a patient with normal hearing in both ears perceives the sound in the midline.
a patient with unilateral conductive loss perceives the sound in the ear with the conductive loss i.e. if the right has a conductive loss, the sound lateralises to the right ear.
a patient with unilateral sensorineural loss perceives the sound in the ear with the better cochlear i.e. if the right ear has a sensorineural loss, the sound lateralises to the left ear.
a patient with a very severe unilateral loss on the right i.e. a dead ear may produce the following results:
Rinne -ve in right ear
Weber lateralising to the left ear
in this case, Rinne's result is a false negative. On testing the right ear, the bone conduction is heard in the normal left cochlear by skull crossover.
the Weber's test is more sensitive than the Rinne's test.
Note:
studies the Weber test has shown low sensitivity and modest specificity
when there is suspicion of hearing loss, audiometry should be performed even if bedside tests are normal (1)
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