Clinical precision of the Rinne test.

The precision of the Rinne test at 128-2048 Hz was studied in 100 ears with confirmed conductive pathologies. The number of negative (diagnostic) Rinnes decreased significantly with fall in frequency. While there were significantly more negative than positive Rinnes at 128 and 256 Hz, there were significantly more positive results at higher frequencies; indicating that the Rinne is not reliably diagnostic above 256 Hz. However, the possibility of vibrotactile responses must be remembered with low frequency tuning forks. Also, conductive lesions manifested as high tone air-bone gaps will not be identified with low frequency Rinne tests. Air-bone gaps of 25 to 40 dB, depending on frequency, are necessary for the Rinne to identify the presence of conductive components in most cases. Gaps of 25-30 dB for 128 Hz; 35-40 dB for 256 Hz; 55-60 dB for 512 Hz; and 45-50 dB for 1024 Hz, are necessary for the Rinne to meet a 75% correct detection criterion. The 2o48 Hz Rinne does not attain even chance detection. The Rinne test cannot be validly employed as a criterion against which other measures can be evaluated.