The Rinne test (// RIN-ə) is a hearing test, primarily for evaluating loss of hearing in one ear (unilateral hearing loss). It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid. Thus, one can quickly screen for the presence of conductive hearing loss.
The Rinne test is performed by placing a high frequency (512 Hz) vibrating tuning fork against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Once they signal they can't hear it, quickly position the still vibrating tuning fork 1–2 cm from the auditory canal, and again ask the patient to tell you if they are able to hear the tuning fork.
Normal Hearing: Air conduction should be greater than bone conduction and so the patient should be able to hear the tuning fork next to the pinna (outer ear) after they can no longer hear it when held against the mastoid.
- If they are not able to hear the tuning fork after the mastoid test, it means that their bone conduction is greater than their air conduction. This indicates there is something inhibiting the passage of sound waves from the ear canal, through the middle ear apparatus and into the cochlea (i.e., there is a conductive hearing loss).
- In sensorineural hearing loss the ability to sense the tuning fork by both bone and air conduction is equally diminished, implying they will hear the tuning fork by air conduction after they can no longer hear it through bone conduction. This pattern is similar to what is found in people with normal hearing, but patients with sensorineural hearing loss will indicate that the sound has stopped much earlier. This can be revealed by the investigator (with normal hearing) placing the fork close to their own ear after the patient indicates that the sound has subsided, noting that the sound from the fork is still loud and clear to a normal ear.
The Rinne test is not reliable in distinguishing sensorineural and conductive loss cases of unilateral severe or total sensorineural loss. In such cases bone conduction to the contralateral normal ear will be better than air conduction resulting in a false negative. In such a case the Weber test will, however, show signs of lateralization, implying some kind of pathology. Formal audiometry testing would be required if any abnormal result is presented.
Air vs. bone conductive hearing loss
Air conduction uses the apparatus of the ear (pinna, eardrum and ossicles) to amplify and direct the sound whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear.
|In a normal ear, air conduction (AC) is better than bone conduction (BC)||AC > BC||this is called a positive Rinne|
Note that the words positive and negative are used in a somewhat confusing fashion here, as compared to their normal use in medical tests. Positive or negative in this case means that a certain parameter that was evaluated was present or not. In this case, that parameter is whether air conduction (AC) is better than bone conduction (BC). Thus, a "positive" result indicates the healthy state, in contrast to many other medical tests. Therefore, some prefer to avoid using the term 'positive' or 'negative', and simply state if the test was normal or abnormal e.g. 'Rinnes test was abnormal in the right ear, with bone conduction greater than air conduction'.
|AC > BC||lateralizes to left||no lateralization||lateralizes to right|
|left||right||left ear||right ear||both ears||left ear||right ear|
|⊕||⊕||Normal||Sensorineural loss||Normal||Sensorineural loss||Normal|
|⊖||⊕||Conductive loss||Normal||Combined loss||Normal|
|⊕||⊖||Normal||Combined loss||Normal||Conductive loss|
|⊖||⊖||Conductive loss||Combined loss||Conductive loss||Combined loss||Conductive loss|
|Combined loss = conductive and sensorineural loss|
Effect on opposite ear
The effect on the opposite ear, relative to the tuning fork, is reverse to the ear being tested. Here, conduction through the skull to the opposite side is more effective than conduction through room air around the head. Thus, if the normal ear is not masked, bone conduction could be reported as louder by the patient, even if both ears are normal.
- Thijs C, Leffers P (January 1989). "Sensitivity and specificity of Rinne tuning fork test". BMJ. 298 (6668): 255. doi:10.1136/bmj.298.6668.255. PMC 1835543. PMID 2493884.
- synd/2447 at Who Named It?
- F. H. A. Rinne. Beiträge zur Physiologie des menschlichen Ohres. Vierteljahrsschrift für die praktische Heilkunde, Prague, 1855, 45: 71-123.
- Bagai A, Thavendiranathan P, Detsky AS (January 2006). "Does this patient have hearing impairment?". JAMA. 295 (4): 416–28. doi:10.1001/jama.295.4.416. PMID 16434632.
- Tuning Fork Tests - Family Practice Notebook. Retrieved February 3, 2007.