Question

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. Right conductive hearing loss
• B. Right sensorineural hearing loss
• C. Left sensorineural hearing loss
• D. Left conductive hearing loss

Hint:

A falsely negative Rinne from severe unilateral sensorineural loss still shows a Weber that lateralizes to the healthy ear.

Answer 1

The Correct Option is B

Step 1: Recall what a normal Rinne test means.
The Rinne test compares air conduction (AC) and bone conduction (BC) in one ear. Normally AC is louder and longer than BC, called a positive Rinne. A negative Rinne, where BC is heard louder or longer than AC, is the classic sign of conductive hearing loss in that ear, because the middle ear is not transmitting sound well through air.

Step 2: Recall what Weber's test tells us.
In Weber's test a vibrating tuning fork is placed on the midline of the skull. In conductive hearing loss the sound lateralizes to the affected ear, because the blocked middle ear shuts out background masking noise. In sensorineural hearing loss the sound lateralizes to the better, normal ear, because the damaged cochlea on the bad side cannot pick up the signal as well.

Step 3: Put the two findings together.
Here the Rinne is negative on the right, which alone would suggest a right conductive loss. But Weber lateralizes to the left ear, that is, away from the ear with the negative Rinne. This combination does not fit simple conductive loss, where Weber should have gone to the same (right) ear.

Step 4: Recognize the false negative Rinne.
When one ear has severe or profound sensorineural hearing loss, a tuning fork placed on the mastoid of that bad ear can still be heard, not by the damaged cochlea, but because the vibration travels through the skull bone and is picked up by the good cochlea on the other side. This makes bone conduction seem present or even louder than air conduction in the bad ear, producing a Rinne test that looks negative even though the ear has no real conductive problem. This is called a false negative Rinne.

Step 5: Apply this to the case.
The right ear shows a falsely negative Rinne because the right cochlea is so severely affected that the left cochlea is actually picking up the bone-conducted sound. The true finding is a right sensorineural hearing loss, confirmed by the Weber test lateralizing to the good left ear, exactly as expected in sensorineural loss.

Step 6: Rule out the other options.

(A) Right conductive hearing loss: Would need Weber to lateralize to the right ear, not the left, so this does not fit.

(C) Left sensorineural hearing loss: The left ear has a normal, positive Rinne and Weber lateralizes toward it, meaning the left ear is the better ear, not the diseased one.

(D) Left conductive hearing loss: A conductive loss on the left would make Weber go to the left, which matches on its own, but the left Rinne here is positive, not negative, so the left ear is not conductively affected.

Step 7: Final Answer.
The findings fit a severe right sensorineural hearing loss causing a false negative Rinne test on the right, with Weber correctly lateralizing to the healthy left ear.
\[ \boxed{\text{Right sensorineural hearing loss}} \]