Rinne test
Encyclopedia
The Rinne test is a hearing test
. It compares perception of sound
s 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
.
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); the Weber test
was named after Ernst Heinrich Weber
(1795 – 1878).
(512 or 256 Hz) against the patient's mastoid bone and ask the patient to tell you when the sound is no longer heard. Time this interval of bone conduction with a watch, noting the number of seconds. Quickly position the still vibrating tines 1-2 cm from the auditory canal, and again ask the patient to tell you when the sound is no longer heard. Continue timing the interval of sound due to air conduction heard by the patient. Compare the number of seconds sound is heard by bone conduction versus air conduction; air conducted sound should be heard twice as long as bone conducted sound (e.g., if bone-conducted sound is heard for 15 seconds, air-conducted sound should be heard for 30 seconds).
and ossicles
) to amplify and direct the sound 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.
Note that the words positive and negative are used in a somewhat confusing fashion here, other than their normal use in medical test
s. Positive or negative means that a certain parameter that was evaluated was present or not. In this case, that parameter is if air conduction (AC) is better than bone conduction (BC). Thus, a "positive" result indicates the healthy state, in contrast to many other medical tests. Therefore, if presenting your findings to a physician, to avoid confusing yourself, it may be wise to avoid using the term 'positive' or 'negative', and simply state if the test was normal or abnormal e.g. 'Rinnes test was abnormal in the right ear, with bone conduction greater than air conduction'.
, are quick screening tests and are no replacement for formal audiometry
. Recently, its value as a screening test has been questioned.
Thus, if the normal ear is not masked, bone conduction could be reported as louder by the patient, even if both ears are normal.
Hearing test
A hearing test provides an evaluation of the sensitivity of a person's sense of hearing and is most often performed by an audiologist using an audiometer. An audiometer is used to determine a person's hearing sensitivity at different frequencies. There are other hearing tests as well, e.g...
. It compares perception of sound
Sound
Sound is a mechanical wave that is an oscillation of pressure transmitted through a solid, liquid, or gas, composed of frequencies within the range of hearing and of a level sufficiently strong to be heard, or the sensation stimulated in organs of hearing by such vibrations.-Propagation of...
s transmitted by air conduction to those transmitted by bone conduction
Bone conduction
Bone conduction is the conduction of sound to the inner ear through the bones of the skull.Bone conduction is the reason why a person's voice sounds different to him/her when it is recorded and played back. Because the skull conducts lower frequencies better than air, people perceive their own...
through the mastoid. Thus, one can quickly screen for the presence of conductive hearing loss
Conductive hearing loss
Conductive hearing loss occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane , or middle ear ....
.
A Rinne test should always be accompanied by a Weber test
Weber test
The Weber test is a quick screening test for hearing. It can detect unilateral conductive hearing loss and unilateral sensorineural hearing loss...
to also detect sensorineural hearing loss
Sensorineural hearing loss
Sensorineural hearing loss is a type of hearing loss in which the root cause lies in the vestibulocochlear nerve , the inner ear, or central processing centers of the brain....
and thus confirm the nature of hearing loss.
The Rinne test was named after German otologist Heinrich Adolf Rinne
Heinrich Adolf Rinne
Heinrich Adolf Rinne was a German otologist born in Vlotho an der Weser. He received his doctorate from the University of Göttingen and practiced medicine in the city of Göttingen...
(1819-1868); the Weber test
Weber test
The Weber test is a quick screening test for hearing. It can detect unilateral conductive hearing loss and unilateral sensorineural hearing loss...
was named after Ernst Heinrich Weber
Ernst Heinrich Weber
Ernst Heinrich Weber was a German physician who is considered one of the founders of experimental psychology.Weber studied medicine at Wittenberg University...
(1795 – 1878).
Procedure
The Rinne test is performed by placing a vibrating tuning forkTuning fork
A tuning fork is an acoustic resonator in the form of a two-pronged fork with the prongs formed from a U-shaped bar of elastic metal . It resonates at a specific constant pitch when set vibrating by striking it against a surface or with an object, and emits a pure musical tone after waiting a...
(512 or 256 Hz) against the patient's mastoid bone and ask the patient to tell you when the sound is no longer heard. Time this interval of bone conduction with a watch, noting the number of seconds. Quickly position the still vibrating tines 1-2 cm from the auditory canal, and again ask the patient to tell you when the sound is no longer heard. Continue timing the interval of sound due to air conduction heard by the patient. Compare the number of seconds sound is heard by bone conduction versus air conduction; air conducted sound should be heard twice as long as bone conducted sound (e.g., if bone-conducted sound is heard for 15 seconds, air-conducted sound should be heard for 30 seconds).
Air vs. Bone Conductive Hearing Loss
Air conduction uses the apparatus of the ear (pinna, eardrumEardrum
The eardrum, or tympanic membrane, is a thin membrane that separates the external ear from the middle ear in humans and other tetrapods. Its function is to transmit sound from the air to the ossicles inside the middle ear. The malleus bone bridges the gap between the eardrum and the other ossicles...
and ossicles
Ossicles
The ossicles are the three smallest bones in the human body. They are contained within the middle ear space and serve to transmit sounds from the air to the fluid-filled labyrinth . The absence of the auditory ossicles would constitute a moderate-to-severe hearing loss...
) to amplify and direct the sound whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear
Inner ear
The inner ear is the innermost part of the vertebrate ear. In mammals, it consists of the bony labyrinth, a hollow cavity in the temporal bone of the skull with a system of passages comprising two main functional parts:...
albeit at a reduced volume, or via the bones of the skull to the opposite ear.
| Description | Relative | Positive/negative |
|---|---|---|
| In a normal ear Ear The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system.... , air conduction (AC) is better than bone conduction (BC) |
AC > BC | this is called a positive Rinne |
| In conductive hearing loss Conductive hearing loss Conductive hearing loss occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane , or middle ear .... , bone conduction is better than air |
AC < BC | negative Rinne |
| In sensorineural hearing loss Sensorineural hearing loss Sensorineural hearing loss is a type of hearing loss in which the root cause lies in the vestibulocochlear nerve , the inner ear, or central processing centers of the brain.... , bone conduction and air conduction are both equally depreciated, maintaining the relative difference of bone and air conductions |
AC > BC | positive Rinne |
| In sensorineural hearing loss patients there may be a false negative Rinne | AC < BC | negative Rinne |
Note that the words positive and negative are used in a somewhat confusing fashion here, other than their normal use in medical test
Medical test
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. For example:* to diagnose diseases, and preferably sub-classify it regarding, for example, severity and treatability...
s. Positive or negative means that a certain parameter that was evaluated was present or not. In this case, that parameter is if air conduction (AC) is better than bone conduction (BC). Thus, a "positive" result indicates the healthy state, in contrast to many other medical tests. Therefore, if presenting your findings to a physician, to avoid confusing yourself, it may be wise to avoid using the term 'positive' or 'negative', and simply state if the test was normal or abnormal e.g. 'Rinnes test was abnormal in the right ear, with bone conduction greater than air conduction'.
Hazards
This test and its complement, the Weber testWeber test
The Weber test is a quick screening test for hearing. It can detect unilateral conductive hearing loss and unilateral sensorineural hearing loss...
, are quick screening tests and are no replacement for formal audiometry
Audiometry
Audiometry is the testing of hearing ability, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or...
. Recently, its value as a screening test has been questioned.
Effect on Opposite Ear
The effect on the opposite ear, relative to the tuning fork, is reverse to the ear being tested. Here, conduction through the skull to the opposite side is more effective than conduction through room air around the head.Thus, if the normal ear is not masked, bone conduction could be reported as louder by the patient, even if both ears are normal.
External links
- Tuning Fork Tests - Family Practice Notebook. Retrieved February 3, 2007.