Auditory Nerve Viii Cochlear component

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Test by whispering numbers into one ear while masking hearing in the other ear by occluding and rubbing the external meatus. If hearing is impaired, examine external meatus and the tympanic membrane with auroscope to exclude wax or infection. Differentiate conductive (middle ear) deafness from perceptive (nerve) deafness by:

1. Weber's test: Hold base of tuning fork (256 or 512 Hz) against the vertex. Ask patient if sound is heard more loudly in one ear.

CONDUCTIVE DEAFNESS Sound is louder in affected ear since distraction from external sounds is reduced in that ear

NERVE DEAFNESS Sound is louder in the normal ear

2. Rinne's test: Hold the base of a vibrating tuning fork against the mastoid bone. Ask the patient if note is heard. When note disappears - hold tuning fork near the external meatus. Patient should hear sound again since air conduction via the ossicles is better than

2. Rinne's test: Hold the base of a vibrating tuning fork against the mastoid bone. Ask the patient if note is heard. When note disappears - hold tuning fork near the external meatus. Patient should hear sound again since air conduction via the ossicles is better than

Further auditory testing and examination of the vestibular component requires 16 specialised investigation (see pages 60-62).

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