Weber's and Rinne's Tests

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Could someone please help me understand these two tests? i'm confused.

Let say, a pt come in with hearing difficulty, and you are trying to figure out whether the pt has conductive hearing loss or sensorineural hearing loss.

thanks.

 

[swtiepie711]

Could someone please help me understand these two tests? i'm confused.

Let say, a pt come in with hearing difficulty, and you are trying to figure out whether the pt has conductive hearing loss or sensorineural hearing loss.

thanks.

Ok Pt#1 w/ conductive hearing loss comes in "Doc, I'm not hearing well out of my right ear."

We bang a tuning fork & stick it on the patients head (Weber). The patient will receive both sounds via the air (testing conduction) and through their skull (testing sensorineural). If they have a conduction defect, then ambient noise will seem less so the sound being transmitted through the skull to the ossciles/etc will seem relatively louder. Therefore, this patient will day, "Doc, I hear that better in my right ear!"

Now we bang the fork & stick it on their mastoid process. They will hear noise (both conducted through air & through the bone). In the normal person, AC > BC (+Rinne) so when they stop hearing it on the mastoid process, you can move the fork to their ear and they will still hear a faint noise. But in our patient, he will hear it on the mastoid process, but won't hear it when moved to his ear (-Rinne). We have now identified that the patient has a conductive hearing loss on the right.

Patien #2: "Doc, I can't hear out of my right ear!" (sensorineural hearing loss).

Weber: stick on top of head - now, no matter what the pt can't hear it on the affected (right) side so she will day "doc, it's louder in my left ear."

So you do the Rinne test on the left and low & behold, AC>BC (normal, +Rinne). Now you do the Rinne on the right and AC>BC too. Now you know that it's sensorineural (b/c AC>BC, +Rinne) and b/c of the way that Weber lateralized, you know the patient has a right sided sensorineural loss.


In summary:
Normally: Weber doesn't lateralize, and both ears have +Rinne (AC>BC).
Conductive loss: Weber localizes to AFFECTED ear, -Rinne in affected ear
Sensorineural loss: Weber localizes to UNAFFECTED ear, +Rinne in both ears

Another way:
Weber lateralizes left: your patient has a conductive hearing loss in the Left ear or a sensorineural hearing loss in the right ear.
Weber lateralizes right: your patient has a conductive hearing loss in the right ear or a sensorineural hearing loss in the left ear.

I'm sure things get way more complicated (combined hearing losses, etc) but I can't imagine we'd be expected to know that right now for step 1?

 

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swtiepie711, thank you.
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[PistolPete]

Thanks for that great summary. I think I finally get it.

 

[scube]

you can recreate conductive hearing loss in yourself so that the webber test is better understood to you. Get your tuning fork going, stick a finger in one of your ears and put tuning fork on your head. Its how i finally got it.

 

[DrUKDO]

Check out this link for more info and for a mnemonic to help you remember: http://www.internalizemedicine.com/2011/12/deciphering-the-weber-and-rinne-tuning-fork-tests.html

 

[ChessMaster3000]

My question is, I understand why you need the Rinne with the Weber, but if you were to do a Rinne alone and find that BC>AC in a particular ear, can't you immediately diagnose conductve loss in that ear? Why do you need the weber for that?