This document discusses tuning fork tests used to evaluate hearing, including the Weber, Bing, Rinne, and Schwabach tests. The Weber test determines whether a hearing loss is sensorineural or conductive by placing a tuning fork on the head and having the patient indicate the side heard. The Bing test evaluates occlusion effect by placing a tuning fork on the mastoid and having the patient report if the sound is louder with the ear open or closed. The Rinne test compares air conduction to bone conduction to identify conductive hearing losses.

1. Tunning Fork Tests
Presenter:-
Ashutosh Singh

2. Tunning fork:-
The tuning fork was invented in 1711 by British musician John
Shore.
It is a instrument usually made up of Steel, Aluminium,
Magnesium.
There are various frequencies of tunning fork i.e. 128Hz,
256Hz, 512Hz, and 1024Hz etc.
This were used to test Hearing long before the development
of the audiometer.
A set of tunning fork used for this purpose is shown in this fig.

3. • Four of the more well known of these tests are the –
1. Weber
2. Bing
3. Rinne
4. Schwabach

4. Weber test
• This test is used to help determine whether a unilateral hearing loss is
sensorineural or conductive.
• It is a Lateralization test because patient is asked to indicate the
direction from which a sound appears to be coming.
• The procedure involves putting the base of the tunning fork on
midline of the skull, most commonly center of the forehead or top of
the head .
• Sometimes bone vibrator is used instead of tunning fork known as
audiometric weber test.

5. Interpretation:-
• Hearing the tone in the "Better ear" implies that there is a
sensorineural loss in the “poorer ear”.
• When hearing the tone in “Poorer ear” suggests a Condutive loss in
that ear.
• The tone is heard midline, or both the ears when the patient has
normal (or sensorineural) hearing.

6. Bing test
• This test is based on occlusion effect (perception of increase in
loudness of the tone through Bone Conduction(BC) when the ear is
occluded{close}).
• In this test the base of the tunning fork is placed on the mastoid
process, and open and closes the canal simultaneously through the
tragus.
• And patient is asked to report whether a tunning fork sounds louder
with the ear canal open or closed.
• Bing test is completely subjective judgement of louder vs not louder.

7. Interpretation:-
• Positive bing :- If the occlusion effect is present, covering the canal
should cause the tunning fork to sound louder, it implies that the ear
is normal or sensorineural hearing loss.
• Negative bing:- If the patient is report that there is no any difference
while closing or opening the ear canal, which implies that there is
conductive hearing loss.

8. Rinne test
• This test was proposed by the Heinrich Adolf Rinne in 1855.
• This test is based on idea that the hearing mechanism is normally
more efficient by air-conduction than it is by bone-conduction.
• In this test, the clinician just find out whether the patient hears the
sound louder through air-conduction(AC) or bone-conduction(BC).
• This test involves asking the patient to indicate whether a vibrating
tunning fork sounds louder when its base is held against the mastoid
process (bone-conduction) or when its prongs are held near the
pinna, facing the opening of the ear canal(air-conduction).

9. Interpretation:-
• Positive rinne:- if the fork is louder by air-conduction, and this finding
implies that the ear is normal or sensorineural hearing loss.
( AC > BC )
• Negative rinne:-if bone-conduction is louder than the air-conduction,
which is interpreted as revealing the presence of a conductive
abnormality.
( BC > AC )
• Sometimes, the AC=BC (equally loud on both side), then in this
situation this test involves timing how long the patient can hear the
tunning for at the two locations.

10. In this case, the result are postive
• When the tone is heard longer by the air-conduction (AC).
( AC > BC )
Negative
• when it is heard longer by the bone-conduction (BC).
( BC > AC )

11. Thank you