Tuning Fork Test

TUNING FORK TESTS
USE: Qualitative
assessment of hearing by
performing Rinne test,
Weber test and Absolute
Bone Conduction test.
Gardiner
Brown
Tuning Fork
TUNING FORK TESTS
Tuning fork test can distinguish

between conductive and sensorineural
hearing loss.
The tests are carried out by vibrating of
tuning forks of varying frequency 256,
512, 1024 etc.
The most useful fork is 512 cps
TUNING FORK TESTS
In air conduction the sound waves are

transmitted through external auditory canal,
tympanic membrane, middle ear and
ossicles to the inner ear.
Thus, by the air conduction test, the

function of both the conductive mechanism
and cochlea are tested.
TUNING FORK TESTS
In bone conduction, sound waves

are transmitted through the skull
bones and directly stimulated the
inner ear.
So, bone conduction is a measure
of cochlear function only.
RINNE TEST
Principle:
Comparison of air conduction with

bone conduction of same ear of
same individual.
RINNE TEST
How to perform:
A vibrating tuning fork is placed on the

patient’s mastoid and when he stops
hearing, it is brought beside the
meatus. If he still hears, AC is more
than BC.
RINNE TEST
INTERPRETATION:
1. Rinne’s positive: Air conduction is better
than bone conduction. In normal hearing
person.
2. Reduced/low Rinne’s positive: Air
conduction is still better than bone
conduction but short duration or short
volume. In patient with partial
sensoryneural hearing loss.
RINNE TEST
INTERPRETATION:
3. Rinne’s negative: Bone conduction is

better than air conduction in conductive
deafness.
4. False Rinne’s negative: In patient with
severe unilateral sensorineural hearing loss.
This is confirmed by masking the non-test
ear and Weber test.
WEBER TEST
Principle:
Comparison of bone conduction

between two ears of same
individual.
WEBER TEST
How to perform:
In this test, a vibrating tuning fork is

placed in the middle of the forehead
and the patient is asked in which ear
the sound is heard.
WEBER TEST
INTERPRETATION:
1. In conductive deafness Weber lateralized

to same ear.
2. In sensorineural deafness Weber

lateralized to opposite ear.
ABSOLUTE BONE CONDUCTION TEST
Principle:
Comparison of bone conduction

between the patient and the examiner,
assumed that examiner’s hearing is
normal
How to perform:
The vibrating tuning fork is held on the
mastoid of the patient, closing the external
auditory canal firmly with the tragus, the
patient is asked to signal when he no longer
hear the sound.
The fork is then transferred by the examiner
to his won mastoid closing the external
meatus.
Interpretation:
If the examiner still hears the sound, then

patient is said to be reduced/ shortened. This
is found in sensoryneural deafness.
If the examiner also does not hear the sound
then the result is normal. This is found in
normal hearing person or with conductive
deafness.
PURE TONE AUDIOMETRY
Pure tone audiometer is an electronic device

which produce pure tone in desired
frequency and intensity.
Usually air conduction thresholds are
measured for tones of 125, 250, 500, 1000,
2000, 4000 and 8000 Hz and bone
conduction thresholds for 250, 500, 1000,
2000 and 4000Hz.
Using head phone and bone vibrator, each

ear is tested individually for air conduction
and bone conduction thresholds.
The results are plotted as a graph called
audiogram.
PTA will give a graphical

representation of different hearing loss.
Both quantity and quality can be
studied.
Normal hearing threshold is 0 dB
(range -10 to 25 dB)
WHO classification of degree of hearing loss
Normal hearing (0-25dB)

Mild hearing loss (26-40 dB)
Moderate hearing loss (41-55 dB)
Moderate-severe hearing loss (56-70 dB)
Severe hearing loss (71-90 dB)
Profound hearing loss (>90 dB)
Audiogram
Interpretation:
Normal hearing: Both air conduction

and bone conduction threshold are
within 25 dB.
Normal
hearing
person
Conductive deafness:
Bone conduction threshold within 25

dB.
Increased air conduction threshold.
Air-Bone gap present (10 dB or more)
Sensorineural hearing loss:
Both air conduction and bone

conduction threshold are raised.
No air-bone gap.
Sensori-
neural
hearing
loss
Moderate
sensorineural
hearing loss
Mixed hearing loss:
Both air conduction and bone

conduction threshold are raised.
Air-bone gap is present.
TYMPANOMETRY
It is an objective test, widely

used in clinical practice for
diagnosis of middle ear
diseases.
A tympanogram is a graphic
presentation of the relationship
between the air pressure in the
external auditory canal and the
movement of the tympanic
membrane.
Tympanometry measure the air
pressure in the middle ear and
compliance of the ear drum.
The compliance will be greatest when

the air pressure in the meatus is equal
to the air pressure in the middle ear.
TYMPANOMETRY
It is based on simple principle:
When a sound strikes tympanic membrane,

some of the sound energy is absorbed while
the rest is reflected. A stiffer/stretched
tympanic membrane would reflect more of
sound energy than a compliant one.
TYMPANOMETRY
How to perform:
A probe is inserted in external auditory canal
which seal the canal. Probe has three channels-
A) Oscillator to produce a tone of 220 Hz.

B) Microphone to pick up the reflected sound.
C) Air pump to increase or decrease air pressure in
the external auditory canal.
Ear probe has
three channels
TYMPANOMETRY
By varying the pressure in the external ear

canal, the compliance of ear drum may be
calculated by the degree of sound reflected back.
Normal middle ear pressure: -100 to +50 mm

H2O (daPa). Average 0 mm H2o.
Normal compliance: 0.3 to 1.7 cc. Average .6 cc.
TYMPANOMETRY
The graphic recording of these information is called

tympanogram. There are three basic types:
Type A: Normal pressure and normal compliance.

Type B: It is a flat curve denoting that pressure
change do not have much effect on the compliance.
Example - OME
Type C: Normal compliance in negative middle ear
pressure. Example- Eustachian tube dysfunction.
Type A curve
Type B flat curve
Type C curve:
Normal
compliance at
negative middle
ear pressure
CALOTIC TEST
The basis of this test is to induce

nystagmus by thermal stimulation
of vestibular system.
CALOTIC TEST
In this test, patient lies supine with head tilted 30

degree forward so that horizontal canal is vertical.
Each ear is irrigated for 40 seconds alternatively
with water at 30 degree and 44 degree and eyes
observed for appearance of nystagmus till its end
point.
Normally the nystagmus lasts for about 90 seconds
to 150 seconds (average 120 seconds)
CALOTIC TEST
Cold water induces nystagmus to

opposite side and warm water to the
same side.
The result is recorded on a calorigram
CALOTIC TEST
Applied importance:
Canal paresis: is present, if the

duration of nystagmus is reduced for
both hot and cold water. This signifies
peripheral vestibular lesion.
Normal
caloric
responses
Right canal
paresis

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TUNING FORK TESTS

Tuning fork test can distinguish

In air conduction the sound waves are

Thus, by the air conduction test, the

In bone conduction, sound waves

Comparison of air conduction with

A vibrating tuning fork is placed on the

3. Rinne’s negative: Bone conduction is

Comparison of bone conduction

In this test, a vibrating tuning fork is

1. In conductive deafness Weber lateralized

2. In sensorineural deafness Weber

Comparison of bone conduction

If the examiner still hears the sound, then

Pure tone audiometer is an electronic device

Using head phone and bone vibrator, each

PTA will give a graphical

WHO classification of degree of hearing loss

Normal hearing (0-25dB)

Normal hearing: Both air conduction

Bone conduction threshold within 25

Sensorineural hearing loss:

Both air conduction and bone

Mixed hearing loss:

Both air conduction and bone

It is an objective test, widely

The compliance will be greatest when

It is based on simple principle:

When a sound strikes tympanic membrane,

A) Oscillator to produce a tone of 220 Hz.

By varying the pressure in the external ear

Normal middle ear pressure: -100 to +50 mm

The graphic recording of these information is called

Type A: Normal pressure and normal compliance.

The basis of this test is to induce

In this test, patient lies supine with head tilted 30

Cold water induces nystagmus to

Canal paresis: is present, if the

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