TL;DR: It is proposed that a ‘three windows’ model (in which the abnormal communication provided by the enlarged endolymphatic duct and sac in LVA acts as the ‘third window’ for sound conductance) might explain the air-bone gap in patients with abnormal communication between the inner ear and cerebrospinal fluid through the LVA.
Abstract: The Bing test is based on the principle that occlusion of the external auditory meatus improves the perception of bone-conducted sounds unless there is a conductive hearing impairment. An air-bone gap has been reported in patients with large vestibular aqueduct (LVA) syndrome without apparent middle ear dysfunction. We therefore performed the Bing test on nine patients with this syndrome to evaluate whether it is associated with an air-bone gap or middle ear dysfunction. Bone conduction thresholds did not change significantly during the Bing test in any patient. Because an air-bone gap is observed in patients with abnormal communication between the inner ear and cerebrospinal fluid through the LVA, dehiscent superior canal, or dilated inner ear meatus; we propose that a 'three windows' model (in which the abnormal communication provided by the enlarged endolymphatic duct and sac in LVA acts as the 'third window' for sound conductance) might explain the air-bone gap in such patients.
TL;DR: The Weber test was found to be most sensitive and reliable with the tuning fork stem placed on the upper incisors, and the Rinne tests showed a transition point from Rinne positive to negative at 19 dB when performed using the normal loudness comparison technique and at 24 dB with a threshold comparison technique.
Abstract: The Weber, Rinne and Bing tests were examined in normally hearing and hearing impaired subjects, using different techniques. The Weber test was found to be most sensitive and reliable with the tuning fork stem placed on the upper incisors. The Rinne tests showed a transition point from Rinne positive to negative at 19 dB when performed using the normal loudness comparison technique and at 24 dB with a threshold comparison technique. The Bing test with the tuning fork placed either on the mastoid or the vertex showed a transition point from Bing positive to negative at approximately 9 dB air-bone gap.
TL;DR: Fifty children seen in an ENT clinic received the Bing and Rinne tuning fork tests, otoscopic examination, and puretone audiometry to determine the accuracy of the tuning Fork tests in predicting otoscopic abnormality or conductive hearing loss.
Abstract: Fifty children seen in an ENT clinic received the Bing and Rinne tuning fork tests, otoscopic examination, and puretone audiometry to determine the accuracy of the tuning fork tests in predicting otoscopic abnormality or conductive hearing loss. Neither tuning fork test showed high accuracy. The Bing test overidentified by yielding negative results (conductive loss) for many ears with normal hearing or sensorineural loss. It correctly identified conductive loss or otoscopic abnormality only slightly better than chance57% to 66% of the time. The Rinne test identified with high accuracy those ears with a 40 dB or greater air-bone gap. For air-bone gaps of 10-35 dB, only 27% of the ears gave negative results, meaning correct identification. However, when a negative Rinne occurred, the result was in error only 2% of the time.
TL;DR: Occlusion effects were determined and compared on three groups of subjects (20 normal hearers, 20 with conductive hearing loss, and 20 with sensorineural hearing loss).
Abstract: Occlusion effects were determined and compared on three groups of subjects (20 normal hearers, 20 with conductive hearing loss, and 20 with sensorineural hearing loss). As in previous studies, the ...
TL;DR: The Rinne test with the 256 Hz fork and the loudness comparison method was more sensitive than the Bing tuning-fork test, and had similar specificity, and the Rinne is therefore the better test for clinical use.
Abstract: The Bing test is based on the principle that occlusion of the external auditory meatus improves the perception of bone-conducted sounds unless there is a conductive hearing impairment. However, its sensitivity and specificity have not been reported. Tuning-fork and audiometric Bing tests were carried out on 126 patients with otological symptoms prior to any otological history or examination. Test results were compared with the pure tone air-bone gaps. The specificity and sensitivity of each test method was estimated. The tuning-fork Bing test was less sensitive than the audiometric Bing test, but had greater specificity. However, the Rinne test with the 256 Hz fork and the loudness comparison method was more sensitive than the Bing tuning-fork test, and had similar specificity. The Rinne is therefore the better test for clinical use.