A patient with profound unilateral sensorineural hearing loss undergoes tuning fork tests. The examiner is surprised to find the Rinne test NEGATIVE on the affected side. This 'false negative' Rinne occurs because:
- A The fork on the mastoid is heard by the opposite cochlea through transcranial transmission ✓
- B Bone conduction bypasses the outer and middle ear and is always better than air conduction
- C Severe cochlear damage paradoxically enhances perception of low-frequency vibration
- D The fork placed near the canal produces an occlusion effect in the dead ear
Correct answer: A. The fork on the mastoid is heard by the opposite cochlea through transcranial transmission
Explanation
In profound unilateral sensorineural loss, neither air nor bone conduction is perceived by the diseased ear. Bone conduction applied to the affected mastoid crosses the skull and stimulates the healthy contralateral cochlea, so the patient reports bone conduction as heard and air conduction as not heard, mimicking a negative Rinne. The Weber test, which lateralises away from the dead ear, exposes this error.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.