Enhancing the sensitivity for Rinne test through tuning fork modifications

OBJECTIVE: The Rinne test generally detects large air-bone gaps; this approach decreases the value of tuning forks as a screening tool. The purpose of this study was to evaluate the effectiveness of simple tuning fork modifications to increase the sensitivity of the Rinne test. MATERIALS and METHODS: Two different modifications were performed with 128 and 256 Hz tuning forks. Fifteen healthy subjects with otolaryngology specialist training backgrounds were enrolled in the measurement of tuning fork, sound-intensity output at their bone conduction threshold. RESULTS: The reductions in the threshold gap required for the Rinne test to turn from positive to negative for 128 Hz tuning forks were not statistically significant. The threshold gap was reduced by 3.85±3.88 dB when 256 Hz tuning forks were modified through metal disk attachment (p=0.001). CONCLUSION: The modified 256 Hz tuning forks effectively reduced the subjective loudness gap between the two ends of the tuning fork in the Rinne test. The modification theoretically increases the sensitivity of the Rinne test, which may increase the value of tuning forks as hearing loss screening tools.