Question

A 27-year-old male presents with recurrent ear infection. Otoscopic examination shows central perforation of tympanic membrane. Tuning fork examination reveals: Rinne negative on left and positive on right; Weber lateralization to left. What is the type and localization of hearing loss?

• A. Left sensorineural hearing loss
• B. Right sensorineural hearing loss
• C. Left conductive hearing loss
• D. Right conductive hearing loss

Hint:

Rinne negative + Weber lateralizes to same ear = conductive hearing loss in that ear.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
This clinical scenario involves interpreting tuning fork tests (Rinne and Weber) to differentiate between Conductive Hearing Loss (CHL) and Sensorineural Hearing Loss (SNHL) in a patient with a known ear pathology.
Step 2: Key Concepts of Tuning Fork Tests:

Rinne Test: Positive (+ve) means Air Conduction (AC) > Bone Conduction (BC), which is Normal or SNHL. Negative (-ve) means BC > AC, which is diagnostic of Conductive Hearing Loss.

Weber Test: Sound lateralizes to the ear with Conductive loss or to the better-hearing ear in Sensorineural loss.

Step 3: Detailed Explanation:

Evaluating the Left Ear: The Rinne test is negative (-ve) on the left. This indicates that Bone Conduction is perceived better than Air Conduction on that side, pointing toward a Conductive Hearing Loss (CHL) on the left.

Evaluating the Right Ear: The Rinne test is positive (+ve) on the right, suggesting the right ear has either normal hearing or SNHL.

Evaluating the Weber Test: The sound lateralizes to the left side. In the presence of a negative Rinne on the left, this lateralization confirms that the left ear is the affected side with Conductive Hearing Loss. In CHL, the "bad" ear hears the bone conduction better because it is shielded from the masking effect of ambient room noise.

Clinical Correlation: The otoscopic finding of a "central perforation" is the classic physical finding for the mucosal type of Chronic Suppurative Otitis Media (CSOM), which by its nature causes a conductive deficit by impairing the transformer mechanism of the middle ear.

Step 4: Final Answer:
The negative Rinne on the left and Weber lateralization to the left side collectively diagnose Left Conductive Hearing Loss.