This activity highlights the role of the interprofessional team in the care of patients with hearing problems. This activity reviews the indications and techniques involved in performing the Rinne test and interpreting the results. This activity describes the technique of conducting the Rinne test and its clinical relevance. The Rinne test is used when conductive hearing loss is suspected and used in patients with otosclerosis to determine if a patient might benefit from stapes surgery. Both these tests are now routinely taught in medical schools and are performed regularly to evaluate patients with hearing problems. Over the years, many types of tuning forks tests had been developed to assess hearing loss, but today only two have withstood the test of time: Rinne and Weber. A Rinne test should be done in conjunction with a Weber test to detect sensorineural hearing loss. It can serve as a quick screen for conductive hearing loss. The Rinne test differentiates sound transmission via air conduction from sound transmission via bone conduction. Physical examination Rinne test Tuning fork.Need Help? If you have a system or content concerns, please contact Activity Description Placement of the tuning fork tines in parallel as opposed to perpendicular to the EAC results in a higher sound amplitude at the level of the tympanic membrane. 02) for the two harmonic frequencies (500 and 4 kHz) respectively.Ĭlinicians vary in their orientation of the tuning fork tines in relation to the EAC when performing the Rinne test. The 256 Hz tuning fork in parallel with the EAC as opposed to perpendicular to was louder by 0.83 dB (95% CI: -0.26, 1.93 dB p = 0.14) for the fundamental frequency (256 Hz), and by 4.28 dB (95% CI: 2.65, 5.90 dB p < 0.001) and 1.93 dB (95% CI: 0.26, 3.61 dB p =. 001) for the two harmonic (non-fundamental) frequencies (1 and 3.15 kHz), respectively. The sound intensity (sound-pressure level) recorded at the tympanic membrane with the 512 Hz tuning fork tines in parallel with as opposed to perpendicular to the EAC was louder by 2.5 dB (95% CI: 1.35, 3.65 dB p < 0.0001) for the fundamental frequency (512 Hz), and by 4.94 dB (95% CI: 3.10, 6.78 dB p < 0.0001) and 3.70 dB (95% CI: 1.62, 5.78 dB p =. ![]() The amplitudes of the sound delivered to the tympanic membrane with the activated tuning fork tines held in parallel, and perpendicular to, the longitudinal axis of the EAC were measured using a Knowles Electronics Mannequin for Acoustic Research (KEMAR) with the microphone of a sound level meter inserted in the pinna insert.Ĥ7.4 and 44.8% of 116 survey responders reported placing the fork parallel and perpendicular to the EAC respectively. To assess the variability in performing the Rinne test, the Canadian Society of Otolaryngology - Head and Neck Surgery members were surveyed. ![]() The present study had two goals: determine if (1) there is clinician variability in tuning fork placement when presenting the air-conduction stimulus during the Rinne test (2) the orientation of the tuning fork tines, parallel versus perpendicular to the EAC, affects the sound amplitude at the ear. Whether the orientation of the tuning fork tines affects the amplitude of the sound signal at the ear in clinical practice has not been previously reported. Guidelines and text-book descriptions of the Rinne test advise orienting the tuning fork tines in parallel with the longitudinal axis of the external auditory canal (EAC), presumably to maximise the amplitude of the air conducted sound signal at the ear.
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