How good is the Rinnie test in differentiating between conductive and sensorineural hearing loss?

During one of my GP visits, I encountered a 42-year-old officer worker, of Irish origin, who presented with reduced hearing that she felt was more significant in her right ear. She reported she was finding it increasingly difficult to hear over a last the last 4-6 years. However, more recently it has been effecting her work. She is finding it rather difficult to take minutes in meetings and has to ask colleagues to repeat themselves. She reported this has been making her anxious and to feel ‘stupid’. She is concerned she may have to stop working in the near future. The patient denied any vertigo, aural fullness, otalgia and tinnitus. The patient reported her mother had otosclerosis in her 50s and had an unsuccessful stapedotomy. According to Schrauen and Van Camp (2010) the patient’s relevant risk factors for otosclerosis include being female, late 40s, family history, Asian or Caucasian ethnicity and pregnancy. The GP performed otoscopy to rule out infection, glue ear, cholesteatoma or perforated tympanic membrane.

The GP performed the Rennie test to assess whether the hearing loss was a sensorineural or a conductive hearing loss. A negative Rinne’s and family history would be suggesting otosclerosis.

This encounter at the GP prompted me to think about the value of tuning fork tests in rolling in and out conditions that cause hearing loss and furthermore how confidently I could distinguish between conductive and sensorineural hearing loss.

Using the PICO framework (Figure 1), I generated the following research question: ‘Is the Rennie test good at differentiating between conductive and sensorineural hearing loss?’ This essay will compare Rennie’s test to the gold standard pure tone audiometry (reference test).