed us to identify the main factors leading to hearing loss and assess the condition of the auditory analyzer in 20 students aged 20-22 years. Data collection was carried out on the basis of comprehensive surveys, questionnaires and reports. To assess hearing, anamnesis was collected, external examination of the ear, palpation, otoscopy, whispering and colloquial speech, tests with tuning forks, tonal threshold audiometry at four typical frequencies. The results of the study of the condition of the auditory analyzer showed that in 10% of cases sulfur plugs were detected in the external auditory canal, in 5% of cases – the presence of scars and pathological color of the membrane. The study of auditory function revealed that in 20% of cases, whispered speech was detected from a distance of 4 meters, and not from 6. The values of air and bone conduction during the Rinne test in all cases did not reach the standard values, in 20% of cases the test on the right ear was negative, and on the left ear – in 10%. In Federici's experiment, it was revealed that in 15% of cases, bone conduction was higher than air. The results of the Weber test showed that in 45% of cases the sound was shifted and uneven. The data obtained using a high-frequency tuning fork 2048 showed that in 85% of cases, the air conductivity values of both the right and left ears were below normal values. The study of hearing acuity demonstrated that in 15% of cases the values reached the upper limit of the norm. The results of the questionnaire to identify the determining factors showed that 30% of students noticed hearing impairment. More than 50% of students answered that they often listen to loud music and use headphones. Thus, the main risk factors and the first signs of hearing loss in students were identified.

Optimization of Approaches to Early Diagnosis of Hearing Impairment in Primary Care

Almost 500 million people worldwide suffer from hearing loss or impairment. The causes of hearing loss are very diverse. Hearing loss can be caused by hereditary and non-hereditary genetic factors, certain complications during pregnancy and delivery, infectious and chronic diseases, head or ear trauma, etc. A common problem today is hearing impairment. Development of diagnostic algorithm for hearing disorders in primary care will improve the quality of diagnosis, optimize the patient’s management and ensure the earliest possible treatment and prevention measures, which will positively effect the results of treatment and patients quality of life. Primary care physicians use the ICPC-2 classification in their practice. They collect complaints, anamnesis, and test hearing ability. There are various methods to examine auditory function, most of which are based on the patient’s subjective data about perception of the heard sounds. These include perception of whispered and spoken speech, tuning fork experiments (accumetry), audiometry. Hearing is considered normal if a whispered speech is perceived at a distance of 6 m. The whispered speech degree of perception is the greatest distance from which the patient correctly repeats the words spoken by the doctor fro three times. Primary care physicians conduct a tuning fork examination of the patient using the Weber test (W), Rinne test (R), Schwabach test (Sch). Timely hearing examination with the help of modern diagnostic methods in primary care and the correct assessment of the potential capabilities of the auditory system of patients allows correct evaluation of its condition. The normal functioning of the hearing organ is one of the crucial factors for the overall development and healthy human life. After all, thanks to the auditory analyzer, a person receives information about the surrounding world.

Audiological profile of adult Long COVID patients

IntroductionHearing loss is one of the self-reported symptoms of Long COVID patients, however data from objective and subjective audiological tests demonstrating diminished hearing in Long COVID patients has not been published. Materials and methodsRespondents of a large Long COVID online survey were invited to the ENT-department for an otologic exam. The participants were split into three groups based on their history of SARS-CoV-2 infection and persistence of symptoms. Respondents with a history of a SARS-CoV-2 infection were allocated to the Long COVID group, if they reported persistent symptoms and to the Ex COVID group, if they had regained their previous level of health. Participants without a history of SARS-CoV-2 infection made up the No COVID control group. In total, 295 ears were examined with otoscopy, tympanograms, pure tone audiometry and otoacoustic emissions. Ears with known preexisting hearing loss or status post ear surgery, as well as those with abnormal otoscopic findings, non-type A tympanograms or negative Rinne test were excluded. ResultsCompared to the No COVID and Ex COVID groups, we did not find a clinically significant difference in either hearing thresholds or frequency specific TEOAEs. However, at 500 Hz the data from the left ear, but not the right ear showed a significantly better threshold in the Ex COVID group, compared to Long COVID and No COVID groups. Any of the other tested frequencies between 500 Hz and 8 kHz were not significantly different between the different groups. There was a significantly lower frequency-specific signal-to-noise-ratio of the TEOAEs in the Long COVID compared to the No COVID group at 2.8 kHz. At all other frequencies, there were no significant differences between the three groups in the TEOAE signal-to-noise-ratio. ConclusionThis study detected no evidence of persistent cochlear damage months after SARS-CoV-2 infection in a large cohort of Long COVID patients, as well as those fully recovered.

Maximizing Opportunities for Anatomy Learning: Use of Authentic OSPE as Part of Assessment in Anatomy

In the care of patients, a practicing physician performs a selected and integrated set of individually skillful acts that are pertinent to each patient encounter. These include, for example, engaging the patient in a professional relationship, taking a clinical history, performing a mental and physical examination, performing, or initiating clinical tests or procedures, and undertaking diagnostic and therapeutic interventions. From an analytic perspective, these component acts of medical care reflect the generic competencies which comprise the practitioner’s basic clinical method1.Skill learning requires the demonstration of skill proficiency that must be observable. This observation is necessary to evaluate performance. Moreover, learners need repeated and deliberate practice followed by constructive feedback to continually refine and improve their performance of the skill. Therefore, the evaluation of skill proficiency requires the direct involvement of a trained observer, such as a supervising expert or an experienced patient2.The utility or value of assessment items (question used in an examination) depends on; their validity, reliability, educational impact, cost, and acceptability3. For instance, a written examination item had good value and utility if it tests learning in the knowledge domain. In the same way, a written examination item has poor utility if used for testing psychomotor skills.The so‐called OSPE (Objective Structured Practical Examination) has its origins in physiology4 where competence in performing physiological tests (e.g. Rinne’s test) are examined through observation by an examiner using a structured checklist (similar to Objective Structured Clinical Examination, OSCE). Within the context of medical education, an activity could be regarded as a clinical skill if it satisfies three conditions namely, the activity must be demonstrable, observable, and employs using knowledge, psychomotor and attitude components of learning (Fig 1).Anatomy learning in medical education underpins the development of clinical reasoning, understanding of medical imaging, the basis of clinical procedures, and physical examination of patients. An authentic utilization of the concept of OSPE in anatomy education should be in the context of evaluating a true skill competence. This will include evaluating competence in physical examination and/or clinical procedural skill (Fig 2). In current undergraduate medical education, these skills and more are now part of a comprehensive and integrated clinical skills curriculum.References AAMC, (2005). Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Association of American Medical Colleges. Duvivier et al. (2011) BMC Medical Education 11:101 Van der Vleuten CPM, (1996). Advances in Health Sciences Education 1 (1), 41‐67 Nayar U et al. (1986). Med Educ 20 (3):204‐9

Comparison Of Retinopathy And Hearing Impairment In Poorly Controlled Diabetics In Population Of Muzaffarabad AJK

Aim: Prevalence and comparison of retinopathy and sensorineural hearing loss in poorly managed diabetics Methodology: A cross sectional study was designed with the approval of the Ethical Review Board Committee. The study enrolled 50 people who met the inclusion criteria. Anthropometric data were collected using standardized procedures. All laboratory assays were performed on the initial visit to the diabetes research center's laboratory. Tuning fork and PTA examinations of the ears were performed. The scores of Rinne and Weber were recorded and synchronised. Fundoscopy was used in ophthalmic investigations. Results: The Rinne test was found to be normal in 50(100%) cases of population while Weber’s test was centralized in 43(86%) of patients, 1(2%) case was lateralized to right, 5(10%)cases were lateralized to left, 1(2%) case had moderate disease. PTA scores revealed mild disease in 1(2%), moderate 14(28%), severe 1(2%) and 34(68%) patients showed normal results. Fundoscopy demonstrated normal results in 11(22%), Grade 1 retinopathy in 15(30%), grade 2 RP in 17(34%) and grade 3 RP in 7(14%). Conclusion: Retinopathy is more prevalent with poorly managed diabetic individuals in contrast to hearing impairment. Key words: Retinopathy, Fundoscopy, Diabetes mellitus

Post-traumatic Malleo-Incudal Complex Dislocation

A 27-year-old man undergoes otolaryngologic evaluation for blunt head trauma suffered in a vehicular accident. With regards to the right ear, pertinent otologic findings include an ear canal laceration and a delayed-onset facial nerve paresis. Tuning fork testing reveals an abnormal Rinne test on the right (AC<BC). The radiologist’s interpretation of the computerized tomographic imaging study of the temporal bone indicated the presence of a longitudinal fracture of the right temporal bone with no disruption of the ossicular chain. (Figure 1) However, careful examination of the anatomy of the malleo-incudal complex in relation to the other structures in the epitympanum actually reveals findings indicative of a malleo-incudal complex dislocation. How can this discrepancy in the radiologic interpretation be accounted for? By what objective parameters can the presence of a malleoincudal complex dislocation be identified?
 
 Meriot et al.1 described five types of traumatic ossicular dislocation injury: incudomalleolar joint separation, incudostapedial joint separation, stapediovestibular dislocation, incus dislocation, and malleo-incudal complex dislocation. Of these, incudomalleolar joint separation would probably be the most easily identified, as it would manifest as a disruption in the distinctive ice-cream cone appearance of the malleus head and the body and short process of the incus visualized on axial CT imaging of the temporal bone. (Figure 2) In contrast, malleo-incudal complex dislocation would involve movement of both ossicles en-bloc within the tympanic cavity (usually into the mesotympanum), without disruption of the incudomalleolar joint.1 As such, the ice-cream cone configuration may be preserved in this type of injury. Proper identification of this type of injury would be based on identifying any discrepancy in the positional relationship between the ossicular complex and the other structures within the confines of the
 tympanic cavity.
 
 The malleus head and the body and short process of the incus are located in the most superior portion of the tympanic cavity, the pneumatised area called the epitympanum. Also known as the attic or
 epitympanic recess, this region is bordered superiorly by the tegmen tympani and inferiorly by the mesotympanum. The epitympanum is divided into two compartments: the anterior epitympanic space or
 recess, and the much larger posterior epitympanum, which houses the epitympanic portions of the malleus and incus. This division is created by a thin bony plate known as the cog, which projects downwards from the tegmen tympani and is located anterior to the malleus head.2 In the axial plane, the malleo-incudal complex is normally centered within the posterior epitympanum with the short process of the incus pointing into the incudal fossa. The position of the malleo-incudal complex may sometimes be slightly lateral, but is never medial in the normal situation.1
 
 Based on these broader anatomical relationships, it can be seen that in the imaging study under investigation (Figure 3), the malleo-incudal complex (the ice-cream cone) has actually shifted forward - the malleus head is located not posterior to the cog, but at the same level as the cog in the antero-posterior dimension. Additionally, the malleo-incudal complex is located more medially within the posterior epitympanum, and is much closer to the tympanic segment of the facial nerve than to the lateral bony margin (the scutum) of the epitympanum. These findings clearly and unequivocally demonstrate the presence of a malleo-incudal complex dislocation.
 
 In summary, one of the keys to the proper evaluation of post-traumatic ossicular injury is to look not only at the anatomical relationship between ossicles, but also at the relationship of the entire ossicular complex to the other structures that are also located within the confines of the tympanic cavity

Validation of a smartphone-based Rinne test to detect an air-bone gap.

ObjectiveTo validate a smartphone-based Rinne test employing the vibration application of mobile telephones.Study designProspective controlled clinical study.SettingTertiary referral medical center.MethodsTwenty consecutive patients hospitalized in the otolaryngology department of a tertiary medical center due to unilateral hearing loss (HL study group), and 30 consecutive inpatients on the same ward who had no otological history (controls) were enrolled. Each participant underwent the traditional 512 Hz tuning fork-based Rinne test, as well as a smartphone-based Rinne test by means of a single uncovered smartphone with a vibration application. The test results were compared to those of formal audiometry.ResultsThe overall agreement between the traditional Rinne test and the smartphone-based test was 98%. The Sensitivity was 85% for both tests, specificity was 90% and 93% for smartphone and tuning fork tests, respectively. The smartphone-based Rinne test could correctly discriminate between patients with an air–bone gap ≥ 25 dB at 512 Hz from patients with a lower or no air–bone gap at 512 Hz. The smartphone-based Rinne could not evaluate two patients with a moderately severe/severe sensorineural hearing loss due to their inability to detect the vibrations.ConclusionA smartphone-based Rinne test was validated for the detection of an air–bone gap ≥ 25 dB at 512 Hz in the clinical setting. The validity of patient-operated smartphone-based Rinne test awaits further study.Level of evidence2B.

Rinne Test Results: How Badly Can We Be Mistaken?

ObjectiveTo establish the extent to which sound amplitudes delivered by a vibrating tuning fork change around its long axis and to evaluate whether such differences in amplitude might change the results of the Rinne test.Study DesignExperimental measurements.SettingLaboratory setting.MethodsSetup I: a vibrating tuning fork was handheld and manually rotated around its long axis next to a sound recording device (the simulated ear) in order to record sound amplitude data at a full range of angles relative to the device; files were split into segments in which sound amplitude changed: A (from a maximum to a minimum) and B (from a minimum to a maximum). Setup II: a vibrating tuning fork was machine-rotated, and the angle of rotation, along with the sound amplitude, was automatically recorded through a single full rotation.ResultsThe angles of 0° and 180° (which equate to the established best practice in Rinne testing) were associated with the highest sound amplitudes. All other angles decreased sound amplitude. The greatest decrease in amplitude was recorded at 51° and 130°. This difference ranged from 9.8 to 34.7 dB, depending on the initial amplitude.ConclusionThe outcome of a Rinne test can be affected if attention is not paid to the precise angle at which the tuning fork is held relative to the ear. The potential of this effect will be greater when high background noise or patient hearing loss requires that the tuning fork be vigorously excited to obtain high sound amplitudes.

Implemetasi Pada Guru/Pegawai di SMA Negeri 12 Pekanbaru Dengan Metode Tes Uji Rinne Pada Remaja Gangguan Pendengaran Dengan Penggunaan Handphone

Mobile phone is one of the developing communication tools today. The global debate and controversy regarding the health effects of cell phones continues. There are concerns that radio frequency energy (radio waves) emitted can cause health problems, especially to hearing function. The aim of the study was to find out how "the description of hearing loss with the use of mobile phones in Pekanbaru 12 SMA. The type of research used is descriptive with probality sampling sampling technique where the sample in this study is to take respondents based on random or coincidental in SMA Negeri 12 Pekanbaru which amounted to 249 respondents. Data collection tools using questionnaires as well as examination of auditory function by means of the rinne test used is univariate. The results of the research which was conducted on 23 July - 28 July 2018 showed that of 249 respondents (100%) were all mobile users and from the results of rinne test, 66 respondents (26.5%) had positive hearing loss and 183 respondents (73 , 5%) negative did not experience hearing loss.

Utility of Rinne’s tuning fork test for quantitative assessment of conductive hearing loss

<p><strong>Background:</strong> The Rinne tuning fork test is used routinely in clinical ENT examination. It is used to assess the person’s hearing acuity. Ideally, 3 tuning forks are used 256, 512 and 1024 Hz. Rinne tuning fork tests can be used to diagnose conductive hearing loss. Aim of our study an attempt is made to find the utility of three different tuning forks (256,512,1024 Hz) for quantification of conductive hearing loss and their accuracy.</p><p><strong>M</strong><strong>ethods:</strong> A retrospective study with a sample size of 300 was undertaken over 12 months from April 2018 to March 2019 at the out-patient department of ENT of VMKV medical college and hospital, Salem. Patients of both sexes and aged above 10 yrs presenting with conductive hearing loss due to varied etiology were subjected to complete ENT examination including Rinne test with three different tuning forks (256, 512, 1024 Hz).</p><p><strong>R</strong><strong>esults:</strong> The results of all the tuning forks (256, 512, 1024 Hz) shows that 29 patients were Rinne’s positive to all tuning forks had the air-bone gap range of 15 dB to 19 dB with a mean air-bone gap of 17.63 dB. 83 patients were negative to 256 Hz tuning fork but positive to 512 and 1024 Hz tuning forks had the air-bone gap range of 20 to 29 dB with a mean air-bone gap of 25.46 dB.</p><p><strong>C</strong><strong>onclusions: </strong>We conclude that Rinne’s tuning fork test can be used to quantify the degree of conductive hearing loss into mild (20-30 dB), moderate (30-45 dB), and severe (45-60 dB).</p>

Endoscopic findings and long-term hearing results for pediatric unilateral conductive hearing loss

ObjectivesAnalyze reasons for unilateral conductive hearing loss (CHL) with unknown etiology in children. IntroductionUnilateral conductive hearing loss (HL) without known etiology can be undiagnosed despite of hearing screening programs. It can be difficult to find the reason for HL and to make a treatment plan. Middle ear endoscopy gives hard-evidence diagnosis and basis for an individual treatment plan. Methods and materialProspective clinical follow-up study for a cohort of generally healthy elementary school age children with unilateral conductive HL with unknown etiology. The study population was 192 children, of which 46 had a HL of at least 25 dB with more than 10 dB conductive component. Mean age was 8.7 years. Preoperative tests included otomicroscopy, bone- and air-conduction audiogram, tympanometry, stapes reflex tests, Rinne and Weber test and Otoacoustic emissions. The children underwent endoscopy of the middle ear with an individual treatment plan and long-term follow-up. The aim was to explore etiology and to give a treatment plan for hearing loss. Follow-up included air- and bone conduction hearing tests annually or every other year. Mean follow-up was 5.2 years. ResultsA clear etiological finding was found in 36 (78%) ears, stapes anomaly (23) as the most common (64%) finding. Other findings were two cholesteatomas, 2 status after trauma, 5 middle ear anomalies, 5 incus fixations and one incus erosion. Air conduction hearing improved spontaneously during follow-up in 81% (17/21, 2 dropouts) of the stapes anomaly ears (mean 11,3 dB, range 4–32 dB), and none of these ears showed hearing deterioration. In the incus fixation group, one ear showed hearing deterioration. There were no major complications for exploration, and 5 minor postoperative infections. ConclusionsThe most common reason for pediatric unilateral conductive hearing loss was stapes anomaly/fixation. The HL does not deteriorate. Hearing loss in stapes anomalies shows a tendency for spontaneous recovery. Stapes surgery can be postponed or avoided.

The implications of variability in the instruction and practice of the Rinne test

PurposePrior to graduation, all medical students are expected to master the delivery of two basic hearing examinations: the Rinne and Weber tuning fork tests. Throughout basic science years, these tests are routinely examined to determine student competency in clinical skills. However, there exists a high level of variation between practitioners in their modes of implementing these examinations. Materials and methodsUtilizing online databases, YouTube and PubMed, the phrases “Rinne tuning fork test” and “Weber tuning fork test” were searched to find instructional guidelines on how to perform these hearing examinations. Each medium was assessed on five different parameters related to clinical implementation of the hearing exam. In total, 31 of 35 videos met inclusion criteria with views ranging from 1,000 to 1,100,000 and were subsequently assessed for data collection. ResultsThrough our research investigating instructional video resources of the Rinne test, as well as guidelines in textbooks and journal articles, we were able to determine the major source of incongruity in the instructional process. Of the 31 videos analyzed, bone conduction was tested prior to air conduction in 30 of the 31 videos, while 20 of 31 practitioners held the fork tines parallel to the axis of hearing with the point of reference being the external auditory canal. Only 3 of 31 videos provided guidance regarding the distance the tuning fork should be held away from the patient. A high level of variability exists concerning the purported best approach to testing air and bone conduction in the educational materials available. ConclusionAfter reviewing and cross-referencing multiple sources from different mediums, the conclusion was drawn that specific parameters of delivery did not impact the diagnostic reliability of the Rinne test. The major commonality amongst these educational sources was that patients must be able to identify air conduction being louder that bone conduction in order to have a “positive” Rinne test. Given the high level of discrepancy that exists and the likelihood that these examinations will be replaced by audiometry, are these screening tests necessary to teach medical students?

Tullio phenomenon and drop attacks – An unsuspected cause

Tullio phenomenon or loudness intolerance is most commonly associated with superior semicircular canal dehiscence. We describe a patient presenting solely with this phenomenon and found to have an unsuspected cause. A 43-years-old gentleman presented to us complaining of intolerance to loud noise, occasionally leading to falls, for six months. These complaints were insidious in onset and steadily progressing. Interestingly, the intolerance in heavy traffic used to subside on wearing a helmet. There was no history of hearing loss, tinnitus, earache, or ear discharge. Clinical tests of hearing including Rinne, Weber and absolute bone conduction test were within normal limits. The neurologic as well as systemic examination was normal. Pure tone audiometry (PTA) showed mild conductive hearing loss in left ear and brainstem auditory evoked response (BAER) was normal. Patient’s skull radiograph showed multiple large lytic lesions giving the appearance of “geographical skull”. Chest X-ray showed a lytic lesion with pathological fracture involving posterior part of in left sided rib. Computed Tomography of head with bone window also showed multiple lytic lesions in skull (Figure 1,2). Brain parenchyma was normal. Incisional biopsy of one of the skull lesions was performed, which was consistent with a diagnosis of Langerhans cell histiocytosis (LCH) (Figure 3). The patient showed considerable improvement after being initiated on Etoposide and Vinblastine. LCH is a rare cause of Tullio phenomenon. It appears that the loss of skull tissue due to lytic lesions leads to impairment of “modifier” function of intact skull, resulting in “volume conduction” and noise intolerance.

Re – evaluation of Rinne Test with Aluminum Alloy Tuning Fork 256 Hz and 512 Hz

Objective : To study the sensitivity, specificity and accuracy of the 256 Hz and 512 Hz aluminum tuning fork in the detection of conductive hearing loss by quick Rinne test. Methods : The patients with hearing problems recruited from out-patient unit were tested with the 256 Hz and 512 Hz aluminum quick Rinne test. The audiometry was performed on the same day and the results were compared. Results : During the study period, 246 ears with conductive hearing loss and 246 ears with non-conductive hearing loss were recruited. The 256 Hz Rinne test had higher sensitivity than the 512 Hz Rinne test (93.83% and 71.95% respectively). The specificity and accuracy of the 512 Hz Rinne test was markedly greater than the 256 Hz Rinne test (91.18 % vs. 26.7% specificity and 83.57% vs. 61.85% accuracy). The 512 Hz Rinne test had sensitivity over 80% when the air-bone gap was equal to or greater than 20 dB. The sensitivity was even higher (more than 90%) if the air-bone gap was equal to or greater than 30 dB. Conclusion : This study demonstrated that the 512 Hz Rinne test had better accuracy than the 256 Hz Rinne test for the diagnosis of conductive hearing loss. The 512 Hz Rinne test can detect the air-bone gap of 30 dB or greater which indicates the surgical role with the sensitivity more than 90%. We recommend that 512 Hz Rinne test should be used as a screening tool for the detection of conductive hearing loss.

Association of Cigarette Smoking with Hearing Loss in Young Male Adults of Hyderabad, Pakistan

OBJECTIVE: To evaluate the effects of cigarettes smoking on hearing loss in young adult’s aged < 35 years.METHODOLOGY: This cross-sectional research was carried out in the ENT department of Combined Military Hospital Hyderabad. The hearing loss was assessed by Audiometry, Whisper test, Rinne's test and Webbers test. The young healthy adults with no known history of exposure to extreme noise were included. All the participants which had any type of infections or any otic injury were excluded from study. The audiometry was performed on the audiometer MAICO-MA39 (Berlin Germany) at Combined Military Hospital Hyderabad.RESULTS: In this study, 148 apparently healthy participants were selected, out of 148, 73 were smokers and 75 were nonsmokers. The age of the participants ranged between 20 to 35 years with the mean age of smokers 28.99±3.731, and nonsmokers 28.00±4.451 non-smokers. The data collected indicate significantly higher prevalence of hearing loss in smokers 49.31%, P < 0.01 than in non-smokers (30.66%). Age of smokers was positively correlated (r = 0.427, P < 0.01) with hearing loss. Frequency of cigarettes smoked per day was positively correlated (r=0.715, P < 0.01) and year of smoking was also positively correlated with hearing loss (r = 0.620). The correlation of frequency of cigarette smoking and duration of smoking with hearing level was extremely significant (P < 0.01).CONCLUSION: These findings suggest that cigarette smoking is associated with hearing loss in young adults; this study will be helpful in making public health policies.

Diagnostic Accuracy of Tuning Fork Tests for Hearing Loss: A Systematic Review.

Objective (1) To determine the diagnostic accuracy of tuning fork tests (TFTs; Weber and Rinne) for assessment of hearing loss as compared with standard audiometry. (2) To identify the audiometric threshold at which TFTs transition from normal to abnormal, thus indicating the presence of hearing loss. Data Sources PubMed, Ovid Medline, EMBASE, Web of Science, Cochrane, and Scopus and manual bibliographic searches. Review Methods A systematic review of studies reporting TFT accuracy was performed according to a standardized protocol. Two independent evaluators corroborated the extracted data and assessed risk of bias. Results Seventeen studies with 3158 participants, including adults and children, met inclusion criteria. The sensitivity and specificity of the Rinne test for detecting conductive hearing loss ranged from 43% to 91% and 50% to 100%, respectively, for a 256-Hz fork and from 16% to 87% and 55% to 100% for a 512-Hz fork. The audiometric thresholds at which tests transition from normal to abnormal ranged from 13 to 40 dB of conductive hearing loss for the Rinne test and from 2.5 to 4 dB of asymmetry for the Weber test. Significant heterogeneity in TFT methods and audiometric thresholds to define hearing loss precluded meta-analysis. There is high risk of bias in patient selection for a majority of the studies. Conclusion Variability exists in the reported test accuracy measurements of TFTs for clinical screening, surgical candidacy assessments, and estimation of hearing loss severity. Clinicians should remain mindful of these differences and optimize these techniques in specific clinical applications to improve TFT accuracy.

Diagnostic Accuracy of Parallel vs Perpendicular Orientation of the Tuning Fork in the Identification of Conductive Hearing Loss

This study compares patients’ responses to the Rinne test when performed with the tuning fork positioned parallel vs perpendicular to the external auditory meatus.

Otologic Manifestations and Progression in Patients with Wegener's granulomatosis: A Survey in 55 Patients.

Granulomatosis with polyangiitis (GPA; also known as Wegener's granulomatosis) is a primary systemic vasculitis involving the ear, nose and throat system (ENT) and lower respiratory tract. Because of the lack of knowledge regarding the clinical findings of GPA due to the limited number of studies, the current study was designed to investigate the prevalence and nature of the otology manifestations in the disease course. In the current prospective study, patients with a diagnosis of GPA from 2012-2016 were included. A definitive diagnosis was made based on the history, physical examination (otomicroscopy, Rinne and Weber test), audiometry, tympanometry, cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibody (C-ANCA and P-ANCA) investigations, and pathologic studies. Twenty-seven male and 28 female patients aged 41.6±15.3 years were enrolled. Ear involvement was found in 20 patients (36.3%), and the most prevalent symptom was loss of hearing followed by otalgia and tinnitus. Tinnitus improved in none of the patients. The most prevalent sign was otitis serous followed by mastoiditis and external otitis. The most important audiometry finding was sensorineural hearing loss. Pathological studies using pulmonary samples were more useful for diagnosis. Precise clinical examination is crucial for the early diagnosis of GPA. Otological manifestations are common, especially loss of hearing and otitis serous, and can be the first sign of this disease. Early diagnosis can lead to better treatment of Wegener's granulomatosis.

Rinne test: Does the tuning fork position affect the sound amplitude at the ear?

BackgroundGuidelines and text-book descriptions of the Rinne test advise orienting the tuning fork tines in parallel with the longitudinal axis of the external auditory canal (EAC), presumably to maximise the amplitude of the air conducted sound signal at the ear. Whether the orientation of the tuning fork tines affects the amplitude of the sound signal at the ear in clinical practice has not been previously reported. The present study had two goals: determine if (1) there is clinician variability in tuning fork placement when presenting the air-conduction stimulus during the Rinne test; (2) the orientation of the tuning fork tines, parallel versus perpendicular to the EAC, affects the sound amplitude at the ear.MethodsTo assess the variability in performing the Rinne test, the Canadian Society of Otolaryngology – Head and Neck Surgery members were surveyed. The amplitudes of the sound delivered to the tympanic membrane with the activated tuning fork tines held in parallel, and perpendicular to, the longitudinal axis of the EAC were measured using a Knowles Electronics Mannequin for Acoustic Research (KEMAR) with the microphone of a sound level meter inserted in the pinna insert.Results47.4 and 44.8 % of 116 survey responders reported placing the fork parallel and perpendicular to the EAC respectively. The sound intensity (sound-pressure level) recorded at the tympanic membrane with the 512 Hz tuning fork tines in parallel with as opposed to perpendicular to the EAC was louder by 2.5 dB (95 % CI: 1.35, 3.65 dB; p < 0.0001) for the fundamental frequency (512 Hz), and by 4.94 dB (95 % CI: 3.10, 6.78 dB; p < 0.0001) and 3.70 dB (95 % CI: 1.62, 5.78 dB; p = .001) for the two harmonic (non-fundamental) frequencies (1 and 3.15 kHz), respectively. The 256 Hz tuning fork in parallel with the EAC as opposed to perpendicular to was louder by 0.83 dB (95 % CI: −0.26, 1.93 dB; p = 0.14) for the fundamental frequency (256 Hz), and by 4.28 dB (95 % CI: 2.65, 5.90 dB; p < 0.001) and 1.93 dB (95 % CI: 0.26, 3.61 dB; p = .02) for the two harmonic frequencies (500 and 4 kHz) respectively.ConclusionsClinicians vary in their orientation of the tuning fork tines in relation to the EAC when performing the Rinne test. Placement of the tuning fork tines in parallel as opposed to perpendicular to the EAC results in a higher sound amplitude at the level of the tympanic membrane.

Enhancing the Sensitivity for Rinne Test through Tuning Fork Modifications

Enhancing the Sensitivity for Rinne Test through Tuning Fork Modifications