PMID- 27013057
OWN - NLM
STAT- MEDLINE
DCOM- 20161020
LR  - 20181113
IS  - 1916-0216 (Electronic)
IS  - 1916-0208 (Print)
IS  - 1916-0208 (Linking)
VI  - 45
DP  - 2016 Mar 24
TI  - Rinne test: does the tuning fork position affect the sound amplitude at the ear?
PG  - 21
LID - 10.1186/s40463-016-0133-7 [doi]
LID - 21
AB  - BACKGROUND: Guidelines and text-book descriptions of the Rinne test advise 
      orienting the tuning fork tines in parallel with the longitudinal axis of the 
      external auditory canal (EAC), presumably to maximise the amplitude of the air 
      conducted sound signal at the ear. Whether the orientation of the tuning fork 
      tines affects the amplitude of the sound signal at the ear in clinical practice 
      has not been previously reported. The present study had two goals: determine if 
      (1) there is clinician variability in tuning fork placement when presenting the 
      air-conduction stimulus during the Rinne test; (2) the orientation of the tuning 
      fork tines, parallel versus perpendicular to the EAC, affects the sound amplitude 
      at the ear. METHODS: To assess the variability in performing the Rinne test, the 
      Canadian Society of Otolaryngology - Head and Neck Surgery members were surveyed. 
      The amplitudes of the sound delivered to the tympanic membrane with the activated 
      tuning fork tines held in parallel, and perpendicular to, the longitudinal axis 
      of the EAC were measured using a Knowles Electronics Mannequin for Acoustic 
      Research (KEMAR) with the microphone of a sound level meter inserted in the pinna 
      insert. RESULTS: 47.4 and 44.8% of 116 survey responders reported placing the 
      fork parallel and perpendicular to the EAC respectively. The sound intensity 
      (sound-pressure level) recorded at the tympanic membrane with the 512 Hz tuning 
      fork tines in parallel with as opposed to perpendicular to the EAC was louder by 
      2.5 dB (95% CI: 1.35, 3.65 dB; p < 0.0001) for the fundamental frequency (512 
      Hz), and by 4.94 dB (95% CI: 3.10, 6.78 dB; p < 0.0001) and 3.70 dB (95% CI: 
      1.62, 5.78 dB; p = .001) for the two harmonic (non-fundamental) frequencies (1 
      and 3.15 kHz), respectively. The 256 Hz tuning fork in parallel with the EAC as 
      opposed to perpendicular to was louder by 0.83 dB (95% CI: -0.26, 1.93 dB; 
      p = 0.14) for the fundamental frequency (256 Hz), and by 4.28 dB (95% CI: 2.65, 
      5.90 dB; p < 0.001) and 1.93 dB (95% CI: 0.26, 3.61 dB; p = .02) for the two 
      harmonic frequencies (500 and 4 kHz) respectively. CONCLUSIONS: Clinicians vary 
      in their orientation of the tuning fork tines in relation to the EAC when 
      performing the Rinne test. Placement of the tuning fork tines in parallel as 
      opposed to perpendicular to the EAC results in a higher sound amplitude at the 
      level of the tympanic membrane.
FAU - Butskiy, Oleksandr
AU  - Butskiy O
AD  - Division of Otolaryngology - Head and Neck Surgery, Vancouver General Hospital, 
      Vancouver, BC, Canada. butskiy.alex@gmail.com.
AD  - Department of Surgery, University of British Columbia, Vancouver, BC, Canada. 
      butskiy.alex@gmail.com.
AD  - Gordon & Leslie Diamond Health Care Centre, 4th. Fl. 4299B-2775 Laurel Street, 
      Vancouver, BC, V5Z 1M9, Canada. butskiy.alex@gmail.com.
FAU - Ng, Denny
AU  - Ng D
AD  - Department of Mechanical Engineering, University of British Columbia, Vancouver, 
      BC, Canada.
FAU - Hodgson, Murray
AU  - Hodgson M
AD  - Department of Mechanical Engineering, University of British Columbia, Vancouver, 
      BC, Canada.
AD  - School of Population and Public Health, University of British Columbia, 
      Vancouver, BC, Canada.
FAU - Nunez, Desmond A
AU  - Nunez DA
AD  - Division of Otolaryngology - Head and Neck Surgery, Vancouver General Hospital, 
      Vancouver, BC, Canada.
AD  - Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
AD  - Gordon & Leslie Diamond Health Care Centre, 4th. Fl. 4299B-2775 Laurel Street, 
      Vancouver, BC, V5Z 1M9, Canada.
LA  - eng
PT  - Journal Article
DEP - 20160324
PL  - England
TA  - J Otolaryngol Head Neck Surg
JT  - Journal of otolaryngology - head & neck surgery = Le Journal 
      d'oto-rhino-laryngologie et de chirurgie cervico-faciale
JID - 101479544
SB  - IM
MH  - Bone Conduction/*physiology
MH  - Ear Canal/*physiopathology
MH  - Equipment Design
MH  - Hearing Loss/*diagnosis/physiopathology
MH  - Hearing Tests/*instrumentation
MH  - Humans
MH  - Sound
MH  - Tympanic Membrane/*physiopathology
PMC - PMC4807550
OTO - NOTNLM
OT  - Physical examination
OT  - Rinne test
OT  - Tuning fork
EDAT- 2016/03/26 06:00
MHDA- 2016/10/21 06:00
PMCR- 2016/03/24
CRDT- 2016/03/26 06:00
PHST- 2016/01/05 00:00 [received]
PHST- 2016/03/15 00:00 [accepted]
PHST- 2016/03/26 06:00 [entrez]
PHST- 2016/03/26 06:00 [pubmed]
PHST- 2016/10/21 06:00 [medline]
PHST- 2016/03/24 00:00 [pmc-release]
AID - 10.1186/s40463-016-0133-7 [pii]
AID - 133 [pii]
AID - 10.1186/s40463-016-0133-7 [doi]
PST - epublish
SO  - J Otolaryngol Head Neck Surg. 2016 Mar 24;45:21. doi: 10.1186/s40463-016-0133-7.