What does a normal Rinne test finding indicate in terms of air conduction versus bone conduction in a patient?

Normal Rinne Test Findings

A normal Rinne test is positive, meaning air conduction is greater than bone conduction (AC > BC), which should be present in both ears of individuals with normal hearing or sensorineural hearing loss. 1

How to Perform the Rinne Test

• Strike a 256 or 512 Hz tuning fork on a covered elbow or knee to activate it 1
• Place the vibrating tuning fork firmly over the mastoid bone (behind the ear) and ask the patient to indicate when they can no longer hear the sound 1
• Immediately move the tuning fork to the entrance of the ear canal (approximately 1-2 cm from the external auditory meatus) and ask if they can still hear it 1
• Ask the patient where the sound is louder: behind the ear (bone conduction) or in front of the ear (air conduction) 1

Interpretation of Normal Results

In normal hearing, air conduction is louder than bone conduction, producing a "positive" Rinne test result. 1 This occurs because:

• Sound transmitted through air via the external and middle ear mechanisms is more efficient than sound transmitted directly through bone to the cochlea 1
• The normal middle ear amplifies sound by approximately 25-30 dB, making air conduction superior to bone conduction 1

Expected Findings in Different Populations

• Normal hearing individuals: Positive Rinne test (AC > BC) bilaterally, present in 97% of ears with normal hearing 2
• Sensorineural hearing loss: Positive Rinne test (AC > BC) in both ears, because both air and bone conduction are equally reduced but maintain their normal relationship 1
• Children with normal hearing: Positive Rinne test in 97% of cases when using 256 Hz tuning fork 2

Clinical Significance of Normal Findings

A positive Rinne test indicates that the conductive pathway (external ear canal, tympanic membrane, and ossicular chain) is functioning normally. 1 This finding:

• Rules out significant conductive hearing loss (air-bone gap < 15-20 dB) 1
• Does not rule out sensorineural hearing loss, as both types of conduction are equally affected in that condition 1
• Should be interpreted alongside Weber test results for complete bedside assessment 1

Important Caveats

• The Rinne test has approximately 77-85% sensitivity and 85-94% specificity compared to formal audiometry 1
• An air-bone gap of at least 13-15 dB is required for the Rinne test to reliably convert from positive to negative 2, 3
• The test performs poorly in detecting mild conductive hearing loss with air-bone gaps of 5-15 dB 2
• Tuning fork tests do not replace formal audiometric testing—they provide preliminary screening information only and cannot quantify the degree of hearing loss 4, 1
• Remove impacted cerumen before testing, as it can cause false-negative results by creating artificial conductive hearing loss 1