The validity of tuning fork tests in diagnosing hearing loss

Tuning fork tests are subjective and response bias must be accounted for when determining their validity as diagnostic tools. A significant proportion of patients who present for otologic evaluation have mixed hearing loss and it is important to know how this group responds to tuning fork testing. The need for masking in audiometry is indisputable but its role in tuning fork testing has never been established. The purpose of this study was to determine the sensitivity of tuning fork tests. The Weber, unmasked and masked Rinne, and Bing tests were administered in a prospective, random, and blind manner to 68 patients referred for audiologic assessment. Patients found to have normal hearing served as the control group. Signal Detection Theory was used to compare the results to pure-tone air- and bone-conduction audiometry. Overall the Rinne is an unbiased test with a sensitivity of 0.84 regardless of the type, severity, or frequency of hearing loss. This is not improved by masking. There is no role for either the Weber or Bing as independent tests. Mixed hearing loss behaves as conductive hearing loss. The Rinne without masking should be administered to patients suspected of having a hearing loss.