HEENT Special Tests – Weber, Rinne & Eye Exam

Question-and-answer flashcards covering Weber and Rinne tests, interpretation for conductive vs sensorineural loss, fundoscopic findings, visual acuity and field testing, and sinus percussion.

How is the Weber test performed?

Place a vibrating tuning fork on the midline of the skull (forehead or vertex) and ask which ear hears the sound louder.

In the Weber test, sound lateralizing to the affected ear indicates what type of hearing loss?

Conductive hearing loss.

In the Weber test, sound lateralizing to the unaffected ear indicates what type of hearing loss?

Sensorineural hearing loss.

Describe the steps of the Rinne test.

Place a vibrating tuning fork on the mastoid bone (bone conduction). When the patient no longer hears it, move the fork in front of the ear canal (air conduction) and ask if they still hear it.

What is considered a normal Rinne result?

Air conduction (AC) is greater than bone conduction (BC).

What Rinne finding suggests conductive hearing loss?

Bone conduction is greater than or equal to air conduction (BC ≥ AC).

What Rinne finding is seen in sensorineural loss?

AC > BC, but both air and bone conduction are diminished compared with normal.

For unilateral conductive loss, how do Weber and Rinne results combine?

Weber lateralizes to the affected ear; Rinne in that ear shows BC ≥ AC.

For unilateral sensorineural loss, how do Weber and Rinne results combine?

Weber lateralizes to the unaffected ear; Rinne in the affected ear remains AC > BC (both diminished).

Name at least three structures or findings that can be verbalized during fundoscopic examination.

Optic disc and cup (cup-to-disc ratio), retinal vessels (AV nicking, hemorrhages), macula/fovea, papilledema, cotton-wool spots.

What clinical condition does papilledema on fundoscopic exam suggest?

Elevated intracranial pressure (e.g., mass lesion, hydrocephalus, pseudotumor cerebri).

How is visual acuity typically assessed in clinic?

Using a Snellen chart at 20 ft (or a handheld near-vision chart), having the patient cover one eye and read the smallest line with at least 50% accuracy.

How do you screen peripheral visual fields at the bedside?

Perform confrontation testing: sit facing the patient, cover opposite eyes, and move fingers from the periphery into each visual quadrant, asking when they are first seen.

Maxillary sinus tenderness on percussion most likely indicates what condition?

Sinusitis (inflammation or infection of the maxillary sinus).

True or False: The Weber test alone can differentiate conductive from sensorineural hearing loss.

False—Weber must be interpreted together with Rinne to classify hearing loss.

True or False: A normal Rinne test (AC > BC) rules out conductive loss in the tested ear.

True.