A 40-year-old man complains of decreased hearing in the left ear following an episode of acute otitis media. Otoscopy shows a dull, retracted left tympanic membrane with fluid level. The 512 Hz tuning fork is placed on the vertex (Weber test). Where will the patient hear the sound?

• A Louder in the right ear
• B Not heard at all
• C Equally in both ears
• D Louder in the left ear ✓

Explanation

In unilateral conductive hearing loss, the Weber test lateralizes to the diseased ear. Middle ear fluid prevents ambient sound from reaching the cochlea normally, so bone-conducted sound is perceived louder on the blocked side because there is less environmental masking of that cochlea. In sensorineural loss the sound lateralizes to the better ear, which kills distractor A. Equal perception occurs only when hearing is symmetric bilaterally.

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

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Written and medically reviewed by the StethoPrep medical team.