Expansion
Otoscopy, then Rinne and Weber to classify hearing loss
Expansion
Examination
- Inspect: pinna, pre-auricular and post-auricular areas, scars, discharge
- Otoscopy: pull the pinna up and back in adults, straight back in children. Inspect the canal, then the drum: colour, the cone of light, the handle of malleus, perforation, fluid level, retraction, cholesteatoma
- Facial nerve, since it runs through the temporal bone
Rinne: 512 Hz fork, mastoid then in front of the meatus.
- Air conduction better than bone is normal or sensorineural loss; this is Rinne positive
- Bone better than air is a conductive loss; Rinne negative
Weber: fork on the vertex or forehead.
- Central: normal, or symmetrical loss
- Lateralises to the affected ear: conductive loss on that side
- Lateralises away from the affected ear: sensorineural loss on that side
| Weber | Rinne | Diagnosis |
|---|---|---|
| Central | Positive both | Normal |
| To right | Negative right | Right conductive |
| To left | Positive both | Right sensorineural |
The false negative Rinne is the trap: in severe unilateral sensorineural loss, bone conduction may be heard by the opposite cochlea, mimicking a conductive loss. Weber resolves it.