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This video will present the Weber test. In a patient with unilateral hearing loss, this test is designed to determine if the cause is conductive or sensorineural. Sound is delivered to the cochlea of the inner ear by two conduction pathways. In air conduction, the sound is gathered by the external ear, funneled by the external auditory canal to the tympanic membrane, and onward to the inner ear via the ossicles. In bone conduction, the sound is transmitted directly through the bones of the skull to the inner ear, bypassing the air conduction pathway. Regardless of which pathway brings the sound to the cochlea, it is received here and then transmitted to the brain via the auditory nerve. Conductive hearing loss is caused by a blockage of sound transmission through the outer and middle ear. This could be due to the accumulation of earwax or a perforated eardrum, limiting air conduction. On the other hand, sensorineural hearing loss is caused by problems with the cochlea of the inner ear or neural pathways to the brain.
To explain the Weber test, an example of a patient with hearing loss in the left ear will be used. Strike a 512-hertz tuning fork and place it on the vertex of the skull. Ask the patient in which ear the sound is heard loudest. If the patient reports the sound being heard louder in the bad ear, this suggests a conductive hearing loss in that ear. This is because air conduction in the bad ear is blocked, making it less subject to environmental noise and more sensitive to sound transmitted through the bones of the skull. If the patient reports the sound is louder in the right good ear, this suggests a sensorineural hearing loss in the bad ear because the cochlea or neural pathways to the brain are damaged on that side. The right ear, however, is intact and can hear sound normally.
