A 45-year-old woman complains of inability to hear with the left ear after sudden deafness 2 years ago. Pure-tone audiometry shows profound sensorineural loss in the left ear with normal right ear hearing. Rinne test performed on the left mastoid: the patient reports she does NOT hear the fork when held near the left ear canal, but DOES hear it when placed on the left mastoid. This apparent 'negative' Rinne in a dead ear is explained by:

• A Ossicular fixation in the left middle ear
• B Transcranial transmission of bone-conducted sound to the opposite normal cochlea ✓
• C Recruitment in the profoundly deaf left ear
• D Non-organic exaggeration of the hearing loss

Explanation

In a severe unilateral sensorineural loss, bone-conducted vibrations from the fork on the affected mastoid cross the skull and stimulate the normal contralateral cochlea. The patient therefore 'hears' bone conduction but not air conduction, giving a false negative Rinne despite a purely sensorineural loss. This is why Rinne must always be interpreted together with Weber, which will lateralize away from the dead ear. Ossicular fixation would produce a true conductive pattern, and recruitment does not alter Rinne results.

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

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Written and medically reviewed by the StethoPrep medical team.