Gelle test is performed using a tuning fork on the mastoid with intermittent positive pressure applied via a Siegel speculum. In a patient with stapes fixation due to otosclerosis, the expected result is:

• A Gelle negative, no change in perceived loudness with pressure ✓
• B Gelle positive, loudness decreases with pressure
• C Loudness increases with pressure due to mobilisation of the annular ligament
• D Result depends entirely on cochlear reserve, so it cannot be interpreted

Explanation

In a normally mobile ossicular chain, raising canal pressure displaces the tympanic membrane inward and reduces mobility of the chain, so the perceived loudness of the bone-conducted tone decreases; this is a positive Gelle test. When the stapes is fixed, as in otosclerosis, canal pressure cannot alter basilar membrane stimulation, loudness is unchanged, and the test is negative. Cochlear reserve determines whether the tone is heard at all, but not the direction of the result.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.