Which of the following does not show negative Rinne test in the right ear?
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Correct Answer:
Sensorineural hearing loss of 45 dB ion left ear and normal right ear
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Ans. a. Sensorineural hearing loss of 45 dB ion left ear and normal right ear (Ref Dhingra 5/e p23; A Short Textbook of ENT diseases by K.B. Bhargava, S. K. Bhargava and T.M. Shah s; 7/e pe p23-24)Sensorineural hearing loss of 45 dB in left ear and normal right ear - will show a positive Rinne s test in both the ears, not the negative.Sensorineural hearing loss of 45 dB in left ear and normal right ear - will show a positive Rinne's test in both the ears. Conductive hearing loss of 40 dB in both ears will show negative Rinne's test in both the ears.Conductive hearing loss of 40 dB in right ear and left ear normal will show a positive Rinne's test in left ear and negative in right ear.Profound hearing loss may show a false negative Rinne's test in the right earRINNE TESTPrincipleIt compares the duration of air conduction (AC) and bone conduction (BC) of the sound of the same ear.ProcedureThe tuning fork is set into vibrations and placed near the ear canal for testing AC.When the patient stops hearing, its footplate is transferred to the suprameatal region behind the ear, and BC is testedIf AC is better than BC, the patient does not hear any sound on transferring the tuning fork to the suprameatal region.If necessary, the test can be reversed by testing BC first and AC, later.In practice, it is usually sufficient to ask the patient to compare the loudness of the sound heard by AC and by BC, instead of comparing the duration of the sound.InterpretationsRinnc Positive: When AC is better than BCQ. It indicates-Normal hearingQSensorineural deafnessQ. in which AC and BC are both reduced or absent.Rinne Negative: When BC is better than ACC It indicates-Conductive deafness (For Rinne test to become netgative, hearing loss has to be greater than 15 dB)Q.Rinne Equivocal: When AC and BC are both equalQ It indicates-Very mild conductive deafness (of less than 15 dB).False Rinne NegativWhen a person has severe unilateral sensorineural deafnessQ, his AC and BC are markedly reduced on the diseased side.But the patient may still indicate a better BC on the diseased side.It is due to crossing of the sound from the affected ear to the normal ear through the skull. and the patient actually hears through the opposite normal earQ.This can be avoided by masking the normal earQ.Masking is the presentation of a continuous noise to the normal ear to prevent crossing of the sound from the bad ear to the good ear.This can be achieved by:Making a rustling noise with a piece of paper in the earBaranv noise box which produces noise mechanically to block the better earAudiometry, by presenting noise to the good ear while the bad ear is being testing. Audiometry allows precise masking.
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