- To assess the function of the vestibulocochlear nerve (8th cranial nerve; CN VIII), aids in determining if hearing loss is conductive or neurosensory in origin, and tests for lateralization
- Ensure the room is quite
- Lightly vibrate the fork by stroking it between the thumb and index finger or tapping it on your knuckles
- Place the base of the vibrating fork firmly on top of the patient's head (vertex) or on the mid forehead
- Notes: ensure the fork is equidistant from both ears
- Ask the patient:
- What do you feel? (i.e. buzzing, tingling)
- Do you hear anything?
- If the patients answers no then have the patient close their eyes and ask the question again
- Which ear?
- Normal: vibration is heard equally in both ears or the midline
- Unilateral conductive hearing loss: sound is heard in (lateralized to) the impaired ear (denser objects are better conductors than air)
- Conditions include: osteosclerosis otitis media, perforation of the eardrum, middle ear disease, or occlusion of the external ear canal by cerumen
- Unilateral sensorineural hearing loss: sound is heard in "good" ear (inner ear or cochlear nerve damage impairs transmission to affected ear)
- Sensitivity: 55%-78%
- Neurosensory loss: 79%
- Conductive loss: 92%
- Agreement coefficient of weber test to audiometry
- Overall: 0.82
- Subset (patients in which the test lateralized): 0.98
- The frequency range of conversation speech is between 500-3000 Hz and between 45-60 decibels
- This test does not distinguish normal hearing from bilateral neurosensory loss or from mixed conductive/neurosensory hearing loss
- Use this test only in patients with unilateral hearing loss since patients with normal hearing may lateralize, and patients with bilateral conductive/sensorineural deficits may not lateralize
- Bickley LS et al. Bates' Guide to Physical Examination and History Taking. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2013;237-238, 281.
- McGee S. Evidence Based Physical Diagnosis. St. Louis: Elsevier, 2007.
- Orient, JM. Sapira's Art and Science of Bedside Diagnosis. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2010;230.
- Shuman AG et al. Tuning Fork Testing in Sudden Sensorineural Hearing Loss. JAMA Intern Med. 2013;173(8):706-707.