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Weber and Rinne Test – Clinical Examination

Weber and Rinne Test – Clinical Examination

Weber and Rinne Test - Clinical Examination
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Weber and Rinne Test is must if you have issues. There are 1000’s of people taking benefits from this video. In this video you will be able to see clinical examination of hearing loss.

Weber and Rinne Test – Clinical Examination

The clinical examination of hearing loss should include the distinction between conductive and sensorineural hearing loss. There are different causes of sensorineural hearing loss, such as inner ear disease or damage to the cochlear nerve. In all cases, the perception of sound waves through the air and bone conduction is affected. Therefore, sounds reaching the affected ear will be perceived to be quieter than on the unaffected side.

Conductive hearing loss, on the other hand, is caused by diseases of the middle ear, such as otosclerosis or otitis media. Blockage of the external ear canal, as seen in earwax impaction, for example, can also lead to conductive hearing loss. In this case, air conduction of sound waves from the middle ear to the inner ear is affected. However, bone conduction is not affected and makes sounds on the affected side appear louder.

There are two hypotheses that try to explain this phenomenon. First, impaired sound conduction is assumed to cause positive regulation of the inner ear, making it more sensitive to stimuli received through bone conduction. It also makes these sounds feel louder. Secondly, if sound waves cannot easily reach the inner ear, they probably cannot easily exit either. Therefore, these trapped sound waves could make patients perceive the sounds as louder.

The Rinne and Weber tests are quick and easy methods to differentiate simple forms of conductive and sensorineural hearing loss. More complex diseases, such as combined conductive and sensorineural hearing loss, often result in test results that are difficult to interpret.

Weber and Rinne Test Tuning Fork for USMLE

Weber and Rinne Test Tuning fork for conductive hearing loss and sensorineural hearing loss. Also discussing absolute bone conduction (ABC) and Schwabach test for hearing loss.

Conductive hearing loss includes the area from the external ear to the stapes. Sensorineural hearing loss includes the cochlea and the cranial nerve eight. Using weber and rine tuning fork test you can determine whether the problem is conduction hearing loss or sensorineural hearing loss.

Air conduction occurs when the sounds waves go through the external ear to the cochlea and the senorineural area. Therefore air conduction tests conduction and sensorineural hearing loss. Bone conduction the sound waves travel through the mastoid and bypasses the external ear and activates the cochlea directly.

Therefore bone conduction only tests sensorineural. RINNE TEST Place tuning fork on mastoid until patient can no longer hear. Then place tuning fork next to external auditory meatus and see if the patient can continue to hear. Normally air conduction is two times longer than bone conduction.

If bone conduction is greater than air conduction then it is called a negative Rinne Test and there is a conduction hearing loss. If air conduction is greater than bone conduction then it is a positive rinne test then the patient is either normal or there is sensorineural hearing loss.

If there is severe damage to cochlea than there can be a false positive. WEBER TEST Strike tuning fork on the midline of forehead. Normally the sound will travel to both cochlea equally and the sound will be heard equally (no lateralization). In sensorineural hearing loss the lateralization will go to the good ear. However, if there is conductive hearing loss the sound will lateralize to the bad ear.

Weber and Rinne Test Tuning Fork for USMLE Transcription

All right so today what we’re going to  cover is the can be related to the ear  specifically it’s going to be all the  tuning fork tests so today we’re only  going to look at the tuning fork test  which is a clinical test which allows  you to differentiate whether the patient  has a conductive hearing loss a sensory  neural hearing loss or even a mixed  hearing loss is sometimes possible.

So  let’s first talk about what is  conductive hearing loss and what is  sensory neural hearing loss so here we  have the ears of a patient and then here  is the head right now you have the for  the ear this is the outer ear right here  then you have your meat is here which is  the tract here the tympanic membrane  here are your ossicles that go like this  by the stay piece is a final one and  then this is going to go into the  cochlea and you have the vestibular  apparatus right there so this is just a  general look at it now.

Before I  continue I’m going to do this real quick  I want to make a quick copy of this I  don’t wanna have to keep drawing this so  okay so I’m just going to copy right now  and so I’ll keep using the same picture  over and over again so now what is  conductive hearing loss and what is  sensory neural and also I should add  theirs is the cranial nerve eight is  right over there coming off the copier  so conductive hearing loss is any  hearing loss which is going to be  between the stay PS and the outer ear so  this is going to be conductive and so  that includes the external ear.

 

which is  here this part is the external ear this  is a middle ear and this is the inner  here so that includes the external ear  and the middle ear and sensory neural  hearing loss is pretty much the cochlea  and the cranial nerve so this is just  the cochlea and the cranial nerve 8 and  so using these tests we can use the  tuning fork you can differentiate .

whether the problem is in this area or  in the central area or in the conductive  area so let’s begin let’s first talk  about the different types of conductors  so let me go ahead and just paste that  there so we have two types of conduction  the first type is called air conduction  and the second type is called bone  conduction so how do you get a – how do  you get to sense an air conduction well  the way to get an air conduction is you  take the tuning fork you you know tap it  against your knee or your elbow whatever  you prefer  and you put it right outside the ear so .

when you put it outside the ear the ways are going to travel through you know tympanic membrane and hit the tympanic membrane causing a vibration of the ossicles and then it’s going to get into the  finally given to the cochlea so the air conduction goes through the conduction zone the conduction area that we talked  about and the sensory neural area now .

how do we elicit a bone conduction well  with the bone conduction what you will  do is you’ll put it below the ear on the  mastoid now when you put of course verse  you you know tap it make sure vibrates  then you put it you know behind the ear  on mastoid and now what it will do is a  patient will hear but he won’t hear it  through the tympanic membrane you’ll  hear directly through the bone and it  will directly  activate the coffee yet so with bone  conduction you don’t you don’t go to the  conduction part all you’re getting is  the sensory neural part so bone  conduction is only testing sensory niro .

while air conduction is testing both now  the way I like to think about it it does  help me a little bit is I just think air  Kundera conduction only test conduction  and bone conduction only test sensory  neural now in normal conditions okay in  normal condition conditions your air  conduction your air conduction okay your  air conduction is about two times  greater than your bone conduction so  this is under normal conditions okay so  if you’re Eric and this makes sense  because obviously this is the you know .

This is the normal way that you  hear so normally you hear better through  the regular ear than through the bone  now what does it mean if we do this and  your bone conduction is greater than  your air conduction well that means  you’re able to hear better through your  bone then you can through your ear and  okay well first of all it says that  since your needle is fine because you  can hear because you’re able to hear  through the bone but if you’re hearing  it better than air conduction then that  means the problem is somewhere here so  if your bone conduction is greater than  your air conduction that means you have  a problem in the conduction of your of  the sound now if your air conduction is  greater than your bone conduction then  that means it’s either going to be  normal or you have a sensory neural  hearing loss because remember bone  conduction also requires sensor in your  activation so if that’s bad then you  know both bone conduction Eric  connection would be lower but bone  conductor still should be more lower  than the air conduction so pretty much  the you know there’s two options that  you can have I mean to really make this  simple there’s two options you can have  either air conduction could be better or  bone conduction could be better if air  conduction could be better we call this  I’m just going to raise this because I  wrote there  we call this a positive  Rinne test so if  air conduction is better we call it a  positive  Rinne test and if bone  conduction is better we call it a  negative  Rinne test okay now so if the   Rinne test is negative then that means  you diagnose a conduction problem but if  it’s positive either the patient is  normal or there’s a sensory neural issue  now just general how do you do the  Rinne  test I should I should go over that  first in the  Rinne test first you test  for bone conduction so you put the  tuning fork behind the mastoid and then  you continue to continue to let it ring  until he can’t hear it then you move the  fork to the outer ear and you ask the  patient if you can still hear if you can  still hear then that means it’s positive   Rinne tests those either normal or  sensory neural tissue but if you cannot  hear it then that means the bone  conduction was better and so then that’s  a negative  Rinne test and that means he  has a conduction issue now so that’s  kind of a overview I should have kind of  touched it before of the  Rinne test now  there is another tuning fork test which  is then immediately after  Rinne which is  called the Weber test  now how does the Weber test Oh real  quick sorry we’ll talk about one other  thing if you have severe damage if you  have severe damage to your copy that  this is severe then you could get a  false negative you know  bone conduction grades and air  conduction so that’s only if it’s a very  severe sensory neural damage otherwise  it’s pretty safe to go so now we can  move on to the Weber test so let me just  get a quick print down here so again we  have the head here you have the outer  ear middle ear and the inner ear  now in this Weber’s test what you do is  you take the tuning fork you strike it  make sure it’s vibrating and you put it  on the top of the head now if the  patient is normal then what will happen  is the vibration will go to both ears  actually sorry won’t go to the ear it  will go straight I should raise that it  will go straight to this uh coffee yet  and I’ll just draw something real quick  and it’ll go because remember we’re not  putting it at the ear so the Weber test  is skipping the conduction zone and  going straight to the sensory neural  aspect of the test so in a normal  situation there will be both ears would  be equal both ears will hear it equally  in other words there’ll be no  lateralization now let’s think about it  if you have a sensory neural problem  okay and let’s say for this example you  have a central issue in the let’s say  that’s the right here so you eat your  your sensory neural capacity is blocked  what’s going to happen then will you  hear it on the right hand so this is a  right this is a lab  will you here on the right side no  you’re only going to hear it on the left  side so in this test if there’s a  central issue it’s going to lateral eyes  to the good ear so not the illness  patients complaining up but the opposite  if whatever whichever one that may be  and in this scenario it’s the left ear  now what if you have a conductive loss  if you have a conductive hearing loss so  you know the entire apparatus here so it  goes like that so let’s just say that  you have a problem here well this is  what’s going to happen your your sensory  needle is working fine right so you will  still come down the signal will still  come down and it will reach here but  you’ll hear it better on this side  because you don’t have noise coming from  this side clouding the you know it’s not  competing with any information whereas  this one it is competing with the  information coming from the outside air  and on top so in conducting hearing loss  it’ll actually lateral eyes to the bad  ear and so this is a good way to  differentiate that as well now after  this there’s another test that occurs  this is called the absolute bone  conduction it’s written short ABC so  absolute bone conduction in this test  you do the bone conduction and you’re  comparing it who you’re comparing it to  where you’re comparing the patients in  our patients bone conduction with the  examiners bone conduction but there’s  one little caveat here which which is  which is important how making it read  here the tragus which is that little tag  this comes off of your ear must be a  clue  so the ear must be occluded in other  words you need to rule out any air  conduction so you got to come over here  you got to block the ear so that the  patient can’t hear and what you do is  you will do the bone conduction of the  patient ask them when he can stop  hearing it and then you put it on to  yourself if you’re the examiner and you  will see if you can continue hearing it  now if if there is conductive hearing  loss then you both it will be the same  duration so and obviously if it’s normal  right you guys should be both normal so  there’s normal and conductive hearing  loss in the same duration but let’s say  you take it away from the patient you  put it two years and you can still  continue to hear it then that is a  sensory neural hearing loss so in a  sensory neural hearing loss it is a  shorter duration so you would actually  continue to hear it and therefore the  patient’s ability to hear that is  shorter so that is the ABT test now this  slight variation very slight is going to  be the schwa back test schwa back test  you do the same thing with one slight  difference the ear is not occluded now  in this one if if it’s the same duration  so if it’s normal there will be the same  duration now if it’s sensory neural  hearing loss then it will be sure just  like the previous one so there’ll be a  shorter duration so the patient will not  be hearing as long as you will but if  there’s conductive hearing loss then  it’s actually longer the patient will be  hearing it longer than you and so in  this case maybe you want to introduce  off first and ask the patient if you can  continue to hear so let’s do a recap on  all the different tests cuz we kinda  to a few things here so we have the   Rinne test we have the Weber test we had  the absolute bone conduction and the  floor back okay so now let’s go through  the normal findings the conductive  hearing loss and what you can expect to  find in sensory neural hearing loss so  in the normal findings for  Rinne and on  like haven’t advanced so in the normal  findings for  Rinne test the absolute the  at the air conduction is going to be  greater than bone conduction and  remember the same thing is for since  you’re nearing loss so for both of them  the air conduction is greater and we  call this a positive  Rinne both of these  would be a positive  Rinne but in the  conductive hearing loss the bone  conduction is greater than air  conduction and this is a negative  Rinne  and if you remember I said that number  air conduction is for the conduction  heat conductive hearing loss and bone  conduction is for the sensory neural  hearing loss or in this case normal as  well now let’s talk about lever now in  the normal case there will be no  lateralization so both ears will hear it  equally in conductive hearing loss it’s  going to lateral eyes to the bad ear  because remember the bad ear the sensory  neural still works and the Weber only  test for the sensory neural but in  sensory neural hearing loss it’s  obviously the bad ear is not going to  work so it’s going to lateral eyes to  the group ear now in absolute bone  conduction whether you have normal or  conductive hearing loss it’s you’re  going to have equal you and the patient  will both hear it at the same time but  in sensory neural hearing loss it’s  going to be the patient will hear at a  much shorter duration and that’s the  same for absolute bone conduction and  schwa Beck’s test members well Beck’s is  when you don’t include the ear and the  absolute bone conduction is when you  to occlude to here and so even with  drawbacks you get equal the only  difference is with a conductive hearing  loss it’ll actually be lengthened so  that’s a quick review of the different  tuning fork tests when you’re when  you’re looking for distinguishing  conductive hearing loss and sensory  neural hearing loss

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