Weber Test Performance
The Weber and the Rinne test ( /ˈrɪnə/ RIN-ə) test are typically performed together with the results of each combined to determine the location and nature of any hearing losses detected. In the Weber test a vibrating tuning fork (256Hz used for Weber vibration test; 512Hz used for Rinne hearing test) is placed in the middle of the forehead, above the upper lip under the nose over the teeth, or on top of the head equi-distant from the patient's ears on top of thin skin in contact with the bone. The patient is asked to report in which ear the sound is heard louder. A normal weber test has a patient reporting the sound heard equally in both sides. In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear. In an affected patient, if the normal ear hears the tuning fork sound better, there is sensorineural hearing loss on the other ear (defective ear). However, the aforegoing presumes one knows in advance which ear is defective and which is normal (such as the patient telling the clinician that they cannot hear as well in one ear versus the other) and the testing is being done to characterize the type, conductive or sensorineural, of hearing loss that is occurring. In the case where the patient is unaware or has acclimated to their hearing loss, the clinician has to use the Rinne test in conjunction with the Weber to characterize and localize any deficits. That is, an abnormal Weber test is only able to tell the clinician that there is a conductive loss in the ear which hears better or that there is a sensorineural loss in the ear which does not hear as well.
For the Rinne test, a vibrating tuning fork (typically 512Hz) is placed initially on the mastoid process behind each ear until sound is no longer heard. Then, the fork is then immediately placed just outside the ear with the patient asked to report when the sound caused by the vibration is no longer heard. A normal or positive Rinne test is when the sound heard outside of the ear (air conduction or AC) is louder than that heard of the initial sound heard when the tuning fork end was placed against the skin on top of the mastoid process behind the ear (bone conduction or BC). Therefore, AC > BC; which is how it is reported clinically for a normal or positive Rinne result. In conductive hearing loss, bone conduction is better than air or BC > AC, a negative Rinne.
In a normal patient, the Weber tuning fork sound is heard equally loud in both ears with no one ear hearing the sound louder than the other (lateralization). Similarly, a patient with symmetrical hearing loss will hear the Weber tuning fork sound equally as well with diagnostic utility only in asymmetric (one-sided) hearing losses. In a patient with hearing loss, the Weber tuning fork sound is heard louder in one ear (lateralization) versus the other. This clinical finding should be confirmed by repeating the procedure and having the patient occlude one ear with a finger; the sound should be heard best in the occluded ear.
The results of both tests are noted and compared accordingly below to localize and characterize the nature of any detected hearing losses. Note: the Weber and Rinne are screening tests that are not replacements for formal audiometry hearing tests.
| Weber without lateralization | Weber lateralizes left | Weber lateralizes right | |
|---|---|---|---|
| Rinne both ears AC>BC | Normal | Sensorineural loss in right | Sensorineural loss in left |
| Rinne left BC>AC | Conductive loss in left | Combined loss : conductive and sensorineural loss in left | |
| Rinne right BC>AC | Combined loss : conductive and sensorineural loss in right | Conductive loss in right | |
| Rinne both ears BC>AC | Conductive loss in both ears | Combined loss in right and conductive loss on left | Combined loss in left and conductive loss on right |
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