---
title: "Tuning Fork Tests in ENT | Rinne, Weber, Absolute Bone Conduction, Schwabach, Bing & Gelle Test"
description: "ENT notes on Tuning Fork Tests including Rinne Test, Weber Test, Absolute Bone Conduction Test, Schwabach Test, Bing Test and Gelle Test."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/tuning-fork-tests-rinne-weber-absolute-bone-conduction"
categories: ["Otology", "History and Clinical Examination"]
video: "https://www.youtube.com/watch?v=cV4Kd-n-Qkg"
image: "https://media.theentresident.com/og-images/tuning-fork-tests-rinne-weber-absolute-bone-conduction.png"
---

# Tuning Fork Tests in ENT | Rinne, Weber, Absolute Bone Conduction, Schwabach, Bing & Gelle Test

ENT notes on Tuning Fork Tests including Rinne Test, Weber Test, Absolute Bone Conduction Test, Schwabach Test, Bing Test and Gelle Test. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=cV4Kd-n-Qkg

## 🎵 Tuning Fork Tests

Tuning fork tests are important clinical tests used to determine the **type of hearing loss** a patient may have.

In this post, we will discuss:

* Rinne's Test
* Weber's Test
* Schwabach's Test
* Absolute Bone Conduction (ABC) Test
* Bing's Test
* Gelle's Test

---

### Basic Principles of Tuning Fork Tests

#### 🎚️ Frequencies of Tuning Forks

Tuning forks are available in the following frequencies:

* 128 Hz
* 256 Hz
* 512 Hz
* 1024 Hz
* 2048 Hz
* 4096 Hz

Commonly used in routine practice:

* 256 Hz
* 512 Hz
* 1024 Hz

> Which is the most Preferred frequency of Tuning Fork used? Why?

#### 🔔 How to Activate a Tuning Fork

The tuning fork is vibrated by striking it against:

* Examiner's elbow
* Heel of the hand

❌ Never strike it on a hard surface

> Why should you never strike a tuning fork on a hard surface?

---

### Air Conduction & Bone Conduction

Tuning fork tests assess two things:

1- Air Conduction (AC)

2- Bone Conduction (BC)

#### 👂 Air Conduction

**How is it Tested?**

The vibrating tuning fork is placed **vertically, parallel to the external auditory canal**, at a distance of about **2 cm** from its opening.

**Pathway of Air Conducted Sound**

External auditory canal → Tympanic membrane → Ossicles → Cochlea → Auditory nerve → Central auditory pathway

> What does Air conduction Test?

⭐ Normally, air conduction is **louder and longer** than bone conduction.

#### 🦴 Bone Conduction

**How is it Tested?**

The footplate of the vibrating tuning fork is placed **firmly on the mastoid process**.

**Pathway of Bone Conducted Sound**

Bone conduction **directly stimulates the cochlea**, bypassing the external and middle ear.

> What does Bone conduction Test?

---

### Types of Hearing Loss

#### 1- Conductive Hearing Loss

Caused by a blockage anywhere in the **conductive pathway**.

**Example:** Wax in the external auditory canal

* Air conduction → **Reduced**
* Bone conduction → **Normal** (bypasses external and middle ear)

#### 2- Sensorineural Hearing Loss

Caused by damage to the **sensorineural pathway**.

* Bone conduction → **Reduced**

---

### Rinne's Test

#### 🩺 How is it Performed?

1- Vibrating tuning fork is placed on the **mastoid process**

2- Patient indicates when he stops hearing the sound

3- Tuning fork is immediately shifted **2 cm in front of, and parallel to, the external auditory canal**

4- If the patient still hears the sound → **Air conduction is more than bone conduction**

> What is the Principle of Rinne's test?

> Instead of comparing duration, what other parameter canbe compared in Rinne's test?

#### 📊 Interpretation

| Finding | Result | Seen In |
| --- | --- | --- |
| AC > BC | Rinne Positive | Normal, Sensorineural hearing loss |
| BC > AC | Rinne Negative | Conductive hearing loss |

> Why is AC > BC in Sensorineural hearing loss?

> Why is BC > AC in Conductive hearing loss?

#### 💡 Mnemonic to remember Rinne test findings

**CORN & SERP**

* **CORN** → **CO**nductive hearing loss → **R**inne **N**egative
* **SERP** → **SE**nsorineural hearing loss → **R**inne **P**ositive

#### 📏 Predicting the Air-Bone Gap Using Rinne's Test

The air-bone gap can be predicted even before audiometry.

| Rinne Negative For | Rinne Positive For | Air-Bone Gap |
| --- | --- | --- |
| 256 Hz | 512 Hz, 1024 Hz | 20–30 dB |
| 256 Hz, 512 Hz | 1024 Hz | 30–45 dB |
| 256 Hz, 512 Hz, 1024 Hz | — | 45–60 dB |

#### ⚠️ False Negative Rinne (Important MCQ)

👉 Seen in **Severe unilateral sensorineural hearing loss**

> What is the mechanism behind False negative Rinne seen in Severe unilateral sensorineural hearing loss?

**How to Avoid a False Negative Rinne?**

* Mask the non-test ear with **Barany's noise box** before performing bone conduction

> What is Barany's noise box?

---

### Weber's Test

#### 🔍 Principle

Based on **lateralization of sound through bone conduction**.

* Weber's test is a test of **bone conduction**
* Therefore, it is a test of **cochlear function**

Weber's test determines:

✅ Side of hearing loss

✅ Type of hearing loss

❌ Does not determine degree of hearing loss

#### 🩺 How is it Performed?

The vibrating tuning fork is placed on the:

* Middle of the forehead
* Vertex

The patient is asked in which ear the sound is heard better.

#### 📊 Interpretation

| Hearing Status | Result |
| --- | --- |
| Normal | Heard equally in both ears |
| Conductive hearing loss | Lateralized to the affected (poorer) ear |
| Sensorineural hearing loss | Lateralized to the better ear |

> Explain the mechanism behind the findings seen in Weber's test in Conductive hearing loss and Sensorineural hearing loss.

> Which test is more sensitive - Rinne's test or Weber's Test? Why?

---

### Schwabach's Test

#### 🔍 Principle

Compares the **bone conduction of the patient** with that of the **examiner**, assuming the examiner has normal hearing.

The type of hearing loss is determined by comparing the **duration of bone conduction**.

#### 🩺 How is it Performed?

1- Vibrating tuning fork is placed on the patient's **mastoid process**

2- Patient signals when he stops hearing the sound

3- Tuning fork is immediately placed on the **examiner's mastoid**

4- Examiner checks whether the sound is still heard

#### 📊 Interpretation

| Result | Finding | Seen In |
| --- | --- | --- |
| Normal | Patient and examiner hear for the same duration | Normal hearing |
| Lengthened | Patient hears longer than examiner | Conductive hearing loss |
| Shortened | Patient hears for a shorter duration than examiner | Sensorineural hearing loss |

> Explain the mechanism behind the findings seen in Schwabach's test in Conductive hearing loss and Sensorineural hearing loss.

---

### Absolute Bone Conduction (ABC) Test

📌 Also Known As **Modified Schwabach's Test**.

#### 🔍 Principle

* Compares the bone conduction of the patient with that of the examiner
* Air conduction is blocked by **occluding the external auditory canal by pressing the tragus inwards**

> What is the Absolute Bone Conduction Test checking?

> Why is Absolute Bone Conduction Test also known as Modified Schwabach's Test?

#### 🩺 How is it Performed?

1- External auditory canals of **both patient and examiner** are occluded by pressing the tragus inwards

2- Vibrating tuning fork is placed on the patient's **mastoid process**

3- Patient signals when he stops hearing the sound

4- Tuning fork is immediately placed on the **examiner's mastoid**

5- Examiner checks whether the sound is still heard

#### 📊 Interpretation

| Hearing Status | Result |
| --- | --- |
| Normal | Same as examiner |
| Conductive hearing loss | Same as examiner |
| Sensorineural hearing loss | Reduced |

> Why is there No Role of Absolute Bone Conduction Test in Conductive Hearing Loss?

#### ⚖️ Schwabach's Test vs ABC Test

| Parameter | Schwabach's Test | ABC Test |
| --- | --- | --- |
| External auditory canal | Not occluded | Occluded by pressing tragus inwards |
| Component Tested | Air conduction + Bone conduction | Bone conduction only |

> Which test is more sensitive - Absolute Bone Conduction test or Schwabach's Test? Why?

---

### Bing's Test

#### 🔍 Principle

* Test of **bone conduction**
* Tests the effect of **ear canal occlusion** on hearing

#### 🩺 How is it Performed?

1- Vibrating tuning fork is placed on the patient's **mastoid process**

2- External auditory canal is alternately **opened and closed** by pressing the tragus inwards and outwards

#### 📊 Interpretation

| Result | Finding | Seen In |
| --- | --- | --- |
| Bing Positive | Louder when canal is occluded, softer when open | Normal, Sensorineural hearing loss |
| Bing Negative | No change in loudness | Conductive hearing loss |

> Explain the mechanism behind the findings seen in Bing's test in Conductive hearing loss and Sensorineural hearing loss.

---

### Gelle's Test

#### 🔍 Principle

* Test of **bone conduction**
* Tests the effect of **increased air pressure in the ear canal** on hearing

#### 🩺 How is it Performed?

1- Vibrating tuning fork is placed on the patient's **mastoid process**

2- Air pressure in the ear canal is increased using **Siegel's speculum**

#### 📊 Interpretation

| Result | Finding | Seen In |
| --- | --- | --- |
| Gelle Positive | Sound becomes softer with air pressure | Normal, Sensorineural hearing loss |
| Gelle Negative | No change in loudness | Conductive hearing loss (Otosclerosis) |

> Explain the mechanism behind the findings seen in Gelle's test in Conductive hearing loss and Sensorineural hearing loss.

#### ⚠️ Important Viva Point

* Gelle's test was earlier used to detect **Otosclerosis**
* It has now been replaced by **Tympanometry**, a more sensitive test

> What is Tympanometry?

---

### ⭐ High Yield Rapid Revision Table for Tuning fork tests

| Test | Normal | Conductive Hearing Loss | Sensorineural Hearing Loss |
| --- | --- | --- | --- |
| Rinne's Test | Positive (AC > BC) | Negative (BC > AC) | Positive (AC > BC) |
| Weber's Test | Equal in both ears | Lateralized to affected ear | Lateralized to better ear |
| Schwabach's Test | Same as examiner | Lengthened | Shortened |
| ABC Test | Same as examiner | Same as examiner | Reduced |
| Bing's Test | Positive | Negative | Positive |
| Gelle's Test | Positive | Negative | Positive |

---

### 🧠 Viva Pearls

* A tuning fork is vibrated by striking it against the examiner's elbow or heel of the hand, never on a hard surface.
* Air conduction tests both conductive and sensorineural pathways.
* Bone conduction tests only the sensorineural pathway.
* Normally, air conduction is louder and longer than bone conduction.
* Rinne negative is seen in conductive hearing loss.
* False negative Rinne is seen in severe unilateral sensorineural hearing loss.
* False negative Rinne is avoided by masking the non-test ear with Bárány's noise box.
* Weber's test determines the side and type of hearing loss, but not the degree.
* Weber's test is lateralized to the poorer ear in conductive hearing loss and to the better ear in sensorineural hearing loss.
* Weber's test is more sensitive than Rinne's test.
* Schwabach's test is lengthened in conductive hearing loss.
* ABC test is also known as Modified Schwabach's test.
* ABC test is more sensitive than Schwabach's test.
* Bing's test is negative in conductive hearing loss.
* Gelle's test is negative in otosclerosis and has been replaced by tympanometry.

---

## About This Note

This free ENT note on Tuning Fork Tests in ENT | Rinne, Weber, Absolute Bone Conduction, Schwabach, Bing & Gelle Test was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

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