If hearing loss is detected one should: Test for lateralization. Weber test:
Place the base of the vibrating tuning fork firmly in midline.
- On the top of head
- Between teeth
Patients with normal hearing will hear the sound in mid-line or equally on both sides.
Compare air and bone conduction. Rinne test:
- This requires a 512 tuning fork to perform test with best results.
- Place a vibrating tuning fork on the mastoid bone behind the ear in the grove firmly.
- Once the patient claims not to hear any sound quickly test whether he can hear the sound when placed close to ear canal.
- Normally the sound is heard longer through air than through bone conduction.
- Also, caution patient to listen to the sound and not the vibration.
Rene and Weber test help to distinguish between nerve deafness and conduction problems due to middle ear disease.
- Nerve deafness:
- On Weber's test sound lateralizes to good ear.
- Air conduction lasts longer than bone conduction (Aging, drugs, tumors).
- Conduction deafness:
- Weber test lateralizes to diseased ear.
- Bone conduction lasts longer than air conduction (Otitis media, otosclerosis).