Editing Weber test (section)

==Weber test performance==
The Weber and the [[Rinne test]] ({{IPAc-en|ˈ|r|ɪ|n|ə}} {{respell|RIN|ə}})<ref>{{Cite journal|last1=Vaswani|first1=Ravi|last2=Parikh|first2=Leena|last3=Udochi|first3=Njideka|last4=Vaswani|first4=Surender K.|date=2008-10-10|title=Rinne test modified to quantify hearing|journal=Southern Medical Journal|volume=101|issue=1|pages=107–108|doi=10.1097/SMJ.0b013e31815d3d4d|issn=1541-8243|pmid=18176307}}</ref> are typically performed together when the results of each combined to determine the location and nature of any hearing losses detected.  In the Weber test a vibrating [[tuning fork]] (Typically 256&nbsp;Hz <ref>{{Cite book | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK231/ | isbn=9780409900774| title=Clinical Methods: The History, Physical, and Laboratory Examinations| chapter=The Ear and Auditory System| publisher=Butterworths| year=1990| pmid=21250075| last1=Walker| first1=H. K.| last2=Hall| first2=W. D.| last3=Hurst| first3=J. W.| last4=Turner Js| first4=J. R.}}</ref> or 512&nbsp;Hz <ref>{{Cite web | url=http://american-hearing.org/disorders/hearing-testing/ | title=Understanding Hearing & Balance}}</ref> used for Weber '''vibration''' test; 512&nbsp;Hz used for Rinne '''hearing''' test) is placed in the middle of the forehead, above the upper lip under the nose over the teeth, or on top of the head equidistant from the patient's ears on top of thin skin in contact with the bone. The patient is asked to report in which ear the sound is heard louder.  A normal Weber test has a patient reporting the sound heard equally in both sides.  In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear.  Also in the affected patient, if the normal ear hears the tuning fork sound better, there is sensorineural hearing loss on the other (defective) ear.  However, this assumes that it is known which ear is defective and which is normal (e.g. by the patient telling the clinician that they cannot hear as well in one ear as in the other), when the testing is being done to characterize the type, conductive or sensorineural, of hearing loss that is occurring.  In the case where the patient is unaware or has acclimated to their hearing loss, the clinician has to use the Rinne test in conjunction with the Weber to characterize and localize any deficits.  That is, an abnormal Weber test is only able to tell the clinician that there is a conductive loss in the ear which hears better or that there is a sensorineural loss in the ear which does not hear as well.

For the [[Rinne test]], a vibrating tuning fork (typically 512&nbsp;Hz) is placed initially on the mastoid process behind each ear until sound is no longer heard. Then, without re-striking the fork, the fork is then quickly placed just outside the ear with the patient asked to report when the sound caused by the vibration is no longer heard.  A normal or '''positive Rinne''' test is when sound is still heard when the tuning fork is moved to the air near the ear (air conduction or AC), indicating that AC is equal or greater than bone conduction (or BC).  Therefore, AC > BC; which is how it is reported clinically for a normal or positive Rinne result.  In conductive hearing loss, bone conduction is better than air or BC > AC, a '''negative Rinne,''' if the patient reports that they do not hear the fork once it is moved.  The Rinne test is not ideal for distinguishing sensorineural hearing loss, as both sensorineural hearing loss and normal hearing report a positive Rinne test (though the sensorineural patient will have a decreased duration of hearing sound once the fork is moved to air).

In a normal patient, the Weber tuning fork sound is heard equally loudly in both ears, with no one ear hearing the sound louder than the other (lateralization).  Similarly, a patient with symmetrical hearing loss will hear the Weber tuning fork sound equally well, with diagnostic utility only in asymmetric (one-sided) hearing losses. In a patient with hearing loss, the Weber tuning fork sound is heard louder in one ear (lateralization) than the other.  This clinical finding should be confirmed by repeating the procedure and having the patient occlude one ear with a finger; the sound should be heard best in the occluded ear.

The results of both tests are noted and compared accordingly below to localize and characterize the nature of any detected hearing losses.  Note: the Weber and Rinne are screening tests that are not replacements for formal audiometry hearing tests.  Reported test accuracy measurements are very variable for clinical screening, surgical candidacy assessments, and estimation of hearing loss severity.<ref>{{Cite journal|last1=Kelly|first1=Elizabeth A.|last2=Li|first2=Bin|last3=Adams|first3=Meredith E.|date=2018-08-08|title=Diagnostic Accuracy of Tuning Fork Tests for Hearing Loss: A Systematic Review|journal=Otolaryngology–Head and Neck Surgery |volume=159|issue=2|pages=220–230|doi=10.1177/0194599818770405|issn=1097-6817|pmid=29661046|s2cid=4952175}}</ref><ref name="pmid16434632" />

{| class="wikitable"
! colspan=2 {{diagonal split header 2|<br />Rinne test|Weber test}}
! colspan=2 | lateralizes to left
! no lateralization
! colspan=2 | lateralizes to right
|-
! left ear !! right ear
! left ear !! right ear
! both ears
! left ear !! right ear
|-
! rowspan=2 | <big>⊕</big>
! rowspan=2 | <big>⊕</big>
| rowspan=2 | Normal
| rowspan=2 | '''SN''' loss
| Normal
| rowspan=2 | '''SN''' loss
| rowspan=2 | Normal
|-
| '''SN''' loss
|-
! <big>⊖</big>
! <big>⊕</big>
| '''Conductive''' loss
| Normal
| rowspan=2 | (no such condition)
| '''Combined''' loss
| Normal
|-
! <big>⊕</big>
! <big>⊖</big>
| Normal
| '''Combined''' loss
| Normal
| '''Conductive''' loss
|-
! <big>⊖</big>
! <big>⊖</big>
| '''Conductive''' loss
| '''Combined''' loss
| '''Conductive''' loss
| '''Combined''' loss
| '''Conductive''' loss
|-
| colspan="8" |'''SN''' loss = '''Sensorineural''' loss, '''Combined''' loss = '''Conductive''' & '''Sensorineural''' loss 

|}