# Situation: A 70-year-old retired factory worker is admitted to the medical ward with pneumonia and is started on intravenous gentamicin. His daughter says his hearing has worsened over several years, especially in noisy rooms. Tuning fork tests are performed: Weber test: sound is heard louder in the right ear Rinne test, right ear: bone conduction longer than air conduction Rinne test, left ear: air conduction longer than bone conduction Which interpretation is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630544  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 70-year-old retired factory worker is admitted to the medical ward with pneumonia and is started on intravenous gentamicin. His daughter says his hearing has worsened over several years, especially in noisy rooms.

Tuning fork tests are performed:
Weber test: sound is heard louder in the right ear
Rinne test, right ear: bone conduction longer than air conduction
Rinne test, left ear: air conduction longer than bone conduction
Which interpretation is correct?

## 보기

1. Sensorineural hearing loss in the left ear
2. Sensorineural hearing loss in the right ear
3. Conductive hearing loss in the right ear **✔ 정답**
4. Conductive hearing loss in the left ear

**정답: 3**

## 해설

In conductive loss, the Weber sound lateralizes to the affected ear and the Rinne test shows bone conduction longer than air conduction; in sensorineural loss, Weber lateralizes to the better ear and air conduction remains longer. Weber to the right is ambiguous by itself, but the right Rinne result settles it: the right ear has conductive loss.

## 심화 해설

How the two tuning fork tests work
The Weber test places a vibrating tuning fork on the middle of the forehead or the top of the head, and the client says where the sound is louder. In normal hearing it is heard equally. The Rinne test compares air conduction (fork near the ear canal) with bone conduction (fork on the mastoid bone) in each ear. Normally air conduction is heard longer than bone conduction, which is called a positive Rinne.

Conductive versus sensorineural patterns
In conductive loss, sound cannot travel well through the outer or middle ear. Bone conduction bypasses the blockage, so on the Rinne test bone conduction is longer than air in the affected ear, and on the Weber test the sound lateralizes to the affected ear, because that ear is not masked by room noise. In sensorineural loss, the inner ear or nerve is damaged, so both air and bone conduction are reduced but air stays longer, and the Weber sound lateralizes to the better ear.

| Pattern | Weber | Rinne in affected ear |
| --- | --- | --- |
| Conductive loss | Louder in the affected ear | Bone longer than air |
| Sensorineural loss | Louder in the better ear | Air longer than bone (both reduced) |
| Normal hearing | Equal in both ears | Air longer than bone |

Putting his results together
His Weber sound is louder in the right ear. On its own, that could mean right conductive loss or left sensorineural loss. The right Rinne result settles it: bone conduction is longer than air on the right, which is the signature of conductive loss in the right ear. The left Rinne is normal, with air longer than bone, so the left ear has no conductive loss. Left sensorineural loss would send the Weber sound to the right, but it would not explain the abnormal right Rinne. Right sensorineural loss would send the Weber sound to the left.

Clinical relevance
Common causes of conductive loss include impacted cerumen, middle ear fluid or infection, and otosclerosis. In an older adult, cerumen is frequent and easily treated. The finding does not exclude coexisting age-related sensorineural loss; it means that the right ear has a conductive component that should be evaluated. Accurate baseline hearing information is also important because he is starting an ototoxic drug.

Exam takeaway
Key point Conductive: Weber to the bad ear, bone longer than air. Sensorineural: Weber to the good ear, air longer than bone. Use the Rinne result to decide which ear is affected.

## 임상 시나리오

Interpreting Weber and Rinne TestsConductive versus sensorineural loss
In conductive loss, the Weber sound lateralizes to the affected ear and the Rinne test shows bone conduction longer than air.

In sensorineural loss, the Weber sound lateralizes to the better ear and air conduction stays longer than bone.

Weber to the right with bone longer than air on the right and a normal left Rinne means right conductive loss.

CautionA Weber result alone is ambiguous. Always combine it with the Rinne result in each ear before deciding which ear is affected.

## 핵심 개념

- **Weber test** — A tuning fork test on the midline of the head showing in which ear sound is heard louder.
- **Rinne test** — A tuning fork test comparing air conduction with bone conduction in one ear.
- **Conductive hearing loss** — Hearing loss from blocked sound transmission in the outer or middle ear, such as cerumen or fluid.
- **Bone conduction** — Transmission of sound vibrations through the skull bones directly to the inner ear.

## 같은 주제 문제

- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630316)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630317)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630318)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630319)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630320)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630321)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630322)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630323)

---

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

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