interpretation of results

Last reviewed 03/2023

• a patient with normal hearing in both ears perceives the sound in the midline.
• a patient with unilateral conductive loss perceives the sound in the ear with the conductive loss i.e. if the right has a conductive loss, the sound lateralises to the right ear.
• a patient with unilateral sensorineural loss perceives the sound in the ear with the better cochlear i.e. if the right ear has a sensorineural loss, the sound lateralises to the left ear.
• a patient with a very severe unilateral loss on the right i.e. a dead ear may produce the following results:
  • Rinne -ve in right ear
  • Weber lateralising to the left ear
• in this case, Rinne's result is a false negative. On testing the right ear, the bone conduction is heard in the normal left cochlear by skull crossover.
• the Weber's test is more sensitive than the Rinne's test.

Note:

• studies the Weber test has shown low sensitivity and modest specificity
• when there is suspicion of hearing loss, audiometry should be performed even if bedside tests are normal (1)

References:

• (1) Correspondence to article: D. F. Boatman, et al. How accurate are bedside hearing tests? Neurology 2007; 68: 1311-1314