Accuracy of the Weber and Rinne Tuning Fork Tests in Evaluation of Children with Otitis Media with Effusion

Abstract

Objective: The purpose of this study was to determine the accuracy of the Rinne and Weber tuning fork tests in predicting the degree of hearing loss secondary to otitis media with effusion )OME} in children compared with pure-tone audiometry.Design: A blinded prospective study was performed on cases of unilateral and bilateral OME in children between ages 2 and 11 years.Setting: Patients were recruited from the tertiary Pediatric Otolaryngology Clinic at British Columbia's Children's Hospital in Vancouver.Methods: The subjects consisted of 58 children with unilateral or bilateral OME. The Rinne and Weber tests were performed using a 256 H2 and a 512 Hz tuning fork. Pure-tone audiometry was performed to establish the presence and degree of an air-bone gap (ABG).Main Outcome Measures: The tuning fork responses were correlated with the ABG to determine their accuracy.Results: The Weber test did not show an association between the ABG and the lateralization response using either the 256 Hz (p ^ .4S4) or the 512 Hz tuning fork (p = .120). For the Rinne test, an increase in ABG was significantly associated with a higher rate of response air conduction -bone conduction using eitherthe256 Hz orthe 512 Hzfork [p .04). Age was not associated with outcome for any of the tuning fork tests.Conclusions: The overall accuracy of the Rinne and Weber tuning fork tests in predicting conductive hearing loss associated with OME in children is poor. SOMMAIREObjectif: Le but de cette etude etait de determiner la precision des tests au diapason de Rinne et Weber dans la prediction du degre de perte d'audition dans I'otite moyenne avec epanchement (OME) chez I'enfant en le comparant avec I'audiometrie tonale.Devis: Une etude prospective a I'aveugle a ete faite chez des enfants entre 2 et 11 ans avec des OME unilaterales ou bilaterales. Localisation: Les patients ont ete recrutes a partir de la clinique d'Oto-rhino-taryngologie pediatrique du British Columbia's Children's Hospital, un centre tertiaire a Vancouver au Canada. Methode: Nous avions comme sujets, 58 enfants avec OME unilaterale et bilaterale. Les tests de Rinne et Weber ont ete faits en utilisant le diapason a 256 Hz et 512 Hz. Une audiometrie tonale a permis d'etablir la presence et le degre de Rinne audiometrique (ecart aerien-osseux EAO). Variables evaluees: Les resultats du diapason ont ete mis en correlation avec L'EAO pour en determiner I'exactitude. Resultats: Le test de Weber ne montre pas d'association entre L'EAO et la reponse de lateralisation en utilisant soit le diapason de256 Hz (p = .484) ou celui de 512 Hz (p = .120). Pour le test de Rinne, une augmentation de L'EAO etait significativement assocjee a un Rinne inverse utilisant autant le diapason de 256 Hz que celui de 512 Hz fourchette (p .04). L'age n'etait associe en aucune fa9on aux resultats pour les tests au diapason. Conclusion: Dans I'ensemble, ['exactitude des tests au diapason de Rinne et de Weber pour predrre la surdite de transmission associee a I'OME est faible chez I'enfant.

Recognition of paediatric otopathology by General Practitioners

“…The routine use of tympanometry in general practice can improve the diagnostic accuracy of effusions and perforations as well as retractions of the tympanic membrane associated with negative middle ear pressure; where tympanometry is not available when assessing a patient for OME, the use of a tuning fork to perform the Rinne test has considerable diagnostic value [11,12].…”

Hearing screening techniques for referral purposes: Our experience from a rural setting

“…With the aid of the tuning fork, 48.6% (18) persons were predicted to have conductive hearing loss (CHL), 45.9% (17) with sensorineural hearing loss (SNHL) and only in 5.4% (2) persons was the tuning fork not heard at all [ Figure 3]. Eight persons (21.6%) was performed and intervention (such as aural toileting, foreign body, and wax removal) given where necessary.…”

“…[3] This also agrees with evidence that CHL in the form of glue ear (OME-otitis media with effusion) is commoner in children under 15 years of age. [15,17] Although Behn et al, [18] argue that the overall accuracy of the Rinne and Weber tests in predicting CHL associated with OME in children is poor, most studies, however, agree that they were an invaluable tool for rapid hearing assessments. Furthermore, adultonset SNHL is said to manifest as age increases this is our observation as well since the number rose sharply in the adult groups.…”

Hearing and stomatognathic system: Searching for a link

“…Under some circumstances, the results of the most popular Weber test may be inconclusive. 10,39 In such cases, it is recommended to press the fork against the teeth of the maxilla. BC is more intense there and the sensation associated with it is clearer.…”