Hearing tests

Question 1

Which tests do we use?

Answer 1

1) Whispered voice test
2) Rinne’s test
3) Weber’s test

Question 2

What does the whispered voice test consist of?

Answer 2

Ask the patient if they have noticed any change in their hearing recently.

Explain that you’re going to say 3 words or 3 numbers and you’d like them to repeat them back to you (choose two-syllable words or bi-digit numbers).

1. Approximately 60cm from the ear, whisper a number or word.
2. Mask the ear not being tested by rubbing the tragus.
3. Ask the patient to repeat the number or word back to you. If they get 2/3 correct then their hearing level is 12db or better. If there is no response use a conversational voice (48db or worse) or loud voice (76db or worse).
4. If there is no response you can move closer and repeat the test at 15cm. Here the thresholds are 34db for a whisper and 56db for a conversational voice.
5. Assess the other ear in the same way.

Question 3

Which tuning fork is used for hearing tests?

Answer 3

512 Hz

Question 4

Weber’s test?

Answer 4

Explain to the patient that you are going to test their hearing using a tuning fork.

1. Tap a 512Hz tuning fork and place in the midline of the forehead.
2. Ask the patient “Can you hear the sound? If yes, is it more on one side than the over?”

Normal – sound is heard equally in both ears

Sensorineural deafness – sound is heard louder on the side of the intact ear

Conductive deafness – sound is heard louder on the side of the affected ear

Question 5

If someone presents with hearing loss in there left ear and when Weber’s test is performed they localise to the left ear what does this indicate?

Answer 5

Conductive deafness in the left ear

Examples = Otitis media; otitis externa; perforated eardrum; impacted earwax (cerumen); presence of a foreign object; abscence of the outer ear, ear canal or middle ear.

Question 6

If someone presents with hearing loss in there left ear and when Weber’s test is performed they localise to the right ear what does this indicate?

Answer 6

Sensineural deafness in the left ear

Examples = Noise induced hearing loss; Ageing (Presbycusis); Viral Infections (meningitis etc); Trauma; Tumours (Acoustic neuroma, cholesteatoma), Ototoxic drugs

Question 7

Rinne’s Test?

Answer 7

1. Place a vibrating 512 Hz tuning fork firmly on the mastoid process. This tests bone conduction.
2. Confirm the patient can hear the sound of the tuning fork and then ask them to tell you when they can no longer hear it.
3. When the patient can no longer hear the sound, move the tuning fork in front of the external auditory meatus to test air conduction.
4. Ask the patient if they can now hear the sound again. If they can hear the sound, it suggests air conduction is better than bone conduction, which is what would be expected in a healthy individual (this is often confusingly referred to as a “Rinne’s positive” result).

Summary of Rinne’s test results:

Normal result: Air conduction > Bone conduction (Rinne’s positive)

Sensorineural deafness: Air conduction > Bone conduction (Rinne’s positive) – both air and bone conduction reduced equally

Conductive deafness: Bone conduction > Air conduction (Rinne’s negative)

Question 8

Result for Rinne’s test in senorineural deafness?

Answer 8

Sensorineural deafness: Air conduction > Bone conduction (Rinne’s positive) – both air and bone conduction reduced equally

Question 9

Result for Rinne’s test in conductive deafness?

Answer 9

Conductive deafness: Bone conduction > Air conduction (Rinne’s negative)

Question 10

Result for Rinne’s test in normal population?

Answer 10

Normal result: Air conduction > Bone conduction (Rinne’s positive). Without hearing loss.

Question 11

Result for Weber’s test in senorineural deafness?

Answer 11

Sensorineural deafness – sound is heard louder on the side of the intact ear

Question 12

Result for Weber’s test in conductive deafness?

Answer 12

Conductive deafness – sound is heard louder on the side of the affected ear

Question 13

Result for Weber’s test in normal population?

Answer 13

Patient can hear but it is equal either side

Question 14

When performing a Rinne’s Test if there is hearing loss in the left ear and air conduction>bone conduction what does this indicate?

Answer 14

Sensorineural hearing loss of the left ear

Question 15

When performing a Rinne’s Test if there is hearing loss in the left ear and bone conduction>air conduction what does this indicate?

Answer 15

Conductive hearing loss of the left ear