The Weber Test

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In the Weber test, bone conduction is compared in both ears, and the examiner determines whether monaural impairment is neural or conductive in origin. Stand in front of the patient and place a vibrating 512-Hz tuning fork firmly against the center of the patient's forehead. Ask the patient to indicate whether he or she hears or feels the sound in the right ear, in the left ear, or in the middle of the forehead. Hearing the sound, or feeling the vibration, in the middle is the normal response. If the sound is not heard in the middle, the sound is said to be lateralized, and thus a hearing loss is present. Sound is lateralized to the affected side in conductive deafness. Try it on yourself. Occlude your right ear and place a vibrating tuning fork in the center of your forehead. Where do you hear it? On the right. You have created a conductive hearing loss on the right by blocking the right canal;the sound is lateralized to the right side. The Weber test is illustrated in Figure 11-13.

The explanation for the Weber test effect is based on the masking effect of background noise. In normal conditions, there is considerable background noise, which reaches the tympanic membrane by air conduction. This tends to mask the sound of the tuning fork heard by bone conduction. In an ear with a conductive hearing loss, the air conduction is decreased, and the masking effect is therefore diminished. Thus, the affected ear hears and feels the vibrating tuning fork better than does the normal ear.

In patients with unilateral sensorineural deafness, the sound is not heard on the affected side but is heard by, or localized to, the unaffected ear.

To test the reliability of the patient's responses, it is occasionally useful to strike the tuning fork against the palm of the hand and hold it briefly to silence it. The Rinne and Weber tests are then carried out as indicated, using the silent tuning fork. This serves as a good control.

In summary, consider the following two examples:

Rinne: Right ear: AC > BC (Rinne positive); left ear: AC > BC (Rinne positive) Weber: Lateralization to the left ear Diagnosis: Right sensorineural deafness

Weber Test

Figure 11-13 The Weber test. When a vibrating tuning fork is placed on the center of the forehead, the normal response is for the sound to be heard in the center, without lateralization to either side. A, In the presence of a conductive hearing loss, the sound is heard on the side of the conductive loss. B, In the presence of a sensorineural loss, the sound is heard better on the opposite (unaffected) side.

Figure 11-13 The Weber test. When a vibrating tuning fork is placed on the center of the forehead, the normal response is for the sound to be heard in the center, without lateralization to either side. A, In the presence of a conductive hearing loss, the sound is heard on the side of the conductive loss. B, In the presence of a sensorineural loss, the sound is heard better on the opposite (unaffected) side.

Example 2

Rinne: Right ear: AC > BC (Rinne positive); left ear: BC > AC (Rinne negative) Weber: Lateralization to the left ear Diagnosis: Left conductive deafness

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