In the Rinne test, air conduction is compared with bone conduction. Each ear is tested separately. Strike a 512-Hz tuning fork and place its handle on the mastoid tip near the external auditory meatus. Ask the patient whether he or she hears the sound and to indicate when he or she no longer hears it. When the patient can no longer hear the sound, place the tines of the vibrating tuning fork in front of the external auditory meatus of the same ear, and ask the patient whether he or she can still hear the sound. The tines of the vibrating tuning fork should not touch any hair because the patient may have a hearing impairment but still feel the vibration. The Rinne test is demonstrated in Figure 11-12.
Normally, air conduction (AC) is better than bone conduction (BC), and patients are able to hear the tuning fork at the external auditory meatus after they can no longer hear it on the mastoid tip;this is a Rinne positive test result (AC > BC). In patients with a conductive hearing loss, however, bone conduction is better than air conduction: a Rinne negative test result (BC > AC). Patients with sensorineural deafness have impaired air and bone conduction but maintain the normal response (AC > BC). The middle ear amplifies the sound in both positions.
*Different examiners prefer tuning forks of different frequencies for determining auditory acuity. A tuning fork of too high a frequency yields a tone that fades too quickly.
If there is total deafness in one ear, the patient may hear the tuning fork even when it is placed on the mastoid process of the deaf ear. This results from the transmission of vibrations by bone across the skull to the opposite side, where they are sensed by the healthy ear. This is termed a false-negative Rinne test result.
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