Recommendations from British Society of Audiology (BSA)

Use a 512 Hz Tuning Fork, activated by striking tines on practitioner’s elbow or ball of hand

First perform Weber Test

The Weber test is a test of lateralisation and establishes where a tone is perceived.
Strike the tuning fork and place it on the midline, typically on the patient’s forehead

Results

1. Sound heard centrally: symmetrical normal hearing or symmetrical hearing loss

2. Sound lateralised to one side:
   Sound lateralises towards conductive hearing loss ear (ipsilateral conductive deafness)
   Sound lateralises away from sensorineural hearing loss ear (contralateral sensorineural deafness)

For example, sound lateralised to left ear: left conductive deafness OR right sensorineural deafness

Then perform Rinne Test

This test is a comparison of loudness of perceived air conduction to bone conduction in one ear at a time.

The practitioner should start with the ear where the Weber has lateralised to (if appropriate).

1. Test Air conduction first: Strike the tuning fork and hold the tines of the tuning fork approximately 25mm from the ear canal entrance. The vibrating fork should be held parallel to the acoustic axis of the vibrating tines. Hold the tuning fork there for about 2 seconds.

2. Test Bone conduction next: Without any interruption and without touching the tines press the footplate firmly against the mastoid. Hold the tuning fork in place for another 2 seconds.

3. Repeat testing process in other ear.

Results

Positive Rinne test: air conduction (next to the ear canal) is louder than bone conduction (held on mastoid)
Negative Rinne test: Bone conduction (held on mastoid) is louder than air conduction (next to the ear canal)

Rinne positive (air>bone): normal hearing or ipsilateral sensorineural hearing loss
Rinne negative (bone>air): ipsilateral conductive hearing loss