Which bedside tests are most useful to differentiate conductive from sensorineural hearing loss?

Which bedside tests are most useful to differentiate conductive from sensorineural hearing loss?

• A. Audiometry and tympanometry.
• B. Tuning fork Rinne test only.
• C. Weber and Rinne tests.
• D. Otoscopy alone.

Answer: (C)

Bedside differentiation between conductive and sensorineural hearing loss relies on how sound is heard through a tuning fork in two simple maneuvers. The Weber test places the vibrating fork on the midline of the skull; if the sound seems louder in the ear with a problem, that points to conductive loss on that side, whereas if it sounds louder in the opposite ear, it suggests sensorineural loss in the affected ear. The Rinne test compares air conduction to bone conduction by placing the fork first on the mastoid (bone) and then near the ear (air). Normally air conduction is better than bone conduction. In conductive loss, air conduction is reduced so bone conduction can be heard longer (negative Rinne) on the affected side. In sensorineural loss, air conduction remains better than bone conduction (positive Rinne), though overall hearing is reduced. Combining these two tests gives a reliable bedside way to distinguish the two types: Weber tells you where the loudness shifts, and Rinne confirms whether the deficit is conductive or sensorineural. Audiometry and tympanometry provide more detail but require equipment and setup, while otoscopy alone doesn’t differentiate the loss type.

Bedside differentiation between conductive and sensorineural hearing loss relies on how sound is heard through a tuning fork in two simple maneuvers. The Weber test places the vibrating fork on the midline of the skull; if the sound seems louder in the ear with a problem, that points to conductive loss on that side, whereas if it sounds louder in the opposite ear, it suggests sensorineural loss in the affected ear. The Rinne test compares air conduction to bone conduction by placing the fork first on the mastoid (bone) and then near the ear (air). Normally air conduction is better than bone conduction. In conductive loss, air conduction is reduced so bone conduction can be heard longer (negative Rinne) on the affected side. In sensorineural loss, air conduction remains better than bone conduction (positive Rinne), though overall hearing is reduced.

Combining these two tests gives a reliable bedside way to distinguish the two types: Weber tells you where the loudness shifts, and Rinne confirms whether the deficit is conductive or sensorineural. Audiometry and tympanometry provide more detail but require equipment and setup, while otoscopy alone doesn’t differentiate the loss type.