The tuning fork tests primarily help determine the status of external auditory canal, patency of eustachian tube, condition plus working of ear drum and ossicular chain, state of middle ear cleft, and degree of function of inner ear and eighth nerve. These tests are used for the purpose of differential diagnosis between pathology of conductive apparatus and perceiving mechanism. In spite of a lack of consensus over the clinical use of tuning forks it can be safely said that their use is not outdated if used correctly and appropriately.

This pocket guide describes the principle, method of performing various tuning fork test, interpretation of results, and correlating the findings.

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It has been known for more than four hundred years that sound can be discerned both through air and bone conduction routes. This has formed the basis of the principle of detection of hearing loss caused by diseases of middle ear cleft or those due to pathologies of eighth nerve. Although the tuning forks were invented around the same time, but it took almost a century before these were put into use by otologists. It was in 1845 a German otologist E. Schmalz introduced the tuning fork and the Weber test. Rinne test was described in the year 1855. (II:, 1997)

It needs to be kept in mind that when tuning forks were first introduced the audiometers and equipment to obtain a bright and magnified view of ear drum were not available. During those times these tuning forks were the only available options to make an idea about the possible nature of hearing loss.

The current indications of tuning fork tests are different from those in yesteryears. The acceptability these tests has been in question since day one, however there has been a renewed interest in usability of these tests. Let us look at an example. Idiopathic sudden sensorineural hearing loss (ISSNHL) is regarded as a medical emergency and immediate institution of treatment is critical to the final outcome. As such a patient with sudden perceptive hearing loss needs to be urgently referred to a specialist by his/her GP. Although pure tone audiometry with masking remains the gold standard, a GP can readily differentiate between conductive and sensorineural hearing loss by doing otoscopy and tuning fork tests.

There have been a number of studies which have examined applicability of tuning fork tests in acute hearing loss. One of the studies that examined tuning fork testing in ISSNHL reported that in 78% cases Weber test correctly lateralized to the opposite ear. The results of the study suggest that Weber test is a useful and trustworthy tool for timely referral of subjects who develop ISSNHL. (Bayoumy AB, 2020)

Another study entitled ‘Clinical accuracy of tuning fork tests’ devised a protocol to determine the usefulness of three standard tests the Rinne, the Weber, and the Bing across the frequencies of 256, 512, and 1024 Hz. the results were compared with otological, audiometric, and impedance audiometry data. The results indicated that that these three tuning fork tests do not accurately predict the type of hearing impairment as frequently as the literature suggests. (Stankiewicz JA, 1979)

Yet another study made a sweeping statement based on its results which suggested that tuning fork if appropriately used continues to be a reliable process of detecting conductive hearing loss or one-sided SNHL. It concluded that, “Two groups of people are critical of the tuning fork–those who have never used them and those who do not know how to use them’. (Doyle PJ, 1984) In spite of a lack of consensus it can be safely said that use of TF is not outdated if used correctly and appropriately. (Bayoumy AB, 2020)

Figure 1: Parts of a Tuning Fork