Visual aids: the use of visual prisms or occluders may indicate underlying strabismus.Hearing aids: often worn by patients with vestibulocochlear nerve issues (e.g.Walking aids: gait issues are associated with a wide range of neurological pathology including Parkinson’s disease, stroke, cerebellar disease and myasthenia gravis.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: spasticity, weakness, wasting, tremor, fasciculation) which may suggest the presence of a neurological syndrome). Limbs: pay attention to the patient’s arms and legs as they enter the room and take a seat noting any abnormalities (e.g.Strabismus: may indicate oculomotor, trochlear or abducens nerve palsy.Pupillary abnormalities: mydriasis occurs in oculomotor nerve palsy.Eyelid abnormalities: ptosis may indicate oculomotor nerve pathology.Facial asymmetry: suggestive of facial nerve palsy.Speech abnormalities: may indicate glossopharyngeal or vagus nerve pathology.Perform a brief general inspection of the patient, looking for clinical signs suggestive of underlying pathology: In this case, the patient will state that bone conduction is louder than air conduction, giving a falsely negative Rinne test.You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation. But the sounds are not heard when the tuning fork is held next to the external auditory meatus on the side being tested (left). The way to determine the difference between a true and a false Rinne negative test is to perform the Weber test.įor example, if the left ear is completely dead, the sound waves travel to the good right ear on testing the bone conduction on the left. It seems that bone conduction is better than air conduction, but the ear is nonfunctional. With complete loss of innervation to that ear, the patient will not hear anything from the tuning fork on the mastoid or near the canal. The sound transmits through their skull to the ear on the other side, and they may not be able to identify in which ear they hear the sound. Otosclerosis results in the failure to transmit sound from the stapes through the oval window due to abnormal bone growth.Ī patient with profound sensorineural deafness may have a false negative Rinne. In some patients with otosclerosis, the Rinne test is performed to determine if the patient is eligible for stapes surgery. The Rinne test is frequently recommended when one suspects a conductive hearing loss. A Rinne test should be performed in conjunction with a Weber test to help distinguish between conductive hearing loss and sensorineural hearing loss. By comparing air and bone conduction, it helps detect conductive hearing loss in one ear. The Rinne test differentiates sound transmitted through air conduction from those transmitted through bone conduction via the mastoid bone. The Rinne test is used to evaluate hearing loss in one ear. Heinrich Adolph Rinne (1819-1868), a German otologist, proposed the test, which was subsequently named after him. Both of these tests are now routinely taught in medical schools and performed regularly to assess 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. 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. 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.

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