A 512 Hz tuning fork separates conductive from sensorineural hearing loss at the bedside: Rinne compares air and bone conduction in one ear, Weber compares the two ears.
How it's asked: Interpret a combination of Rinne and Weber results, and the false-negative Rinne in severe unilateral SNHL.
Why this is true
Normally the middle ear's impedance-matching makes air conduction more efficient than bone conduction, so the fork is heard longer by air (Rinne positive). In conductive loss, sound through air is attenuated but bone conduction bypasses the middle ear, so bone wins (Rinne negative) — and because the affected ear is also shielded from room noise, Weber lateralises to it. In sensorineural loss the cochlea or nerve is damaged, so both routes are reduced proportionally (Rinne stays positive) and Weber lateralises to the better cochlea.
Key points
Reading the tests
| Condition | Rinne (affected ear) | Weber |
|---|---|---|
| Normal | Positive | Central |
| Conductive loss (right) | Negative | To the right (worse ear) |
| Sensorineural loss (right) | Positive | To the left (better ear) |
| Severe unilateral SNHL (right) | False negative | To the left |
Common traps
- A negative Rinne with Weber going to the opposite ear means a dead ear (false negative), not conductive loss.
- Rinne positive does not mean normal hearing — it is also positive in sensorineural loss.
Mnemonic
Weber goes to the Worse ear in conductive (Conductive = Comes towards), the better ear in SNHL.
Clinical case
A patient's Rinne is negative on the left and Weber lateralises to the left.
High-yield
Rinne negative = conductive. Weber → worse ear in conductive, better ear in SNHL. False-negative Rinne = severe SNHL (mask the good ear). Fork = 512 Hz.
Quick check
Q1.Weber lateralises to the right ear and Rinne is positive bilaterally. Diagnosis?
Q2.Frequency of tuning fork routinely used: