This test is very sensitive in identifying unilateral deafness. In normal ear and in bilateral equally deaf ears the sound will be heard in the mid line. The patient should be instructed to indicate which ear hears the sound better. This test is name after Ernst Heinrich Weber (1795 – 1878).Ī vibrating fork is placed over the forehead / vertex / chin of the patient. This can easily detect unilateral conductive and unilateral sensorineural hearing loss. Is a tuning fork test (quick) used to assess hearing levels in an individual. If Rinne is negative for 256, 5 Hz then conductive deafness should be greater than 40dB. Use of Rinne test in quantifying conductive deafness:Ĭonductive deafness of more than 25 dB is indicated by negative Rinne with 512 Hz fork, while it is positive for 1024 Hz. If the patient is suffering from profound unilateral deafness then the sound will still be heard through the opposite ear this condition leads to a false positive Rinne. In case of conductive deafness the patient will not be able to hear the fork as soon as it is transferred to the front of the ear (Bone conduction is better than air conduction). (Air conduction is better than bone conduction). This result is known as Positive Rinne test. In patients with normal hearing he should be able to hear the fork as soon as it is transferred to the front of the ear. As soon as the patient signals that he is unable to hear the fork anymore the vibrating fork is transferred immediately just close to the external auditory canal and is held in such a way that the vibratory prongs vibrate parallel to the acoustic axis. The patient is advised to signal when he stops hearing the sound. As soon as the fork starts to vibrate it is placed at the mastoid process of the patient. It should not be struck against metallic object because it can cause overtones. This is the maximum vibratory area of the tuning fork. While striking care must be taken that the strike is made at the junction of the upper 1/3 and lower 2/3 of the fork. It should be struck against the elbow or knee of the patient to vibrate. Under normal circumstances, air conduction is better than bone conduction. It is designed to compare air conduction with bone conduction thresholds. Rinne's test: is a tuning fork test used to clinically test hearing deficiencies in patients. The following tests can be performed using a tuning fork: Will give a rough estimate of the patient’s hearing acuity The vibrating fork should be held parallel to the acoustic axis of the ear being tested.ģ. It is this area of the fork which is capable of maximum vibration. The fork should be struck at the junction of upper 1/3 and lower 2/3 of the fork. The tuning fork must be struck against a firm surface (rubber pad / elbow of the examiner). It should be capable of maintaining the vibration for one full minute It should vibrate at the specified frequencyģ. Sensitivity for frequencies above 1024 Hz is rather poor and hence is not used.Ģ. Frequencies below 254 Hz are better felt than heard and hence are not used. This test can in fact be performed by using tuning forks of the following frequencies (254 Hz, 512 Hz, and 1024 Hz). For complicated cases the bone scan is the gold standard for diagnosis.These tests are performed in order to subjectively assess a person’s hearing acuity. Management should be initiated in patients who have history of stress related below-knee pain and positive tuning fork test without waiting for bone scintigraphy. Tuning fork test is a simple and easy approach of diagnosing stress fractures which can be performed even by athletics and military trainers. Positive and negative predictive values were 88% and 46% respectively. Sensitivity of TFT was found to be 79% and specificity of 63%. Each case was scanned using triple phase bone scintigraphy.įifty-five patients had a total of 67 stress fractures, out of which 53 were picked up by TFT. After history and clinical examination tuning fork test (TFT) was performed on each case by placing 128 Hertz vibrating tuning fork on the site of pain (underlying bony surface) of tibia or fibula. X-rays of all the subjects were unremarkable. The current study examined 55 subjects whose age ranged 18-28 years. The purpose of the study was to evaluate the efficacy of tuning fork in stress fractures by comparing it with three phase bone scan. Stress fractures are quite common both in athletes and military recruits.
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