![]() ![]() 6 In case of idiopathic sudden sensorineural hearing loss, this means that the tuning fork has to be able to differentiate between at least 30 dB sensorineural hearing loss-given the current definition of this condition-and a bone conduction loss.įirst, let us put some of the evidence in favour of the tuning fork. As Schmalz, who described the clinical importance of the Weber test, stated: ‘the test is especially usable in cases of one sick ear, or at least one more than the other’. In all other situations, it is just one of the tools in the armamentarium but not the sole instrument on which to make radical treatment decisions. The most important clinical question nowadays concerns only the accuracy of these tests in diagnosing idiopathic sudden sensorineural hearing loss. The foundation of their use-the occlusion effect (bone conduction gain on occlusion of the auditory meatus) and the phenomenon of lateralisation of bone conduction into the occluded ear-were solidly documented by multiple authors with a rather ‘universally’ reproducible outcome. Thus, their purpose at that time was-obviously-completely different from current reasons to use tuning fork tests. At first, these tests were used for different types of hearing loss to give a ‘rough’ indication, as the best available diagnostic tool for that moment. Tuning fork tests were invented at a time when there was neither electric audiometer nor micro-otoscopy. 5 However, most ENT clinicians consider tuning fork testing to be an appropriate and easy-to-use first step in acute situations to distinguish between conductive and perceptive hearing loss. Their standard use in a neurological setting may lead to ‘bad vibrations’. 5 They are indeed not 100% accurate, 1 and we, like most people, agree that referral for audiometry is the preferred option in the non-acute setting. 3 And still there are occasional reports citing exceptions to the rule that tuning forks do not lie 4 and the renewed discussion about their usefulness. Tuning fork tests have been under attack since their first descriptions. Moreover, anyone who has forgotten how the tests work can easily experience the effect by occluding one ear canal while holding a tuning fork on the forehead. However, a tuning fork fits in every white coat, the tests are easy to use, accurate, non-invasive and inexpensive for acute unilateral hearing loss, they can assist in triage. The gold standard-audiometric testing with adequate masking-is often not directly available in primary care. General practitioners can use otoscopy and the tuning fork tests to differentiate between conductive and perceptive hearing loss. Thus, general practitioners must refer patients with acute perceptive hearing loss urgently to an Ear, Nose and Throat (ENT) clinic for further diagnosis and treatment. 2 These treatments need to start as early as possible, since the best results follow a rapid diagnosis. High-dose corticosteroids are the standard treatment 1 and these might be even more effective when combined with hyperbaric oxygen. Idiopathic sudden sensorineural hearing loss is a devastating disease with limited effective treatment. ![]()
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