During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as:
A. A normal finding.
B. A conductive hearing loss in the right ear.
C. A sensorineural or conductive loss.
D. The presence of nystagmus.
Correct Answer: C. A sensorineural or conductive loss.
In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the client’s head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. The inner ear is more sensitive to sound via air conduction than bone conduction (in other words, air conduction is better than bone conduction).
Option A: Weber test does not demonstrate lateralization: in a normal subject, the sound should be heard in the middle and equally on both sides. In the primary care setting, it is useful to use the Weber test along with the Rinne test to help the clinician differentiate between conductive hearing loss and sensorineural hearing loss. This will guide the clinician to the need for further examination, investigation, and management.
Option B: If the client has a conductive hearing loss in one ear, the sound is heard in that ear. In the presence of a purely unilateral conductive hearing loss, there is a relative improvement in the ability to hear a bone-conducted sound. In the presence of sensorineural hearing loss, the sound will be perceived louder in the unaffected ear, which has the better cochlear.
Option D: Nystagmus is a rhythmic, involuntary, rapid, oscillatory movement of the eyes. The Weber test is a useful, quick, and simple screening test for evaluating hearing loss. The test can detect unilateral conductive and sensorineural hearing loss. The outer and middle ear mediate conductive hearing. The inner ear mediates sensorineural hearing.
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