From the Guidelines
The Weber and Rinne tests are essential bedside tools for differentiating between conductive and sensorineural hearing loss, with the Weber test lateralizing to the affected ear in conductive hearing loss and the unaffected ear in sensorineural hearing loss, and the Rinne test demonstrating a negative result in conductive hearing loss and a positive result in sensorineural hearing loss, as outlined in the 2019 clinical practice guideline for sudden hearing loss 1. The indications for these tests include the initial assessment of patients presenting with sudden hearing loss, where they can aid in making a preliminary diagnosis prior to audiometry being available.
- The Weber test is performed by vibrating a tuning fork and placing it on the midline of the forehead or maxillary teeth, with the patient reporting where the sound is heard loudest.
- The Rinne test involves vibrating a tuning fork and placing it on the mastoid bone, then moving it to the entrance of the ear canal, with the patient comparing the loudness of the sound via bone and air conduction. The interpretation of these tests is as follows:
- In the Weber test, lateralization to one ear indicates conductive hearing loss in that ear, while lateralization to the opposite ear suggests sensorineural hearing loss in the test ear.
- In the Rinne test, a negative result (bone conduction louder than air conduction) indicates conductive hearing loss, while a positive result (air conduction louder than bone conduction) suggests sensorineural hearing loss. It is essential to note that while these tests provide valuable initial information, they do not replace formal audiometric testing, and their results should be interpreted in conjunction with other clinical findings, as emphasized in the 2019 guideline 1.
From the Research
Indications of the Weber Test and Rinne Test
- The Weber test and Rinne test are used to distinguish between conductive and sensorineural hearing loss 2
- These tests are important tools in the primary care setting for patients with hearing loss, allowing for the systematic institution of an individualized treatment plan 2
- The Rinne test is used to compare bone conduction and air conduction, with a positive result indicating normal hearing or sensorineural hearing loss, and a negative result indicating conductive hearing loss 3
- The Weber test is used to lateralize sound, with midline results indicating bilateral normal hearing or sensorineural hearing loss, and lateralization to the poorer ear indicating unilateral conductive hearing loss 3
Interpretations of the Weber Test and Rinne Test
- The Rinne test is positive in 97% of ears with normal hearing or sensorineural hearing loss, and negative in 72% of ears with conductive hearing loss 3
- The Weber test lateralizes to the poorer ear in 63% of ears with unilateral conductive hearing loss 3
- The combination of the Rinne, Weber, and absolute bone conduction tests can be reliable initial diagnostic tools, with an overall sensitivity of 76.86%, specificity of 85.48%, and validity of 78.54% 4
- The diagnostic accuracy of the Rinne test for detecting conductive hearing loss ranges from 43% to 91% sensitivity and 50% to 100% specificity, depending on the frequency of the tuning fork used 5
- The smartphone-based Rinne test has been validated for the detection of an air-bone gap ≥ 25 dB at 512 Hz, with a sensitivity of 85% and specificity of 90% 6