American Board of Internal Medicine (ABIM) Certification Practice Exam

What is indicated by better hearing in the Rinne test when the tuning fork is moved from the mastoid process to outside the ear?

1. Conductive hearing loss

2. Normal hearing

3. Sensorineural hearing loss

4. Mixed hearing loss

The correct answer is: Sensorineural hearing loss

In the context of the Rinne test, better hearing when the tuning fork is moved from the mastoid process to outside the ear suggests the presence of sensorineural hearing loss. This test assesses the patient's ability to hear sounds conducted through air versus bone. In a normal hearing scenario, air conduction is typically more effective than bone conduction, resulting in the patient hearing the sound better when the tuning fork is placed outside the ear. When better hearing is noted during air conduction in this situation, it is indicative that the inner ear (auditory nerve and cochlea) is functioning properly, and the issue lies not with air conduction but rather with conditions affecting the ability to interpret sound, which aligns with sensorineural hearing loss. This contrasts with conductive hearing loss, in which bone conduction is better than or equal to air conduction, leading to diminished sound perception when the tuning fork is moved outside the ear. Mixed hearing loss would show a combination of both conductive and sensorineural issues, typically resulting in impaired air conduction compared to bone conduction. Here, the significant improvement in air conduction indicates that the conductive pathway is functioning better, which is not consistent with the characteristics of mixed or purely conductive loss. Thus, a better hearing shift observed in the Rinne