Tuning fork tests, process and results

1. Types Of Tuning Fork Tests
& Clinical Findings

2. Tuning Fork
The tuning fork is a device, usually made of steel, magnesium or aluminum that
is used to tune musical instruments or by singers to obtain certain pitches.
The tuning fork is set into vibration by holding the stem in the hand and striking
one of the tines against a firm but resilient surface.
512 Hz is an ideal tuning fork.
◦ Tuning forks of lower frequency produce more bone vibration.
◦ Tuning forks of higher frequency have shorter decay time and are difficult to activate for them
to be heard with a moderate or severe sensorineural impairment.

3. Principle of Tuning Fork
The sound can be transmitted to cochlea in 2 ways:
Air conduction (AC):
Transmission of sound to the cochlea via external air
and middle ear.
Measures function of conducting pathway and
cochlea.
Bone conduction (BC):
Transmission of sound to cochlea via vibration is skull
(mastoid) bone, bypassing the external and middle
ear.
Measures function of cochlea only.

4. Types Of Tuning Fork Tests Nature Of Tuning Fork Tests
Rinne test Compare air conduction & bone conduction test
Weber test Bone conduction test
Absolute Bone conduction (ABC) Bone conduction test
Schwabach’s test Bone conduction test
Bing test Bone conduction test
Gelle’s test Bone conduction test

5. Rinne Test Method
The clinician strikes a tuning fork and places it on the mastoid bone behind one ear.
When a patient can no longer hear the sound, signal to the clinician.
Then, the clinician moves the tuning fork next to ear canal.
When a patient can no longer hear that sound, once again signal the clinician.
Clinician ask whether the sound was louder at the beginning (bone conduction) or whether it
became louder (air conduction).
Clinician compares air conduction and bone conduction of same ear.

6. Rinne Test Results
Test Normal Hearing Conductive
Hearing Loss
Total Hearing Loss
Rinne AC > BC
Positive Rinne or
Sensorineural
Hearing Loss
AC < BC
Negative Rinne
AC = BC
Mild CHL
BC+ (heard from
opposite ear)
AC- (sound cannot
be heard)
False Negative
Rinne

7. Weber Test Method
The clinician strikes a tuning fork and
places it on the middle of your head.
Clinician note where the sound is best
heard:
◦ The left ear.
◦ The right ear.
◦ Both equally.

8. Weber Test Results
Normal hearing: Equal sound in both ears.
Conductive loss: Sound to be heard best in the abnormal ear.
Sensorineural loss: Sound to be heard best in the normal ear.
Test Normal Hearing Conductive
Hearing Loss
Sensorineural
Hearing Loss
Weber Sound is heard at
midline
Sound is heard
better in bad ear.
Sound is heard
better in good ear.

10. Schwabach’s Test
The clinician strikes a tuning fork and places it on the mastoid bone of the patient.
When patient raises hand that he has stopped hearing sound fork is placed at mastoid bone of
clinician.
Compare bone conduction of patient to the bone conduction of the clinician.
Test details Interpretation
Clinician and patient hear the fork for same
duration
Normal/ Conductive hearing loss
Patient hear the fork for shorter duration Sensorineural hearing loss

12. Absolute Bone Conduction (ABC) Test
Method
Examiner closes the test ear by gently pressing the tragus against ear canal.
Foot piece of vibrating tuning fork is kept over mastoid bone and patient listens to the fork till
sound disappears completely.
Immediately same fork is transferred over mastoid bone of the clinician and simultaneously ear
canal is closed by pressing the tragus.

13. Absolute Bone Conduction (ABC) Test
Results
Test details
Result Interpretation
Clinician listens longer than
patient
ABC reduced SNHL
Clinician listens equal to that of
patient
ABC normal Normal
Patient listens longer than
clinician
ABC lengthened CHL

14. Bing Test Method
This is like ABC test, but the external ear canal is alternately closed and opened by pressing
and releasing the tragus.
The vibrating fork is placed over the mastoid process and when it ceases to be heard the
examiner’s finger is used to occlude the external auditory canal preventing sound from escaping
via the external canal.
Test details Result Interpretation
Positive Bing test Louder when occluded Normal or SNHL
Negative Bing test No change CHL

15. Gelle’s Test Method
In this test, the air pressure in the external canal
is varied using a Siegle’s speculum.
The vibrating fork is held in contact with the
mastoid process.
In stapes fixation no alteration in the hearing
threshold is evident.
Siegle’s speculum

16. Gelle’s Test Result
Test details Result Interpretation
Positive Gelle’s test Decreased hearing Normal or SNHL
Negative Gelle’s test Normal hearing Ossicular chain fixation
(otosclerosis) or
discontinuation

17. References:
https://www.webmedcentral.com/article_view/3279
https://epomedicine.com/clinical-medicine/hearing-tests-with-tuning-fork/
https://www.youtube.com/watch?v=M5isXR8dOaI
https://www.youtube.com/watch?v=u3bowqrUfio
https://www.youtube.com/watch?v=WgZRpa-WseE
https://www.youtube.com/watch?v=S-G5dGrOJgc
https://www.youtube.com/watch?v=bigzhefm63w
https://www.youtube.com/watch?v=3DXe78A4YRo