Question

A patient presented with c/o hearing loss and the otoscopy finding shown. What will be the Rinne test finding?

• A. True positive
• B. True negative
• C. False positive
• D. False negative

Hint:

Conductive loss gives BC > AC (Rinne negative); if the otoscopy proves real middle-ear disease, the negative is true.

Answer 1

The Correct Option is B

Step 1: Interpret the otoscopy. The otoscopic image shows an abnormal tympanic membrane / middle-ear pathology (e.g. a perforation, retraction or middle-ear disease) consistent with a conductive hearing loss (CHL) in that ear.

Step 2: Recall how the Rinne test works. A tuning fork (512 Hz) compares air conduction (AC, fork held near the ear canal) with bone conduction (BC, fork on the mastoid). Normally AC > BC, called Rinne positive. In conductive hearing loss the air-conduction pathway is impaired so BC > AC in that ear, called Rinne negative.

Step 3: Define the qualifiers. A true (Rinne) negative is a genuine negative Rinne caused by true conductive loss in the tested ear (BC > AC because of that ear's middle-ear pathology). A false (Rinne) negative occurs in severe/total sensorineural loss of the tested ear, where the patient hears the bone-conducted sound through the opposite (better) cochlea by cross-conduction and so reports BC > AC even though there is no conductive component.

Step 4: Apply to this patient. The otoscopy demonstrates genuine middle-ear (conductive) pathology, so the negative Rinne is real - a true negative. Hence option B is correct.

Step 5: Exclude the distractors.
- True positive (A): AC > BC, a normal/healthy or sensorineural-loss ear - does not fit the visible CHL.
- False positive (C): not a standard meaningful Rinne category here.
- False negative (D): requires severe SNHL with cross-hearing, not the conductive picture shown.

Final answer: B. True negative.