Hearing tests
Principles of hearing
Air-conduction
Bone-conduction
Why do we test hearing
To detect one of major hearing impairment
Senzorineural (perception)
Conductive
Tuning fork test
Weber
Rinne
Bing
Schwabach
the tuning fork is first held with its acoustic axis
in line with the external auditory meatus
the sound being heard via the process of air
conduction.
If the tuning fork is pressed firmly against the
skull the note is transmitted directly to the
cochlea by the process of bone conduction.
Tuning fork tests
these allow one to distinguish (much more clearly)
between conductive and sensorineural deafness
Webers test
tuning fork is placed on the patient's forehead (or in
the middle line)
If the sound lateralizes (is louder on one side than
the other), the patient may have either an ipsilateral
conductive hearing loss or a contralateral
sensorineural hearing loss
WEBER TEST
Tests Lateralization
Place the base of the lightly vibrating tuning fork
firmly on top of the patients head or on the
midforehead.
Ask where the patient hears it: on one or both sides.
Normally the sound is heard in the midline or
equally in both ears.
If nothing is heard, try again, pressing the fork
more firmly on the head
WEBER TEST
Normal: midline
sensation
Conductive Hearing
Loss: will hear tone
on poorer ear
Sensorineural
Hearing Loss: will
hear tone on better ear
Rinnes test
comparison is made between bone and air
conduction
base of a tuning fork is placed to the mastoid area
(bone), and then after the sound is no longer
appreciated, the vibrating top is placed near the
external ear canal (air)
positive Rinne healthly or perceptive disease
negative conductive disease
Rinne test
Compare air conduction (AC) and bone conduction (BC)
Place the base of a lightly vibrating tuning fork on the
mastoid bone, behind the ear and level with the canal.
When the patient can no longer hear the sound, quickly
place the fork close to the ear canal and ascertain
whether the sound can be heard again.
Here the U of the fork should face forward,
thus maximizing its sound for the patient.
Normally the sound is heard longer through air
than through bone (AC > BC).
Rinne test result
Hearing status
Positive
Normal or sensorineural
impairment
Negative
AC>BC
AC<BC
Conductive hearing impairment
Bing test
fork is struck and placed on the patient's mastoid tip
examiner alternately occludes the patient's external
meatus
patient with normal hearing or a sensorineural loss,
he or she will notice a change in intensity with
occlusion
patient with conductive hearing loss, he or she will
notice no change
Bing test
An application of the occlusion effect, whereby
the tuning fork is heard louder as the normal
ear is occluded
is based on the principle that occlusion of the
external auditory meatus improves the
perception of bone-conducted sounds
Relies on the principle of masking
TF placed on mastoid process; tester
alternately open and closes patients ear canal
Performing the Bing test
The auditory meatus is alternately occluded and
left open as the vibrating tuning fork is held on the
mastoid
+ Bing = louder tone with ear canal occluded
- Bing = tone is NOT louder with ear canal
occluded
Bing
An increase and decrease in loudness will be perceived by
the normal ear POSITIVE BING
A similar result will occur with sensorineural hearing lossPOSITIVE BING
When the conductive mechanism is modified, as in otitis
media, the patient will not notice a louder toneNEGATIVE BING
Schwabachs test
compares the patient's bone conduction to that of
the examiner's
If the patient stops hearing before the examiner, this
suggests a sensorineural loss
If the patient hears it longer than the examiner, this
suggests a conductive loss
This test is contingent on the examiner having normal hearing..
Schwabach test
Compares patients bone conduction hearing
to that of a normal examiner
TF placed alternately on mastoid process of
patient and examiner. When patient no longer
hear the sound, examiner listens to see
whether he/she can still perceive the sound
Findings:
Normal Schwabach- when the patient and the
examiner have approximately equal bone conduction
Prolong/Increased Schwabach- when the
patients bone conduction is approximately longer
than the examiners as in instance of Conductive
hearing impairment
Diminish Schwabach- examiner can hear well
after the patient- Sensorineural hearing
impairment
Abnormal findings related to
Conduction hearing loss related to or evidenced by:
Impacted cerumen
Obstruction of external ear canal (presence of a foreign body)
Otitis externa (infection in ear canal)
Otitis media (poor eustachian tube function or infection)
Otitis media serous (fluid in middle ear due to allergies or a cold)
Otosclerosis
Bing test: No change in the loudness of the sound
Rinne test: Tone louder or detected for a longer time than the airconducted tone
Schwabach test: Prolonged duration of tone when compared to that
heard by the examiner
Weber test: Lateralization of tone to one ear, indicating loss of heari
ng on that side (i.e., tone is heard in the poorerear)
Sensorineural hearing loss evidenced by:
Congenital damage or malformations of the inner ear
Mnires disease
Ototoxic drugs
Presbycusis (gradual hearing loss experienced in advancing age)
Serious infections (meningitis, measles, mumps, other viral, syphilis)
Trauma to the inner ear (related to exposure to noise or trauma)
Tumor (e.g., acoustic neuroma, cerebellopontine angle tumor)
Vascular disorders
Bing test: Pulsating sound that gets louder and softer when the opening
to the ear canal is alternately opened andclosed
Rinne test: Tone heard louder by air conduction
Schwabach test: Shortened duration of tone when compared to that he
ard by the examiner
Weber test: Lateralization of tone to one ear indicating loss of hearing o
n the other side (i.e., tone is heard in the better ear)
END
