Question:hard
A 38 year old gentleman reports of decreased hearing in the right ear for the past 2 years. On testing with a 512 Hz tuning fork, the Rinne's test (without masking) is negative on the right ear and positive on the left ear, with Weber's test perceived as louder in the left ear. The patient most likely has
A 38 year old gentleman reports of decreased hearing in the right ear for the past 2 years. On testing with a 512 Hz tuning fork, the Rinne's test (without masking) is negative on the right ear and positive on the left ear, with Weber's test perceived as louder in the left ear. The patient most likely has
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A falsely negative Rinne from severe unilateral sensorineural loss still shows a Weber that lateralizes to the healthy ear.
Updated On: Jul 8, 2026
- Right conductive hearing loss
- Right sensorineural hearing loss
- Left sensorineural hearing loss
- Left conductive hearing loss
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Read the Rinne result at face value.
On the right side, bone conduction beats air conduction, a negative Rinne. Taken alone, this usually points to a blocked middle ear on that side.
Step 2: Read the Weber result.
The sound is louder in the left ear during Weber's test. In a purely conductive problem, the ear with the block should sound louder in Weber, not the other ear. Here the louder side, left, is the opposite of the negative-Rinne side, right, so the two tests seem to disagree.
Step 3: Recall why a very damaged cochlea can trick the Rinne test.
If the right cochlea is badly damaged, a fork placed on the right mastoid still sends vibration through the skull bone to the left cochlea, which is healthy and picks it up well. The patient reports hearing the bone-conducted sound in that right test, but it is really the left ear doing the hearing. This makes the right Rinne look falsely negative, as though bone beats air, even with no true conductive block on the right.
Step 4: Resolve the disagreement.
Once we know the Rinne can be fooled this way, the Weber test becomes the deciding clue. Weber lateralizing to the left, the ear with normal hearing, is exactly what happens in sensorineural loss on the right, since the poorer cochlea cannot compete for the sound.
Step 5: Match against each choice.
A true right conductive loss needs Weber to go right, not left, so that is excluded. A left-sided problem, conductive or sensorineural, would need an abnormal left Rinne, but the left Rinne here is normal (positive), so the left ear is fine.
Step 6: Conclude.
$\text{Right sensorineural hearing loss}$ explains a falsely negative right Rinne together with a Weber that lateralizes to the healthy left ear.
\[ \boxed{\text{Right sensorineural hearing loss}} \]
On the right side, bone conduction beats air conduction, a negative Rinne. Taken alone, this usually points to a blocked middle ear on that side.
Step 2: Read the Weber result.
The sound is louder in the left ear during Weber's test. In a purely conductive problem, the ear with the block should sound louder in Weber, not the other ear. Here the louder side, left, is the opposite of the negative-Rinne side, right, so the two tests seem to disagree.
Step 3: Recall why a very damaged cochlea can trick the Rinne test.
If the right cochlea is badly damaged, a fork placed on the right mastoid still sends vibration through the skull bone to the left cochlea, which is healthy and picks it up well. The patient reports hearing the bone-conducted sound in that right test, but it is really the left ear doing the hearing. This makes the right Rinne look falsely negative, as though bone beats air, even with no true conductive block on the right.
Step 4: Resolve the disagreement.
Once we know the Rinne can be fooled this way, the Weber test becomes the deciding clue. Weber lateralizing to the left, the ear with normal hearing, is exactly what happens in sensorineural loss on the right, since the poorer cochlea cannot compete for the sound.
Step 5: Match against each choice.
A true right conductive loss needs Weber to go right, not left, so that is excluded. A left-sided problem, conductive or sensorineural, would need an abnormal left Rinne, but the left Rinne here is normal (positive), so the left ear is fine.
Step 6: Conclude.
$\text{Right sensorineural hearing loss}$ explains a falsely negative right Rinne together with a Weber that lateralizes to the healthy left ear.
\[ \boxed{\text{Right sensorineural hearing loss}} \]
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