Reassessing the Rinne Test: Importance of a Three‐Frequency Tuning Fork Evaluation

Objective (1) To evaluate the accuracy of the Rinne test in the diagnosis of conductive hearing loss (CHL) at the frequencies of 512, 1024 and 2048 Hz comparing to standard audiometry. (2) To define a possible linear relationship between the frequencies of the tuning forks and the proportional increase in the air‐bone gap (ABG). Study Design Retrospective cross‐sectional. Setting Outpatient otology clinic. Methods One hundred and twenty‐one patients diagnosed with otosclerosis in at least 1 ear were evaluated between 1998 and 2019 and underwent the Rinne test with 512, 1024, and 2048 Hz tuning forks followed by an audiometry prior to surgery. Then, the Rinne test results were compared with the ABG found in audiometry. Results The sensitivity of the Rinne test in the diagnosis of otosclerosis was 97.3%, 91%, and 48% at 512, 1024, and 2048 Hz, respectively. The test showed high specificity at all frequencies (90.7% at 512 Hz, 100% at 1024 Hz, and 100% at 2048 Hz). Logistic regression used to calculate the Rinne transition point revealed that the probability of a negative Rinne test result reached 50% from an ABG of 13.9 dB, 18.7 dB, and 31.3 dB when using 512, 1024, and 2048 Hz, respectively. Conclusion The Rinne test has a high sensitivity at the frequencies of 512 and 1024 Hz, being an excellent test for otosclerosis screening. At the same time, the use of the 3 tuning fork frequencies is an excellent method for estimating the severity of pure conductive hearing loss. Level of Evidence Level 3.