What’s the Rinne test?

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The Rinne test is a diagnostic procedure and screening tool used to help pinpoint the cause of hearing loss. It does this by comparing the patient’s perception of sounds that are transmitted through the air versus sounds transmitted through bone conduction through the mastoid process. In the field of otology, doctors and audiologists use the Rinne test to help detect or rule out conductive hearing loss.

In conducting the Rinne test, a tuning fork vibrating at 256 Hz or 512 Hz is first placed on the patient’s mastoid process, a part of the temporal bone. When the patient reports that they no longer hear the sound, the tuning fork is immediately repositioned near the ear opening. If the patient continues to perceive sound, this helps rule out the presence of conductive hearing loss.

The physiology behind the Rinne test is based on the two main ways people perceive sound. When sound reaches the patient through the air, it is conducted by the auricle, eardrum and ossicles, which direct the sound to the inner ear while amplifying it. Also conducted by the bones of the head, sound can bypass these ear mechanisms and travel directly to the inner ear. The sound conducted by the bones of the head has a lower volume than that transmitted through the air.

If ear function is normal, a Rinne test will indicate that air conduction produces better sound than bone conduction. This is called a “positive Rinne”. With conductive hearing loss, however, bone conduction will produce a better sound, called a ‘negative Rinne’.

When a Rinne test is performed, a Weber test should also be conducted. Weber tests help detect the presence of sensorineural hearing loss caused by dysfunction of the vestibulocochlear nerve, inner ear, or parts of the brain that process sound. In the Weber test, a tuning fork is placed at the midpoint of the forehead.

The most common cause of sensorineural hearing loss is abnormalities found in the hair cells of the cochlea. These anomalies can be caused by both external and internal factors. Traumatic noise, such as listening to headphones at a very high volume, is an example of an external factor. An example of an internal factor would be a genetic predisposition to deafness.
If sensorineural hearing loss is present, both bone conduction and air conduction are equally reduced maintaining the relative difference between bone and air sound. This result is also referred to as “Rinne Positive”. There is cause for concern, however, as a “false negative Rinne” can occur when sensorineural hearing loss is involved.

Both the Rinne and Weber tests are intended to provide a means of rapid screening of patients complaining of hearing loss. Neither test is a substitute for more extensive and sophisticated audiometric testing. Patients should consult their doctor for the best options.

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