is still noticeable to a normal ear. In case of a severe sensorineural hearing loss caused due to a dead labyrinth, a false negative Rinne test may occur. It is caused by the fact that even though one ear is unable to respond to the test, the other ear can still be stimulated by the bone conduction test (via conducting sound through skull bones to the opposite ear), causing the patient to respond to the tuning fork on mastoid but not when it's placed near the affected ear's air canal. Air vs. bone conductive hearing loss Air conduction uses the apparatus of the middle ear (pinna, eardrum and ossicles) to amplify and direct the sound to the cochlea, whereas bone conduction bypasses some or all of these and allows the sound to be transmitted directly to the inner ear albeit at a reduced volume, or via the bones of the skull to the opposite ear. Note that the words positive and negative are used in a somewhat confusing fashion here, as compared to their typical use in medical tests. Positive or negative in this case means that a certain parameter that was evaluated was present or not. In this case, that parameter is whether air conduction (AC) is better than bone conduction (BC). Thus, a "positive" result indicates the healthy state, in contrast to many other medical tests. Therefore, some prefer to avoid using the terms "positive" or "negative", and simply state if the test was normal or abnormal. For example: "Rinne's test was abnormal in the right ear, with bone conduction greater than air conduction". Limitations This test and its complement, the Weber test, are quick screening tests and are not a replacement for formal audiometry. Recently, its value as a screening test has been questioned. The Rinne test is not reliable in distinguishing sensorineural and conductive loss cases of severe unilateral or total sensorineural loss. In such cases, bone conduction to the contralateral normal ear will be better than air conduction, resulting in a false negative. In such a case, the Weber test will, however, show signs of lateralization, implying some kind of pathology. Formal audiometry testing would be required if any abnormal result is presented. References See also Internal links Weber test External links Tuning Fork Tests - Family Practice Notebook. Retrieved February 3, 2007. Ear procedures Medical tests