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It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid. Thus, one can quickly screen for the presence of conductive hearing loss. [2] A Rinne test should always be accompanied by a Weber test to also detect sensorineural hearing loss and thus confirm the nature of hearing loss.
A conductive hearing loss is characterized by a difference of at least 15 decibels between the air conduction threshold and bone conduction threshold at the same frequency. On an audiogram, the "x" represents responses in the left ear at each frequency, while the "o" represents responses in right ear at each frequency.
The shape of the audiogram resulting from pure-tone audiometry gives an indication of the type of hearing loss as well as possible causes. Conductive hearing loss due to disorders of the middle ear shows as a flat increase in thresholds across the frequency range. Sensorineural hearing loss will have a contoured shape depending on the cause.
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A patient with a unilateral conductive hearing loss would hear the tuning fork loudest in the affected ear. This is because the ear with the conductive hearing loss is only receiving input from the bone conduction and no air conduction, and the sound is perceived as louder in that ear. [10]
PTA can be used to differentiate between conductive hearing loss, sensorineural hearing loss and mixed hearing loss. A hearing loss can be described by its degree i.e. mild, moderate, severe or profound, or by its shape i.e. high frequency or sloping, low frequency or rising, notched, U-shaped or 'cookie-bite', peaked or flat.
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