Acute Hearing Loss

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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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Sean G., M.D. -

Sorry but I thought the description in the audio of the weber is lacking....saying anything about air conduction and the weber test is misleading. The weber evaluates sensory neural hearing loss only and the pt will hear less in the affected ear. Air conduction is more clearly assessed w the Rinne, tuning fork next to ear will be quieter than applied to mastoid if there is air conduction loss in that ear....simple. This lecture just confused me and I had to go relearn what they taught in med school which confirmed why I was baffled by this...points away from points top yada yada....u have sensory neural hearing loss in left ear? The weber should be softer in left ear during the test. u have air conduction loss in the left ear, the Rinne shou/ld be louder on the mastoid than next to the pinna.

Clayton F. -

Dr. G, stating that the Weber only evaluates sensorineural hearing is untrue. The simple way to remember it is that the Weber goes AWAY from the side of a sensorineural loss or TOWARDS the side of a conductive loss. In fact, because of the amplification mechanism in the middle ear, the Weber is much more sensitive than the Rinne for a conductive loss: the Rinne requires around 20 dB or more of conductive loss (depending on the frequency) before the fork will "flip" and bone conduction will be sensed as louder than air conduction. Conceptualize the Weber in the setting of a conductive loss this way: vibrational energy is able to escape in a reverse manner through the ossicular chain and EAC on the good side, whereas on the side with the conductive loss, that energy is trapped in the temporal bone and the cochlea on that side therefore hears it with greater amplitude.
Note that we're only talking here about patients with a single kind of loss on only one side... the forks get rapidly more complicated with mixed and/or bilateral losses, and that's when having an audiologist nearby becomes very handy.

Jenny C. -

Not a question, just wanted to say thank you to Dr Finley - I used the weber test for the first time since I was an intern; had a 55 yo male w acute R tinnitus, nystagmus, and hearing loss. When the Weber localized to the non affected ear and I called our ENT specialist, discussed the case with my concern for sensorineural loss and my plan to start steroids, he was impressed and grateful for my thoroughness. So a big thanks, seriously

Clayton F. -

Nicely done Dr. C! Happy to be of service :)

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