These noninvasive assessment procedures are done to distinguish conduction hearing loss from sensorineural hearing loss. They may be performed as part of the physical assessment examination and followed by hearing loss audiometry for confirmation of questionable results. The tuning fork tests described in this monograph are named for the four German otologists who described their use. Tuning fork tests are used less frequently by audiologists in favor of more sophisticated electronic methods, but presentation of the tuning fork test methodology is useful to illustrate the principles involved in electronic test methods.

A tuning fork is a bipronged metallic device that emits a clear tone at a particular pitch when it is set into vibration by holding the stem in the hand and striking one of the prongs or tines against a firm surface. The Bing test samples for conductive hearing loss by intermittently occluding and unblocking the opening of the ear canal while holding a vibrating tuning fork to the mastoid process behind the ear. The occlusion effect is absent in patients with conductive hearing loss and is present in patients with normal hearing or with sensorineural hearing loss. The Rinne test compares the patient’s own hearing by bone conduction to his or her hearing by air conduction to determine whether hearing loss, if detected, is conductive or sensorineural. The Schwabach test compares the patient’s level of bone conduction hearing to that of a presumed normal-hearing examiner. The Weber test has been modified by many audiologists for use with electronic equipment. When the test is administered, the patient is askedto tell the examiner the location of the tone heard (left ear, right ear, both ears, or midline) in order to determine whether the hearingloss is conductive, sensorineural, or mixed.