Accuracy of the Weber and Rinne tuning fork tests in evaluation of children with otitis media with effusion

Objective: The purpose of this study was to determine the accuracy of the Rinne and Weber tuning fork tests in predicting the degree of hearing loss secondary to otitis media with effusion (OME) in children compared with pure-tone audiometry. Design: A blinded prospective study was performed on cases of unilateral and bilateral OME in children between ages 2 and 11 years. Setting: Patients were recruited from the tertiary Pediatric Otolaryngology Clinic at British Columbia's Children's Hospital in Vancouver. Methods: The subjects consisted of 58 children with unilateral or bilateral OME. The Rinne and Weber tests were performed using a 256 Hz and a 512 Hz tuning fork. Pure-tone audiometry was performed to establish the presence and degree of an air-bone gap (ABG). Main Outcome Measures: The tuning fork responses were correlated with the ABG to determine their accuracy. Results: The Weber test did not show an association between the ABG and the lateralization response using either the 256 Hz (p = .484) or the 512 Hz tuning fork (p = .120). For the Rinne test, an increase in ABG was significantly associated with a higher rate of response air conduction < bone conduction using either the 256 Hz or the 512 Hz fork (p < .04). Age was not associated with outcome for any of the tuning fork tests. Conclusions: The overall accuracy of the Rinne and Weber tuning fork tests in predicting conductive hearing loss associated with OME in children is poor.