Clinical Tests for
Hearing and Tests of
Eustachian Tube
Function
Dr. Vijayalakshmi S
Tuning Fork
(Gardiner Brown)
Parts:
1. Prongs or tines
2. Shoulder
3. Stem or handle
4. Base or footplate
Tuning Forks
Frequencies used in E.N.T.:
256, 512, 1024 Hz

128 Hz → produces more of vibration sense

more than 1024 → short sound decay time
Striking Surfaces
Hard: Olecranon, radial styloid process, patella
Soft: Thenar & hypothenar eminences,
thick rubber strip
Tuning fork is allowed to fall by its own weight
Impact area is b/w proximal two-thirds & distal
one-thirds of its prongs
Rinne Test
Rinne Test
Duration comparison technique:
Vibrating tuning fork kept on pt's mastoid  Pt
signals when sound ceases → Move vibrating
tuning fork over opening of ear canal (2 cm
away & axis parallel to it) → Patient indicates if
sound is still heard
Rinne Test
Loudness comparison technique (better):
Vibrating tuning fork kept on pt's mastoid  Pt
signals if sound is heard → Move vibrating
tuning fork immediately over opening of ear
canal → If sound is heard → patient asked
which sound is louder
Results of Rinne Test
Better response:

sound heard longer or louder
A.C. > B.C. (positive test):

Normal hearing or Sensorineural deafness
B.C. > A.C. (negative test):

Conductive deafness
Rinne Negative

256 Hz = 15 - 30 dB HL
= mild conductive deafness

512 Hz = 31 - 45 dB HL
= moderate conductive deafness

1024 Hz = 46 - 60 dB HL
= severe conductive deafness
Weber Test
Procedure:
Vibrating 512 Hz
tuning fork placed in
midline of pt’s skull at
forehead / vertex /
central incisor
Results of Weber test
Sound heard equally (central):

Normal hearing or B/L equal deafness
Sound lateralizes to deafer ear:

Conductive deafness
Sound lateralizes to better hearing ear:

Sensorineural deafness
Why Weber lateralizes to deafer
ear in Conductive HL ?
1. Lack of masking effect of surrounding noise
on tuning fork sound, as air conduction is
reduced in conductive deafness
2. Lack of dispersion of sound energy due to
ossicular break
Absolute Bone Conduction Test
Absolute Bone Conduction Test

Pt's B.C. compared vs. examiner's normal B.C.

Vibrating tuning fork kept on pt's mastoid with
pt’s E.A.C. occluded (to prevent A.C.) → pt
signals when sound ceases → vibrating tuning
fork kept on examiner's mastoid with
examiner's E.A.C. occluded
Results of Absolute Bone
Conduction Test
Pt stops hearing before examiner:

sensorineural deafness
Both hear for same duration:

normal hearing / conductive deafness
Schwabach Test
Schwabach Test
Same as A.B.C. but E.A.C. is not occluded
Pt stops hearing before examiner:

sensorineural deafness
Both hear for same duration:

normal hearing
Pt hears longer than examiner:

conductive deafness
False Negative Rinne

Etiology: U/L severe Sensorineural deafness

Detection: Rinne negative, Weber lateralized to
better hearing ear

Confirmation: A.B.C. reduced in deaf ear

Correction: Repeat Rinne test with masking of
better ear with Barany's noise box
False Negative Rinne
Mechanism:
In deaf ear, air conduction & bone conduction are
absent. Trans-cranial transmission of sound to
opposite cochlea is perceived as I/L bone
conduction. Reported as bone conduction > air
conduction in deaf ear (Rinne Negative)
Gelle Test

Vibrating tuning fork placed on pt's
mastoid & examiner increases pt's E.A.C.
pressure with Siegel's speculum
Softer sound:

normal hearing or sensorineural deafness
No change in sound:

conductive deafness
Bing Test

Vibrating tuning fork placed on pt's
mastoid & examiner blocks pt's E.A.C.
Louder sound:

normal hearing or sensorineural deafness
No change in sound:

conductive deafness
Tests for E.T. function
1. Valsalva Maneuver
Forced expiration with
mouth & nose closed.
Otoscopy shows
lateral bulging of
Tympanic membrane
2. Frenzel Maneuver

Hands free Valsalva for pilots

Compression of nasopharyngeal air by
muscles of tongue

Otoscopy shows lateral bulging of tympanic
membrane
2. Frenzel Maneuver
3. Toynbee Maneuver

More physiological

Swallowing with
mouth & nose closed

Otoscopy shows
retraction of tympanic
membrane
4. Pneumatic otoscopy &
Siegelization

Air pressure is alternately increased &
decreased within external auditory canal

Mobility of tympanic membrane is observed

Normal mobility indicates good patency of
Eustachian tube
Siegelization
Pneumatic Otoscope
Normal Tympanic Membrane
Eustachian Tube dysfunction
Early otitis media with effusion
Late otitis media with effusion
Acute suppurative otitis media
Ear drum perforation
5. Politzerization
Politzer Bag
5. Politzerization

Rubber tube attached to a Politzer bag put into
one nostril & both nostrils pinched

Patient asked to swallow or repeat “k”

Politzer bag is squeezed simultaneously

Otoscopy shows lateral bulging of ear drum in
patent Eustachian tube
6. E.T. catheterization
Eustachian tube catheter
6. E.T. catheterization

E.T. catheter passed along nasal floor till it
touches posterior wall of naso-pharynx.

Catheter rotated 90° medially & pulled forward
till it impinges on posterior nasal septum.

Catheter rotated 180° laterally, & its tip inserted
into opening of E.T.

Politzer bag attached to outer end of catheter
6. E.T. catheterization
Air pushed into E.T. catheter by squeezing
Politzer bag. Examiner hears by Toynbee
auscultation tube put in pt's ear.
Blowing sound = normal E.T. patency
Bubbling sound = middle ear fluid
Whistling sound = partial E.T. obstruction
No sound = complete obstruction of E.T.
7. Tymapanometry
7. Tymapanometry

Type C = E.T. dysfunction

Type B = fluid in middle ear
8. William’s pressure
equalization test

200 mm H2O pressure is created in patient’s
external auditory canal

Patient asked to swallow 10 times

Residual pressure in patient’s external auditory
canal after 10th swallow is noted

Test repeated with -ve 200 mm H2O pressure
created in patient’s external auditory canal
William’s Test
Residual Pressure
Result
Up to + 50 mm H2O
normal E.T. function
+ 51 to + 100 mm H2O
mild dysfunction
+ 101 to + 199 mm H2O
moderate dysfunction
+ 200 mm H2O
severe dysfunction
9. Sono-tubometry

Sound made in pt’s nasal cavity & detected with
stethoscope in patient’s external auditory canal

Loud sound = patent Eustachian tube
10. Eustachian tube Salpingogram

Dye instilled through E.T. catheter & X-ray taken
11. C.T. scan & M.R.I. of skull
12. Trans-nasal E.T. video-endoscopy
13. Test for E.T. patency in T.M. perforation

Saccharine crystal / antibiotic ear drop /
methylene blue placed in middle ear via ear drum
perforation.

Sweet taste / bitter taste / blue staining of
secretions indicates patent Eustachian tube
Thank You