surgical candidacy assessments, and estimation of hearing loss severity. Detection of air conductive hearing loss A patient with a unilateral conductive hearing loss would hear the tuning fork loudest in the affected ear. This is because the ear with the conductive hearing loss is only receiving input from the bone conduction and no air conduction, and the sound is perceived as louder in that ear. This finding is because the conduction problem of the middle ear (incus, malleus, stapes, and external auditory meatus) masks the ambient noise of the room, while the well-functioning inner ear (cochlea with its basilar membrane) picks the sound up via the bones of the skull, causing it to be perceived as a louder sound in the affected ear. Another theory, however, is based on the occlusion effect described by Tonndorf et al. in 1966. Lower frequency sounds (as made by the 256 Hz fork) that are transferred through the bone to the ear canal escape from the canal. If an occlusion is present, the sound cannot escape and appears louder on the ear with the conductive hearing loss. Conductive hearing loss can be mimicked by plugging one ear with a finger and performing the Rinne and Weber tests, which will help clarify the above. Humming a constant note and then plugging one ear is a good way to mimic the findings of the Weber test in conductive hearing loss. The simulation of the Weber test is the basis for the Bing test. Detection of sensorineural hearing loss If air conduction is intact on both sides (therefore no CHL), the patient will report a quieter sound in the ear with the sensorineuronal hearing loss. This is because the ear with the sensorineuronal hearing loss is not converting input from either the air or bone conduction, and the sound is perceived as louder in the normal ear. Considerations and limitations This Weber test is most useful in individuals with hearing that is different between the two ears. It cannot confirm normal hearing because it does not measure sound sensitivity in a quantitative manner. Hearing defects affecting both ears equally, as in presbycusis will produce an apparently normal test result. Weber test considerations The Weber test reflects conduction loss in the ipsilateral ear because, in the event of impaired conduction, ipsilateral sensorineural hearing is perceived as louder; this is the same reason humming becomes more salient when covering