HY USMLE Q #1582 – Rinne vs Weber tests

Added: 2026-05-28

[00:00:00]How's it going, guys? So, we have a difficult question. If you don't know these tests, it's a very easy question if you do know these tests, okay? So, we have a 59-year-old woman, progressive history of hearing loss in her left ear over 6 months, and physical exam shows cerumen impaction in the left ear.

[00:00:18]Cerumen is the medical word for earwax.

[00:00:22]It's not fancy, you just got to know this, okay? Which of the following most likely be seen in this patient? So, if you have earwax build-up in the left ear, that's conductive hearing loss in the left ear.

[00:00:34]Doesn't take a rocket scientist to figure that out.

[00:00:37]So, the Rinne test is where you strike the tuning fork, you place the base against the mastoid bone, then you place the tuning fork prongs, which are still vibrating, in front of the ear canal. If you can hear the sound again, then we say air conduction greater than bone conduction. That is normal, and that's because the ossicles, the middle ear bones, amplify sound better than the mastoid bone does.

[00:01:05]So, in a normal patient, AC greater than BC with the Rinne test, this is also what we see with neurosensory hearing loss, AC greater than BC. And this is because the amplification of sounds by the middle ear bones still allows more sounds to reach the cochlea, even if there's damage at the cochlea.

[00:01:25]With conductive hearing loss, let's say cerumen impaction like we have here, otosclerosis, which is a term used for hardening, stiffening of the middle ear bones, age 20 year older, familial association, patient, let's say, has acute otitis media. If we have conductive hearing loss, then the amplification of the middle ear bones not going to be able to do their job the way they're supposed to, or we have a problem in the ear canal. So, bone conduction greater than air conduction. So, for starters, Rinne test, air conduction greater than bone conduction is neurosensory hearing loss as well as normal patients.

[00:02:04]Bone conduction greater than air conduction conductive hearing loss. So, in this [clears throat] patient we expect bone conduction greater than air conduction. We're looking at C and D here. This is our conductive hearing loss for Rinne.

[00:02:20]Now, the Weber test, we strike the tuning fork, place the base on the center of the forehead, and you ask the patient which side does it lateralize to? Which side is it louder in?

[00:02:31]They tell you it's the same in both ears, that's the midline, that's normal patients. Fine.

[00:02:36]If you have neurosensory hearing loss, let's say loss of stereocilia due to noise damage, or there's an acoustic neuroma, then you're not going to be able to have sound transit through the bone to the cochlea, so it's going to be louder in the contralateral ear in neurosensory.

[00:02:55]In conductive hearing loss, it lateralizes to the affected ear because you're blocking out the environmental sound coming from that side, so the patient perceives that bone conduction as louder.

[00:03:11]So, if we have conductive hearing loss on the left side, we would expect it to be louder in the left ear, the Weber.

[00:03:19]So, choice C is our correct answer here.

[00:03:22]So, let's play a little game here.

[00:03:24]What would choice A refer to in terms of neurosensory and conductive?

[00:03:31]And which side?

[00:03:34]So, we said that if air conduction is greater than bone conduction for Rinne, that's normal {slash} neurosensory.

[00:03:40]So, if we're talking about the left ear, this would have to be neurosensory in the left ear, choices A and B.

[00:03:47]And then, so if we have neurosensory in the left ear for A and B here, would we expect A or B to be correct for neurosensory in the left ear I'm asking?

[00:03:59]Well, B would be the correct answer for neurosensory in the left ear cuz we said it's air conduction greater than bone conduction for Renee and that lateralizes to the contralateral ear in neurosensory. You understand?

[00:04:16]Choice D, wrong [ __ ] answer.