A patient has profound unilateral right sensorineural hearing loss. On Rinne testing with a 512 Hz fork on the right mastoid, the patient reports he does NOT hear the fork when it is moved to the right auricle. This apparent 'negative' Rinne in a dead ear is explained by:
- A Sound being transmitted through skull bone to the opposite normal cochlea (shadow hearing) ✓
- B Hyperacusis of the affected ear
- C Fixation of the stapes footplate
- D Recruitment phenomenon in the affected cochlea
Correct answer: A. Sound being transmitted through skull bone to the opposite normal cochlea (shadow hearing)
Explanation
In total or profound unilateral sensorineural loss, bone conduction from the tested mastoid crosses the skull and stimulates the contralateral normal cochlea, so the patient hears the fork by 'shadow hearing'. When the fork is held near the auricle, air conduction is attenuated below what reaches the opposite cochlea, giving a falsely negative Rinne. This is why the Weber test must always be performed alongside Rinne before labelling a loss conductive.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.