Diagnostic Accuracy of Tuning Fork Tests for Hearing Loss: A Systematic Review
Otolaryngology--Head & Neck Surgery
Kelly, E. A., Li, B., et al. (2018).
Otolaryngology--Head & Neck Surgery, 159(2), 220-230.
This systematic review investigates the diagnostic accuracy of tuning fork tests (TFT) compared to pure tone audiometry for determining hearing loss in children and adults. This review also explores the audiometric threshold at which TFT findings transition from normal to abnormal and the factors that affect TFT accuracy.
No funding received
Through May 2016
Published studies (not further specified)
17
"The Weber test has poor sensitivity for identifying unilateral [conductive hearing loss] CHL or [sensorineural hearing loss] SNHL by correct lateralization (18%-67%), and specificity ranged from 33% to 97%" (p. 228).
"The Weber test was more sensitive with 512-Hz forks (vs 256 Hz) and for detecting [conductive hearing loss] CHL versus [sensorineural hearing loss] SNHL" (p. 228).
"Rinne test sensitivity was greater, and specificity lower, for the following conditions: the 256-Hz fork (vs 512 Hz); the loudness comparison technique (vs timed threshold); masking; for detecting larger [conductive hearing losses] CHLs; when equivocal results are considered abnormal; and, based on individual studies, when practitioners have more experience, apply more pressure, and use steel (vs aluminum) forks" (p. 228).
Rinne [tuning fork test] TFT typically transitions from normal to abnormal at 13 to 40 dB of [conductive hearing loss] CHL and from 2.5 to 4 dB of asymmetry for the Weber test.
Sensitivity and specificity of the Rinne test for detecting [conductive hearing loss] CHL varied on the type of fork being used. A 256-Hz fork yielded a sensitivity range of 43%-91% and a specificity range of 50%-100%. The 512-Hz fork had sensitivity values of 16%-87% and specificity values of 55%-100%.
"The sensitivity of the Rinne [tuning fork test] TFT to detect [conductive hearing loss] CHL ranged from 16% to 91% and specificity ranged from 71%-100%" (p. 228).
"Among adult patients (who are most likely to have otosclerosis), the 512-Hz Rinne test had high specificity (97%-100%) and, thus, low false-positive rates for detecting at least 10 to 20 dB of [conductive hearing loss] CHL" (p. 229).
"There is substantial variation in reported accuracy measurements of [tuning fork tests] TFTs for clinical screening, surgical candidacy assessments, and estimation of hearing loss severity" (p. 229).
