# A nurse is assessing a 45-year-old client who reports gradual hearing loss over the past 6 months. Which assessment finding would be most indicative of conductive hearing loss?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541646  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 45-year-old client who reports gradual hearing loss over the past 6 months. Which assessment finding would be most indicative of conductive hearing loss?

## 보기

1. The client reports hearing high-pitched sounds better than low-pitched sounds
2. The Weber test reveals sound lateralizing to the affected ear **✔ 정답**
3. The Rinne test shows air conduction greater than bone conduction in the affected ear
4. The client experiences tinnitus with associated dizziness

**정답: 2**

## 해설

In conductive hearing loss, the Weber test lateralizes to the affected ear because bone conduction bypasses the conductive problem. Other options are more indicative of sensorineural hearing loss or unrelated symptoms.

## 심화 해설

Understanding Conductive Hearing Loss

When sound waves cannot efficiently travel through the outer or middle ear to reach the cochlea, the result is conductive hearing loss (CHL). This can stem from various mechanical obstructions, such as cerumen impaction, tympanic membrane perforation, otitis media with effusion, or ossicular chain fixation. The underlying pathology is a reduction in the mechanical transmission of sound energy. In the context of the NCLEX-RN, distinguishing CHL from sensorineural hearing loss (SNHL) is a critical clinical judgment skill, and tuning fork tests are a fundamental, evidence-based bedside method to make this distinction.

Analysis of the Correct Answer (Option 2)

The Weber test is performed by placing a vibrating tuning fork on the midline of the patient’s skull. In a patient with normal hearing or symmetrical hearing loss, the sound is perceived equally in both ears. The key principle is that sound will lateralize, or be heard louder, in the ear with a conductive deficit. This occurs because ambient room noise is less effectively transmitted through the impaired conductive pathway, eliminating the masking effect and making the bone-conducted sound from the tuning fork seem louder in the affected ear. A recent study on the diagnostic accuracy of the tuning fork Weber test confirms its clinical utility in identifying conductive pathology, noting that sound lateralizing to the affected ear is a hallmark sign [1]. Therefore, a Weber test that lateralizes to the ear with the reported hearing loss is the most indicative finding of a conductive etiology.

Why the Other Options Are Incorrect

- Option 1: Hearing high-pitched sounds better than low-pitched sounds is a classic presentation of presbycusis or other forms of sensorineural hearing loss, not conductive loss. In CHL, low-frequency sounds are typically affected first because the mass and stiffness components of the middle ear system impede the transmission of lower-frequency vibrations.

- Option 3: The Rinne test compares air conduction (AC) to bone conduction (BC). In a normal ear, air conduction is perceived as louder than bone conduction (AC > BC), which is termed a "positive" Rinne. In conductive hearing loss, the mechanical obstruction impairs air conduction, making bone conduction seem louder (BC > AC), a "negative" Rinne. The finding of AC > BC in the affected ear is a normal result and would not be indicative of CHL.

- Option 4: Tinnitus and dizziness are non-specific symptoms that can be associated with various inner ear disorders, such as Meniere’s disease or labyrinthitis, which are sensorineural in nature. While conductive pathologies like otosclerosis can sometimes cause tinnitus, the combination with dizziness is a stronger indicator of a cochleovestibular disorder and is not the most indicative finding for a primary conductive loss. The provided literature highlights that CHL’s primary pathogenic mechanism is a mechanical restriction of sound conduction, such as from ossicular ligament calcification or middle ear fluid, which does not directly involve the vestibular apparatus .References (research sources)

- [1]Diagnostic accuracy of tuning fork weber test and audiometric weber test in school-aged children with conductive hearing loss.Research articlePeng TS, Nik Othman NA, Zakaria MN, Nik Hassan NFH. (2026) · DOI: 10.1007/s00405-026-10325-6

## 임상 시나리오

Weber & Rinne Test InterpretationBedside differentiation of conductive vs. sensorineural hearing loss
In the Weber test, place a vibrating tuning fork on the midline of the skull. Ask the patient where the sound is heard best. Sound lateralizes to the affected ear in conductive hearing loss because ambient room noise is blocked, making bone-conducted sound seem louder.

In the Rinne test, compare air conduction (AC) at the ear canal to bone conduction (BC) on the mastoid process. Normally, AC is greater than BC (AC > BC). In conductive loss, the finding is reversed: bone conduction is greater than or equal to air conduction (BC >= AC).

CautionA normal Rinne test (AC > BC) does not rule out sensorineural loss. If the Weber lateralizes to the better-hearing ear and Rinne is normal, suspect sensorineural hearing loss in the opposite ear.

## 핵심 개념

- **전음성 난청** — Conductive Hearing Loss. A hearing loss that occurs when sound is not efficiently transmitted to the inner ear due to mechanical problems in the external ear canal or middle ear. Causes include impacted earwax, middle ear infection, and otosclerosis, and it has a relatively high potential for treatment.
- **Weber Test** — A test where a vibrating tuning fork is placed on the center of the patient's forehead to assess whether the sound lateralizes to one ear. In conductive hearing loss, the sound lateralizes to the ear on the affected side; in sensorineural hearing loss, the sound lateralizes to the ear on the normal side.
- **Rinne Test** — A test comparing the hearing duration of air conduction (AC) and bone conduction (BC). Normal or sensorineural hearing loss: AC > BC (positive). Conductive hearing loss: BC > AC (negative).
- **감각신경성 난청** — Sensorineural Hearing Loss. Hearing loss caused by damage to the sensory cells of the inner ear (cochlea) or the auditory nerve. Aging, noise exposure, and ototoxic drugs are the main causes, and it is mostly irreversible.
- **이명** — Tinnitus. A subjective symptom where sound is continuously heard in the ear or head without any external sound stimulus. It can be associated with various auditory and vestibular system disorders.

## 같은 주제 문제

- [A nurse is assessing a 45-year-old client who reports gradual hearing loss over the past 6…](https://mymerci.kr/pages/nclex_q.php?qn_id=541645)
- [A nurse is caring for a client with conductive hearing loss caused by otosclerosis. Which …](https://mymerci.kr/pages/nclex_q.php?qn_id=541647)
- [A nurse is caring for a 30-year-old client with conductive hearing loss caused by otitis m…](https://mymerci.kr/pages/nclex_q.php?qn_id=541648)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._