The Rinne test is a subjective, non-invasive and quickly performable ENT test procedure that uses a vibrating tuning fork to compare the bone conduction and air conduction of an ear. The test procedure can be used to make differential diagnostic statements about the type of hearing loss, which in particular allow a distinction to be made between sensorineural and conductive hearing loss. Because the Rinne test is a subjective test procedure, the patient must be willing to cooperate and should also be able to follow the test and the test personnel’s instructions without limitations.
What is the Rinne test?
The Rinne test is a subjective, non-invasive, and quick ENT test procedure that uses a vibrating tuning fork to compare the bone conduction and air conduction of an ear. The Rinne test is a subjective test used in otolaryngology. Heinrich Adolf Rinne first described the procedure in 1855. As with the Weber test and the Bing test, the Rinne test is also a tuning fork test. The air conduction and bone conduction of sound are compared, which, in combination with the results of the Weber test, makes it possible to assign hearing loss. In most cases, the Weber test precedes the Rinne test. However, the two procedures can also be used in reverse order under certain circumstances. The clinically oriented test run of the Rinne test works on the physiological properties of the ear and thus serves to diagnose sound reception or sound conduction disorders. Each ear is tested individually. If the Weber test has previously revealed a unilateral hearing loss, the Rinne test is generally performed on one ear only.
Function, effect and goals
Together with the Weber test, the Rinne test forms the standardized procedure for the examination of hearing disorders today. The test procedure can be used for unilateral hearing loss as well as bilateral hearing loss. Because the Rinne test makes it possible to distinguish between sensorineural and conductive hearing loss, the procedure is primarily of differential diagnostic significance. Every ENT practice is capable of performing the test procedure. In preparation for the test procedure, a tuning fork is set in vibration. The personnel performing the test then place the vibrating foot of the tuning fork on the mastoid process. This is a bone conduit that is responsible for the transfer of sound sensations and is located as a bone process behind each auricle. The patient now hears a tone via the vibrations of the tuning fork. The staff performing the test asks him to let them know when the sound stops. After the subjectively perceived silencing of the bone conduction behind the ear, the tuning fork is now held on the air conduction in front of the ear. The instrument is not struck again for this purpose. Normally, the ossicles and the eardrum amplify the sound on the air conduction in front of the auricle. A patient with normal hearing therefore hears the sound that has been silenced on the bone conduction again on the air conduction in front of the ear as soon as the tuning fork is held in front of the auricle. The air conduction of a healthy patient naturally reproduces the sound in the ear canals longer than the mastoid process of the bone conduction. The gutter test is considered positive if the patient hears the sound again through the air conduction. If he cannot hear it again even in front of the auricle, the result of the test is considered negative. In conductive hearing loss, the patient hears the sound of the tuning fork louder and longer through the bone conduction than through the air conduction. Therefore, a negative Rinne test may indicate a conductive hearing loss. If, on the other hand, there is a sensorineural hearing loss, the patient barely hears the sound over both the bone conduction and the air conduction. However, the perception of sound over the air conduction is never worse than the perception over the bone conduction in sensorineural hearing loss.
Risks, side effects, and hazards
Because the Rinne test is one of the subjective hearing tests, the procedure is not unconditionally suitable for every patient. In children and mentally impaired individuals, the Rinne test may produce false results. The subjective perception and cooperation of the patient are the focus of the test procedure.It is difficult for the personnel performing the test to assess the extent to which the statements made about sound perception correspond to the truth. Therefore, the Rinne test is just as unsuitable for unwilling patients, for example, as other hearing tests from the group of subjective test procedures. In particular, if the results of the Weber and Rinne tests are contradictory, test personnel may question the patient’s cooperation or suspect that the subject’s perception was incorrect. Neither the Weber test nor the Rinne test involves any effort on the part of the patient. In fact, the Rinne test is one of the fastest ENT test runs ever to be performed. Because the test run is a non-invasive procedure, the patient does not need to be hospitalized or follow any special rules of conduct prior to the procedure. There are no risks or side effects associated with the Rinne test. At most, slight temporary ringing in the ears occurs. As a rule, the Rinne test is never performed independently, but always in combination with the Weber test, which is just as easy to perform and, like the Rinne test, has no risks or side effects. The Weber test also involves vibrating a tuning fork, which is placed on the crown of the test person’s head. The sound is transmitted in phase to both inner ears via the bone conduction for normal hearing. Results that deviate from this indicate a unilateral or assymetric hearing disorder, which can be further determined using the Rinne test.
