Combined tuning fork tests in hearing loss: explorative clinical study of the patterns.

Objective: To combine the tuning fork tests of Rinne, Weber, and absolute bone conduction, explore their clinical patterns, and study their combined specificity, sensitivity, and validity in assessing the hearing status of an individual.

Design: A cross-sectional study of the tests of Rinne, Weber, and absolute bone conduction was done on 317 adult patients from the otolaryngology outpatient clinic selected at random. All possible patterns in the combination of three tests were explored, and their interpretations worked out. The findings were compared with those of pure-tone audiometry to check their sensitivity, specificity, and validity.

Results And Observations: Fifty-eight patterns were obtained, which were classified into 10 types (5 tables) according to the type of hearing loss. The type of hearing loss was determined in all cases, and the better ear was identified in many cases. The overall sensitivity was 76.86%, the specificity was 85.48%, and the validity was 78.54%.

Conclusions: The tuning fork tests of Rinne, Weber, and absolute bone conduction, when combined and interpreted, can be reliable initial diagnostic tools. They can be used to decide whether referral to a specialist or further audiometric testing is required. The patterns presented here depict the vast number of logical possibilities wherein the authenticity of these tests can be checked and the source of errors identified.