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How does the Rinne tuning-fork test help identify conductive hearing loss?

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The Rinne test is a qualitative assessment used to differentiate between conductive and sensorineural hearing loss by comparing air conduction to bone conduction.1

To perform the test, a sounding tuning fork is first placed on the mastoid process until the patient can no longer hear the vibration. The examiner then immediately moves the fork near the ear canal. In a normal ear, or one with sensorineural impairment, the sound remains audible through the air longer than through the bone, which is considered a "positive" result.1

A "negative" result—where the sound is heard longer via bone conduction than through air conduction—indicates the presence of conductive hearing loss. This occurs because the conductive mechanism, which normally facilitates sound transmission to the inner ear, is impaired, preventing the efficient passage of sound through the outer and middle ear.21