A 55-year-old man has total right sensorineural deafness confirmed on pure-tone audiometry. When the Rinne test is performed on the right ear with a 512 Hz tuning fork, he reports that the fork is heard louder on the pinna than on the mastoid. How should this result be interpreted?
- A False negative Rinne, because the vibration crossed over to the left cochlea ✓
- B True positive Rinne, indicating right conductive hearing loss
- C Normal Rinne, indicating intact right hearing
- D Positive Rinne caused by right-sided recruitment
Correct answer: A. False negative Rinne, because the vibration crossed over to the left cochlea
Explanation
In a totally deaf (dead) ear, bone-conducted vibration bypasses the tested ear entirely and reaches the opposite cochlea through the skull. Air conduction cannot cross over, so air conduction appears better than bone conduction, producing a false negative Rinne in a profoundly deaf ear. The safeguard is the Weber test, which lateralizes to the better (left) ear, immediately exposing the misleading Rinne result. Recruitment is a cochlear phenomenon and plays no role here.
Reference: Dhingra, Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.