Tuning fork

In this PPT u will know about Tuning Fork and its types.
u can also know the principle , purpose , procedure and implications of types of tuning fork test.

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1. Tuning Fork BY - Anant Arun Student of B.ASLP From SAIMS Date – 11/04/2018

2. INDEX Tuning Fork Types of Tuning Fork Weber Test Rinne Test Bing Test Schwabach Test

3. Tuning fork The tuning fork is a device , usually made of steel , magnesium or aluminium that is used to tune musical instruments or by singers to obtain certain pitches. A tuning fork emits a tone at a particular pitch and has clear musical quality. The tuning fork is set into vibration by holding the stem in the hand and stricking one of the times against a firm but resilient surface. Tuning fork with frequencies less than 512 Hz may be felt (tactile sensation) making it difficult to use for assessing auditory sensation

4. Types of Tuning Fork tests. Weber Test Rinne Test Bing Test Schwabach Test named after the four german otologist who described them (Martin & Clark , 2003 ) The schwabach test is no longer used today .

5. Weber test The Weber Test was named after ‘ Ernst Heinnich Weber ‘ Principle Weber test is based on ‘ strenger principle ‘ Strenger principle : if two tones are identical in all ways except in loudness the sound will be perceived louder in better ear. Purpose The purpose of the weber test is to determine if an affected ear has a conductive hearing loss or a sensorineural hearing loss. Procedure The weber test is performed by placing the stem of the vibrating tuning fork on the midline of the head ( usually on the upper forehead )

6. The weber test can also be performed with an audiometer by placing the bone vibrator on the midline of the head. Other sites are also used , such as the tap or the back of the head , the chin or the upper teeth. (In most cases the upper teeth produces the loudest bone counducted sound) The patient is asked to report where he hear the tone , that is whether he hears the tone in the middle of the head (midline) or an one side or the other The weber test is called a test of lateralization. The weber test results are reported as – Weber midline Weber left Weber right ( to indicate where the patient lateralized the tone) Implications If the hearing is normal or there is a symmetrical (same on both side ) conductive sensorineural or mixed hearing loss, the patient should perceive the tone in the midline or equally in both ears.

7. If the hearing loss is present in only one of the ears , the patient should not perceive the sound in the midline , but should perceive the tone louder in one of the ear ( and not necessarily the good ear ) If the person perceives the tone in the normal hearing ear , it means that the affected ear has a sensorineural hearing loss. If the person perceives the tone in the affected ear , it means that the affected eear has a conductive hearing loss.

8. RINNE TEST The rinne test was named after German otologist Heinrich adolf Rinne (1819-1868) Principle The rinne test is based on the principle that it takes a greater level of vibration to stimulus by BC than by AC , so the more efficient AC stimulation is perceived as louder or can be heard longer. Purpose The purpose of the rinne test is to determine whether or not the patient has a conductive hearing loss by comparing the perception of the tone by BC to the perception by AC

9. Procedure The rinne test is performed by placing the tuning fork on the mastoid process to test by BC and then , without restriking it , moving it next to the auricle to test by AC. The tuning fork is moved back and forth a few times between the mastoid and the auricle and the patient is asked to report if the tone sounds louder when the tuning fork is on the mastoid process or when it is next to the auricle. A modification of the rinne test is sometimes used where the patient indicates when the BC stimulation can no longer be heard , at which time the tuning fork is moved , without restriking it , to the AC condition and the patient is asked if he can hear it again. The rinne can be used to test each ear however , the non test ear must be masked out with a noise in order to be sure the response is coming from the test ear.

10. The Rinne test results are reported as, Positive Rinne Negative Rinne Implications In case of conductive hearing loss , the AC tone should be softer or not heard at all compared to the BC tone . The Rinne Test is reported as a “negative Rinne “ (or BC>AC). In case of normal hearing or sensorineural hearing loss , the person will hear a louder tone when the fork is at the ear . This is called “ positive rinne ” ( or AC > BC ). In case of unilateral sensorineural hearing loss , the person reports the sound behind the ear is louder than the sound presented in the front of the ear . But , actually the front sound is louder , this is called “ false negative rinne “ In cases of conductive hearing loss ( minimal to mild ), the patient reports the front sound louder than the sound behind the ear . But, actually the sound behind the ear is louder. This is called “ false positive rinne “

11. BING TEST The bing test was devised by German otologist : Albert Bing Principle The bing test is based on the principe of occlusion effect when the ear canal is closed off, the sounds generated in the cartilageneous portion of the external ear canal do not escape and are slightly amplified by resonance , called the occlusion effect. Purpose The purpose of the bing test is to determine whether or not the patient has a conductive hearing loss. Procedure The bing test is performed by striking the tuning fork and placing it on the mastoid process and while listening to the tone the patient is asked to alternatelyclose and open the external ear canal by pushingin on the tragus.

12. The patient is asked whether or not the tone sounds louder when the ear canal is occluded ( closed ) compared to when it is unoccluded ( open ). The occlusion effect occurs for low frequencies , the bing test must be done at 250 Hz or 500 Hz. Implications If the patient has normal hearing or a sensorineural hearing loss , the tone sounds louder in the occluded condition ( position bing ). If the patient has a conductive hearing loss , the tone does not sound louder when the ear canal is occluded ( negative bings ).

13. Schwabach Test Principle The Schwabach test is based on the principle that the examiner should have normal hearing , or when the tuning fork is vibrated the sound fades after sometime. Purpose The schwabach test , introduced in 1890 , is a test for bone conduction . The purpose is to compare the hearing sensitivity of a patient with the sensitivity of the examiner. Procedure The tuning fork is set into vibration , and the stem is placed alternately against the mastoid process of the patient and of the examiner. Each time the fork is pressed against the patient’s head , the patient makes a signal if the tone is heard.

14. When the patient no longer hears the tone , the examiner immediately places the stem of the tuning fork behind his or her own ear and using a watch , notes the number of sounds that the tone is audible after the patient stop hearing it. The schwabach test results are reported as , Normal Schwabach Diminished Schwabach Prolonged Schwabach False Normal Schwabach Implications If the both examiners and patients have normal hearing , both will stop hearing the tone emitted by the fork at approximately the same time . This is called a Normal Schwabach If the patient have senserineural hearing loss , hearing by bone conduction is impared and they will stop hearing the sound much sooner than the examiner . This is called a Diminished Schwabach .

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