Rinne Tuning Fork Tests Research Articles

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>

Development of the Brief Geriatric Assessment for the General Practitioner.

The study aimed to develop a brief geriatric assessment (BGA) tool for the general practitioner to evaluate geriatric syndromes in community-dwelling older adults. A cross-sectional study. 58 communities from four aging cities in Taiwan. 1,258 community-dwelling older adults aged 65 years and above. The BGA targeted physical function impairment, cognitive impairment, and mood impairment. The cutoff values of physical function tests (handgrip strength and 6-meter walk test [6MWT]) were estimated by receiver operating characteristic analysis. Second, the diagnostic validity of the BGA was calculated in terms of sensitivity, specificity, and predictive values, which were compared to corresponding comprehensive geriatric assessment (CGA) items. Third, the associated risk factors of geriatric syndromes were selected using stepwise logistic regression. Finally, we combined items selected from literature and CGA and then proposed a practical BGA framework. The proposed BGA comprised dominant handgrip strength, 6MWT, self-report personal birthday, address, and telephone number, question 'Do you have depressive mood for the past two weeks?', Rinne tuning-fork tests, Snellen scale, and body mass index. It evaluated multidimensional aspects of geriatrics syndromes including physical, cognitive, mood, and sensory impairment, sarcopenia, and nutrition status. Sensitivities in the Taiwan BGA items ranged from 48% for dominant handgrip strength to 97.6% for 6MWT corresponding to physical impairment; 58.3% for cognitive impairment corresponding to Short Portable Mental Status Questionnaire; 62.7% for mood impairment corresponding to Geriatric Depression Scale. The Taiwan BGA for the general practitioner takes less than 10 minutes and is suitable in the community setting. Early management of geriatric syndromes in the community is important. The current study demonstrated a practical BGA tool for the general practitioner to comprehensively assess geriatric syndromes in community-dwelling older adults.

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?

West Nile virus neuroinvasive disease presenting with acute flaccid paralysis and bilateral sensorineural hearing loss

West Nile virus (WNV), is an emerging virus [1]. Most human infections are subclinical or manifest as a mild febrile illness, while fewer than 1% develop a neuroinvasive disease (WNND), including meningitis, encephalitis, and/or an acute flaccid paralysis (AFP) [2–4]. We describe a case of sensorineural hearing loss (SNHL) secondary to WNV infection. A 55 year-old previously healthy and normoacousic man, was admitted (in September 2010) for bilateral hearing loss and leg weakness. He complained, about 2 weeks before, of malaise, fever, generalized fatigue, and diffuse myalgias, initially attributed to a flu-like syndrome. After a few days he noted a mild weakness in both of his legs evolving over a week into a flaccid paraparesis. At the same time, he also developed a sudden bilateral hearing loss. He was afebrile, with stable vital signs. Routine and immunological laboratory data were within the normal range. Neurologic examination was remarkable for a flaccid areflexic paraparesis, weakness being more pronounced in the right leg and proximally (3/5 strength in the right leg, 4/5 strength in the left leg), with flexor plantar responses. No cranial nerve involvement, vestibular, cerebellar, brainstem or meningeal signs were noted. MRI of the brain and whole spine was normal without meningeal, parenchymal or ventral nerve root enhancement. Audiological tests, including the Weber and Rinne tuning fork tests, pure tone and speech audiometry, tympanic admittance, auditory evoked potentials (ABRs) and a screening test for acoustic emissions (OAEs), demonstrated a bilateral, down-sloping SNHL—mild on the left side, severe on the right—with normal acoustic admittance, and impaired OAEs, which were absent in the right ear. Weber test was lateralized to the left side, and the Rinne test was not significant. ABR with click at maximum output level (125 dB SPL) was not evocable by stimulating the right ear and normal for the left ear after latencies correction for the hearing threshold elevation. On the whole, the data were compatible with a bilateral asymmetric cochlear damage. Electrodiagnostic studies showed normal sensory and motor nerve conductions, and moderate decrease of compound motor action potential amplitudes. Late responses were normal. Concentric needle electromyography showed active denervation with a neurogenic recruitment pattern in all four limbs, with a clear predominance in legs. The findings fulfilled the diagnostic criteria for WNV AFP [4, 5]. Neurophysiological examination of cranial nerves and brainstem reflexes studies gave normal results. Since the symptoms began during a work-related stay in Romania where a WNV infection outbreak was occurring [6, 7], we considered the above infection in the differential diagnosis. Serum IgM and low-avidity IgG WNV-specific antibodies were detected (titre:1:1,600; 1:51,200, respectively). The presence of IgMand low avidity IgG WNV-specific I. Casetta (&) E. Cesnik Section of Neurology, Department of Medical and Neurological Sciences of Communication and Behaviour, University of Ferrara, Corso della Giovecca 203, 44121 Ferrara, Italy e-mail: cti@unife.it

Accuracy of the Weber and Rinne Tuning Fork Tests in Evaluation of Children with Otitis Media with Effusion

The purpose of this study was to determine the accuracy of the Rinne and Weber tuning fork tests in predicting the degree of hearing loss secondary to otitis media with effusion (OME) in children compared with pure-tone audiometry. A blinded prospective study was performed on cases of unilateral and bilateral OME in children between ages 2 and 11 years. Patients were recruited from the tertiary Pediatric Otolaryngology Clinic at British Columbia's Children's Hospital in Vancouver. The subjects consisted of 58 children with unilateral or bilateral OME. The Rinne and Weber tests were performed using a 256 Hz and a 512 Hz tuning fork. Pure-tone audiometry was performed to establish the presence and degree of an air-bone gap (ABG). The tuning fork responses were correlated with the ABG to determine their accuracy. The Weber test did not show an association between the ABG and the lateralization response using either the 256 Hz (p = .484) or the 512 Hz tuning fork (p = .120). For the Rinne test, an increase in ABG was significantly associated with a higher rate of response air conduction < bone conduction using either the 256 Hz or the 512 Hz fork (p < .04). Age was not associated with outcome for any of the tuning fork tests. The overall accuracy of the Rinne and Weber tuning fork tests in predicting conductive hearing loss associated with OME in children is poor.

Does This Patient Have Hearing Impairment?

Hearing impairment is prevalent among the elderly population but commonly underdiagnosed. To review the accuracy and precision of bedside clinical maneuvers for diagnosing hearing impairment. MEDLINE and EMBASE databases (1966 to April 2005) were searched for English-language articles related to screening for hearing impairment. Original studies on the accuracy or precision of screening questions and tests were included. Articles that used unaccepted reference standards or contained insufficient data were excluded. Medical Subject Headings or keywords used in the search included hearing loss, hearing handicap, hearing tests, tuning fork, deafness, physical examination, sensitivity, specificity, audiometry, tuning fork tests, Rinne, Weber, audioscope, Hearing Handicap Inventory for the Elderly-Screening version, whispered voice test, sensorineural, and conductive. One author screened all potential articles and 2 authors independently abstracted data. Differences were resolved by consensus. Each included study (n = 24) was assigned a methodological grade. A yes response when asking individuals whether they have hearing impairment has a summary likelihood ratio (LR) of 2.5 (95% confidence interval [CI], 1.7-3.6); a no response has an LR of 0.13 (95% CI, 0.09-0.19). A score of 8 or greater on the screening version of the Hearing Handicap Inventory for the Elderly (HHIE-S) has an LR of 3.8 (95% CI, 3.0-4.8); a score less than 8 has an LR of 0.38 (95% CI, 0.29-0.51). An abnormal Weber tuning fork test response has an LR of 1.6 (95% CI, 1.0-2.3); a normal response has an LR of 0.70 (95% CI, 0.48-1.0). An abnormal Rinne tuning fork test response has LRs ranging from 2.7 to 62; a normal response has LRs from 0.01 to 0.85. Inability to perceive a whispered voice has an LR of 6.1 (95% CI, 4.5-8.4); normal perception has an LR of 0.03 (95% CI, 0-0.24). Not passing the audioscope test has an LR of 2.4 (95% CI, 1.4-4.1); passing has an LR of 0.07 (95% CI, 0.03-0.17). Elderly individuals who acknowledge they have hearing impairment require audiometry, while those who reply no should be screened with the whispered-voice test. Individuals who perceive the whispered voice require no further testing, while those unable to perceive the voice require audiometry. The Weber and Rinne tests should not be used for general screening.

The importance of tuning forks

Turning fork tests are used routinely by many otologists. A different group of otologists find the tests inconsistent and unreliable. This controversy has probably developed because the audiometer has replaced the tuning fork in hearing measurement. Some principles of the Weber- and Rinne-tuning fork test are shortly described. The necessary control of pure tone audiometry by tuning forks is pointed out. The value particularly in the diagnosis of conductive hearing loss, and the tuning fork's limitations are discussed.

History of the tuning fork. III: On the way to quantitative pure-tone measurement. Pictures from the history of otorhinolaryngology, represented by instruments from the collection of the Ingolstadt German Medical History Museum

Weber's and Rinne's tuning-fork tests were for a long time considered unreliable, as they often seemed to yield inconsistent results. The sources of error were manifold and lay in the fields of physics, physiology, pathophysiology, and psychology. When the problems came to be understood, more sophisticated instruments and techniques were developed. The prongs of the tuning fork were fitted with clamps to deaden overtones when it was put into vibration (Politzer 1870). By shifting the clamps along the prongs the tone of the tuning fork could be varied in a range up to one octave (Könlg 1878). A knob of hom or metal was fixed to the end of the shaft to ensure a good coupling to the skull when testing bone conduction (Lucae 1886). A small hammer fixed to the shaft and driven by a spring would activate the tuning fork with reproducible strength (Lucae 1899). A wedge-shaped figure drawn on the lateral surface of the clamps would allow one to optically control the amplitude of vibration (Gradenigo 1899). The time during which a patient hears the tuning fork after it has been struck as compared to that of a normal hearing subject was measured as parameter of hearing acutiy (v. Conta 1864). A number of tuning forks at intervals of one octave each were assembled in sets to cover the whole frequency range of hearing. The most sophisticated example of these sets was the Bezold-Edelmann continuous tone series (1894). It comprised ten tuning forks with sliding clamps, two pipes of the organ type, and a Galton whistle. With this instrumentation it was possible to test the whole range of hearing. The results of testing the hearing via air conduction and bone conduction measured in duration and calculated as percentage of normal hearing were presented in charts (Hartmann 1885, Gradenigo 1893) which can be considered precursors of modern audiograms. The evolution of these instruments and methods is described in detail and illustrated by exhibits from the museum.

History of the tuning fork. II: Evolution of the classical experiments by Weber, Rinne and Schwabach

Since the 17th centrury it was known that sounds could be perceived via air conduction and bone conduction and that this provided a means of differentiating between hearing disorders located in the middle ear and those located in the acoustic nerve. For a long time to come, however, there was no need for such a differential diagnosis. After the invention of the tuning fork in 1711 this instrument had soon become widely used in music, but it took well over 100 years until it was introduced into physiology and otology. FROM DIRECTIONAL HEARING TO WEBER'S TEST: J. B. Venturi, a physicist in Modena, Italy, in 1802 had shown that the perception of the direction from which a sound is coming is governed by the fact that one ear is hit by the sound more intensely than the other ear. C. T. Tourtual, a physician in Münster, Germany, demonstrated in 1827 that this also holds true for sound conducted via the skull bones. He used a watch as sound source. He found that occlusion of both ear canals would increase the sensation in both ears equally, but that occlusion of only one ear would increase the sensation only in the occluded ear, thus giving the impression that the sound were coming from that side. He was interested in a comparison between vision and audition, and he concluded that with regard to recognizing the direction of a sensory signal vision was superior to audition. In the same year 1827 C. Wheatstone, a physicist in London, investigating the mode of vibration of the tympanic membrane and using a tuning fork found the same phenomena as Tourtual and some more effects. E. H. Weber, an anatomist and physiologist in Leipzig, Germany, described the very same phenomena as Tourtual and Wheatstone once more in 1834. He wanted to prove that airborne sound is perceived by the vestibulum and the semicircular canals, bone conducted sound by the cochlea. None of these investigators was thinking of a clinical use of their findings and made no such suggestion. E. Schmalz, an otologist in Dresden, Germany, in 1845 introduced the tuning fork and the test later named after Weber into otology and explained in great detail all possibilities of a diagnostic evaluation of the test. His grand achievement, however, passed unnoticed at his time. A. Rinne, a physician in Göttingen, Germany. In 1855 described the test which later was named after him, in an elaborate treatise on the physiology of the ear. He wanted to demonstrate that in man and animals living in the air, as opposed to those living in water, the conduction of sound via the bones of the skull is just an unavoidable side effect of sound perception. He mentioned a clinical application of his test only in a footnote and obviously never used it himself in a systematic way. His test was made generally known by Lucae in Berlin only after 1880. The value of Weber's and Rinne's tuning fork tests was much disputed even at the turn of the century and only gradually became generally accepted.

Sensitivity and specificity of Rinne tuning fork test.

Sensitivity and specificity of Rinne tuning fork test.

Sensitivity and specificity of Rinne tuning fork test: Authors' Reply

Sensitivity and specificity of Rinne tuning fork test: Authors' Reply

Sensitivity and specificity of Rinne tuning fork test.

Sensitivity and specificity of Rinne tuning fork test.

The Rinne test for conductive deafness. A critical reappraisal.

The Rinne tuning fork test for the detection of conductive hearing loss is the most widely used tuning fork test in clinical medicine. However, the frequency of the tuning fork used to perform the test has not been standardized. In a study of 200 patients with known air-bone gaps, we found that the 256-Hz tuning fork was more sensitive than the 512-, 1024-, and 2048-Hz tuning forks for discriminating conductive from sensorineural hearing deficits. However, the occurrence of false-positive responses limits its usefulness. Therefore, we believe that the 512-Hz tuning fork should become the standard tuning fork used in performance of the Rinne test to screen patients for conductive hearing loss.

ERROR IN TESTING

<i>To the Editor</i>: I was surprised at the article by Crowley and Kaufman on the Rinne tuning fork tests. This article appeared in the October issue of theArchives, as you know. I cannot imagine why they did the Rinne test the way they described it. It's just 100% wrong and I am sure if they said they did tuning fork tests like this when they took their boards they would have been flunked, or at least given a pretty bad mark. The whole paper seemed to me to be full of errors and I do not think these ought to be allowed to get by without some protest. I hope you agree.

II. An Analytic Study of the Rinne and other Tuning Fork Tests

II. An Analytic Study of the Rinne and other Tuning Fork Tests