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Old 05-10-2012
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Question Weber Rinne tests

Wikipedia:

The Rinne test is performed by placing a vibrating tuning fork (256 Hz) against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Quickly position the still vibrating tuning fork 1-2 cm from the auditory canal, and again ask the patient to tell you if they are able to hear the tuning fork. Air conduction should be greater than bone conduction and so the patient should be able to hear the tuning fork after they can no longer feel it. If they are not able to hear the tuning fork at this point it means that their bone conduction is greater than their air conduction, indicating there is something inhibiting the passage of sound waves to the cochlea (i.e., there is a conductive hearing loss). In neurosensory hearing loss the ability to sense the tuning fork by both bone and air conduction is equally diminished and therefore air conduction will still be greater than bone conduction.



Question:

So does that mean than neurosensory loss is only partial? How is the ear able to hear it though???
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Quote:
Originally Posted by DocSikorski View Post
air conduction will still be greater than bone conduction.
i dont get that bit.

i figured:
conduction loss: bone conduction > air conduction
neurosensory loss: both cannot be heard.
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Old 05-10-2012
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yes, it is when the sensoryneural hearing loss is partial... (mild and moderate degrees), the more common types..... it means that of whatever the pt could hear its the air conduction better than bone conduction... if its a dead ear, then its dead with no sound being heard ...

also in severe sensoryneural hearing loss,

AC > BC (can occur)

this is a false negative Rinnie... wherein the BC heard by the pt is actually heard thru the other ear... occurs due to transcranial conduction of the BC component...
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Quote:
Originally Posted by DocSikorski View Post
Wikipedia:

The Rinne test is performed by placing a vibrating tuning fork (256 Hz) against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Quickly position the still vibrating tuning fork 1-2 cm from the auditory canal, and again ask the patient to tell you if they are able to hear the tuning fork. Air conduction should be greater than bone conduction and so the patient should be able to hear the tuning fork after they can no longer feel it. If they are not able to hear the tuning fork at this point it means that their bone conduction is greater than their air conduction, indicating there is something inhibiting the passage of sound waves to the cochlea (i.e., there is a conductive hearing loss). In neurosensory hearing loss the ability to sense the tuning fork by both bone and air conduction is equally diminished and therefore air conduction will still be greater than bone conduction.

Question:

So does that mean than neurosensory loss is only partial? How is the ear able to hear it though???
"In neurosensory hearing loss the ability to sense the tuning fork by both the tuning fork by both bone and air conduction is equally diminished " - because of neurosensory deficit the brain will have diminished ability not totally destroyed) to receive that impulse (both from air and bone conduction in the same degree).

Note that when they say: "and therefore air conduction will still be greater than bone conduction." they are NOT saying that the pt will hear better thanks to the air conduction. They are just saying that this type of conduction will be dominant (as it is in a healthy patient). Because there's no conductive hearing loss. Also bone conduction is intact.

The ear will still hear thanks to the air AND bone conduction but the senstaion of those impulses going through air and bone cond will be diminished. Bc the caller (brain) on the other end of this line doesn't recognize the language
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Quote:
Originally Posted by Dr.NickRiviera View Post
i dont get that bit.

i figured:
conduction loss: bone conduction > air conduction
neurosensory loss: both cannot be heard.
yap that is correct
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no its not correct, at least according to what Wikipedia and High Yield Neuroanatomy says...
===========================

@Cassandra oh, didn't see 2 previous posts.

So basically in sensorineuronal loss - you have "cut the cord" between brain and ear, so no actual hearing happens, but ear is not plugged or something, so air conduction anatomically still prevails.

- but I assume pt won't recognize it anyway, cuz his ear is deaf now?
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Cool always boggs me down...

although simple ans stratght foreward, this test always confuses me, and everytime have to read it again...
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Quote:
Originally Posted by DocSikorski View Post
basically in sensorineuronal loss - you have "cut the cord" between brain and ear, so no actual hearing happens, but ear is not plugged or something, so air conduction anatomically still prevails.

- but I assume pt won't recognize it anyway, cuz his ear is deaf now?
no,

sensory rural hearing loss doesn't mean pt is deaf completely. as it says it is a type of hearing loss(diminished hearing) owing to diminished perception pathology in cochlea or VIII nerve while conduction of sound is intact. So both AC & BC conduction are equally decreased and AC > BC
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no,

sensory rural hearing loss doesn't mean pt is deaf completely. as it says it is a type of hearing loss(diminished hearing) owing to diminished perception pathology in cochlea or VIII nerve while conduction of sound is intact. So both AC & BC conduction are equally decreased and AC > BC
what provides hearing than if the nerve is cut?
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I agree, pt will be completely deaf then.

I just wanted to say that not necessarily VIII n has to be cut, it can even happen with intact VIIi N when hair cells are damaged as in Noise induced hearing loss(which is also a type of SN hearing loss) or cochlear damage
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Old 05-12-2012
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To all those who find these test confusing.. here's a simple way of remembering.

1. Rinne's test : You can read how it is done i'll just tell you the interpretation.

if AC > BC on the Rt Side, it means the Rt ear is either normal or has SNHL.
BC > AC Conducting hearing loss.

Let's take this pt as having AC > BC and compare with Webber later.

You need to compare this with Webber's test to find out if there's a defect.

2.Webber: again read the method from the book.

When you do Webber, a normal person will be able to hear equally with both ears but if ear hears better with one ear than the other, then you got a problem. Just draw a line towards the ear that hears better.

Supposing the left ear hears better than do it this way


Rt -----------------------------------> Lt
on the Rt the pt has SNHL........... On the Lt the pt has Conducting loss.



But again you cannot say what the problem is by just doing webber test as you can get 2 results.

Compare Rinne and webber and you will get the answer.

For this pt, he must be having Rt sided SNHL
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But is all this high yield? As in there's nothing about the ears in FA and just a couple of questions in FA while a detailed explanation is given in KLN.. You think we need to know the anatomy of ears as given in KLN??
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Old 05-14-2012
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Quote:
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But is all this high yield? As in there's nothing about the ears in FA and just a couple of questions in FA while a detailed explanation is given in KLN.. You think we need to know the anatomy of ears as given in KLN??
I remember only 2 types of questions on the exam - about organ Corti and the 2nd is about where is the low/high pitched sound is heard.

But I have had a questions about these tests on one of the NBME's...
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I remember only 2 types of questions on the QBANKS - about organ Corti and the 2nd is about where is the low/high pitched sound is heard.

But I have had a questions about these tests on one of the NBME's...
thats what I ment
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