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The Rinne test of hearing compares perception of sounds, as transmitted by air or by sound conduction through the mastoid. This is achieved by placing a vibrating tuning fork (512 Hz) initially on the mastoid, then next to the ear and asking which sound is loudest. Air conduction uses the apparatus of the ear (pinna, eardrum and ossicles) to amplify and direct the sound whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear.

In a normal ear, air conduction (AC) is better than bone conduction (BC)

AC > BC, positive Rinne.

In conductive hearing loss, bone conduction is better than air

BC > AC, negative Rinne.

In sensorineural hearing loss, bone conduction and air conduction are both equally depreciated, maintaining the relative difference of

AC > BC, positive Rinne.

In sensorineural hearing loss patients there may be a false negative Rinne

BC > AC,

if the normal ear is not masked, and bone conduction heard in the normal ear is reported as louder by the patient because conduction through the skull to the opposite ear is more effective than conduction through room air around the head.

A Rinne test should always be accompanied by a Weber test to confirm the nature of hearing loss.

This test, and its complement the Weber test, are quick screening tests and are no replacement for formal audiometry.

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