Tuning Fork Tests flashcards |

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Schwabach

-based on occlusion effect; stronger at lower freq., so use low freq. tuning fork

Schwabach Procedure

-Set into vibration
-Place stem on patient's mastoid (behind ear)
Patient indicates if tone is heard
-When patient no longer hears the tone, examiner uses a watch to determine # of secs sound is audible after patient stops hearing it.
-Examiner MUST have normal hearing!

Schwabach Results

-NORMAL HEARING: examiner and patient stop hearing tone at approximately the same time
-SNHL: patient stops hearing before examiner = DIMINISHED SCHWABACH
-CONDUCTIVE HL: patient hears as long or longer than examiner, patients hearing in low pitches may appear better than normal = PROLONGED SCHWABACH

DIMINISHED SCHWABACH

-patient stops hearing before examiner
-SNHL

PROLONGED SCHWABACH

-patient hears as long or longer than examiner, patients hearing in low pitches may appear better than normal
-Conductive HL

Schwabach Problems

-Interpretation is difficult with mixed HL
-Difficulty determining which ear is being tested
-FALSE NORMAL SCHWABACH: if ears differ, patient's response will be related to the better ear
-Deciding which fork to use; you must state which you used

Rinne

looks at performance at AC vs. BC

Rinne Procedure

-Set into vibration
-Place on mastoid (behind ear) and then beside ear canal
-Ask which is louder

Rinne Results

-NORMAL HEARING: beside ear is louder; AC more effective = POSITIVE RINNE
-SNHL: beside ear is louder; same degree of loss by both AC & BC = POSITIVE RINNE
-CONDUCTIVE HL: behind ear is louder; BC is WNL & AC is abnormal = NEGATIVE RINNE

Negative Rinne

-behind ear is louder; BC is WNL & AC is abnormal
-Conductive HL

POSITIVE RINNE

-beside ear is louder; AC more effective = Normal Hearing

or

-beside ear is louder; same degree of loss by both AC & BC = SNHL

Rinne Problems

-Difficulty determining which ear is being tested
-Can't tell if there is an asymmetric loss
-FALSE NEGATIVE RINNER: inner ear of NTE is responding, patient is comparing AC of one ear to BC of the other ear (improper diagnosis of conduction HL if non-test BC is better than TE)

Bing

tests the pt's occlusion effect

Bing Procedure

-Set into vibration
-Place fork on mastoid
-Push tragus in and out of ear
-If it sounds like "wooo wooo woooo" then you created an occlusion effect , which signifies normal hearing

Bing Results

-NORMAL HEARING: patient hears the occlusion effect = POSITIVE BING
-SNHL: patient hears the occlusion effect = POSITIVE BING
-CONDUCTIVE HL: no change in loudness is heard, no occlusion effect = NEGATIVE BING

POSITIVE BING

-patient hears the occlusion effect = normal hearing

or

-patient hears the occlusion effect = SNHL

NEGATIVE BING

-no change in loudness is heard, no occlusion effect = Conductive HL

Bing Problems

-Examiner must not suggest what patient's response should be
-Difficulty determining which ear is being tested
-If ears are asymmetrical

Weber

test of lateralization (where patient hears the tone: right ear, left ear, both, or midline); if they pick an ear, do Bing test to pick results.

Weber Procedure

-Set into vibration
-Place fork on patient's forehead
-Say "I want you to tell me where you hear this sound."

Weber Results

-NORMAL HEARING: equally loud in both ears, cannot tell a difference, tone originates in middle of forehead = MIDLINE SENSATION
-Equal amounts of the same type of hearing loss (conductive, SNHL, mixed) = MIDLINE SENSATION
-SNHL (in one ear): hear tone in better ear; possibly due to Stenger principle
-CONDUCTIVE HL (in on ear): hearing tone in poorer ear; results poorly understood, possibly result of prolonged BC (see Schwabach test)

Weber: MIDLINE SENSATION

-Equally loud in both ears, cannot tell a difference, tone originates in middle of forehead = normal hearing

or

-Equal amounts of the same type of hearing loss (conductive, SNHL, mixed)

Stenger Principle

-2 tones identical except for loudness presented at the same time in both ears, only the louder tone will be perceived
-If same tone presented to both ears, one of which has poorer BC sensitivity
-Perception that tones are louder in ear with better sensitivity
-Only louder tone (better BC sensitivity) will be heard; patient responds they only hear it in one ear

Weber Advantages

-Can be used to verify diagnosis of Schwabach or Rinne

-FALSE NORMAL SCHWABACH or FALSE NEGATIVE RINNE: both due to better ear responding rather than test ear
-Weber can verify unilateral SNHL

Weber Problems

Patient could have a long standing unilateral loss

EXAMPLE:
Rinne: negative, in that the patient heard louder tone when fork was behind the ear on the mastoid than with tones near the ear canal

โ€ขAssuming that BC is WNL and AC is not normal
โ€ขWant to know these results could be due to other ear responding

โ€ขPERFORM WEBER: sound heard in 1 ear.
โ€ขPOSSIBLE RESULTS: unilateral SNHL

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