**Rinne's** - place 512 hz tuning fork against pts mastoid bone and ask them to say when sound no longer heard. after they cannot hear it, place still-vibrating tuning fork 1-2 cm from audiory canal, then ask pt to indicate when they are no longer able to hear it - interpretation - *normal and sensorineural hearing loss*: will hear tuning fork by air conduction after they no longer hear it through bone conduction - *conductive* hearing loss: hear better through bone conduction **Webber's** - place vibrating tuning fork in middle of forehead or on top of head, ask pt which side is louder - interpretation: - *normal* - sound equally in both sides - *conductive hearing loss* - sound is better in the DEFECTIVE ear - *sensorineural hearing loss* - sound is better in the NORMAL ear | | Rinne's test | Weber's test | | ------------------ | -------------------------------- | ----------------- | | Normal | air conduction > bone conduction | heard in midline | | conductive loss | bone conduction > air conduction | heard in bad ear | | sensorineural loss | air conduction > bone conduction | heard in good ear | | | conductive hearing loss | sensorineural hearing loss | | --------------------- | ------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Definition | external or middle ear pathology affects conduction of sound into the inner ear | inner ear, cochlear, or auditory nerve pathology impairs neuronal transmission to brain | | associated conditions | - otitis externa<br>- otitis media<br>- foreing body<br>- tympanic membrane perf | - congenital<br>- presbycusis (age-related)<br>- noise-induced<br>- acoustic neuroma<br>- ototoxic drugs<br>- infection<br>- autoimmune | | clinical features | - non-distorted sound<br>- features of external ear path<br>- volume of voice normal<br>- hearing improves in noisy enviornment | - distorted sound +/- tinnitus<br>- no features of external ear pathology<br>- vol of voice is loud, hearing worsens in in nosy environments and high frequencies lost first |