Weber test accuracy in sudden sensorineural hearing loss: which frequency is best?

Abstract

Background

Recent guidelines encourage the use of Webet test (WT) as a part of the physical examination of a newly suspected sudden sensorineural hearing loss (SSNHL) patient. However, the most sensitive tuning-fork frequency has never been identified.

Objective

To identify the most sensitive frequency for initial WT of patients with suspected SSNHL.

Methods

Medical records of patients with confirmed SSNHL, who underwent formal audiometry in which the WT was carried out with different frequencies were analyzed.

Results

319 medical records were identified. The most sensitive WT frequency was 500 Hz, with a sensitivity of 94.49% (223/236. confidence interval 90.76–97.03). There was a non-significant difference between 1000 Hz EBO and 500 Hz EBO (p = .1655), a tendency towards a significant difference between 1000 Hz EBO and 2000 Hz EBO (p = .0578), and a significantly better sensitivity than the 4000 Hz EBO (p = .0163).

Conclusion

The most sensitive WT frequency for SSNHL diagnosis is 500 Hz. However, the sensitivity of this frequency is 94.49%.

Significance

512 or 1024 Hz should be used to better identified SSNHL. Even WT lateralization to the affected ear, does not preclude the diagnosis of SSNHL. Formal audiometry should be used in any case of medical history suspected for sudden hearing loss with normal otoscopy.

Chinese abstract

背景：最近的指南建议将Webet测试（WT）用作对新疑似突发感觉神经性听力损失（SSNHL）患者进行身体检查的一部分。但是, 从未发现最敏感的音叉频率。

目的：确定疑似SSNHL患者首次WT的最敏感频率。

方法：分析确诊为SSNHL的患者的病历。这些患者接受了正式的听力检查, 以不同的频率进行WT测试。

结果：确认了319份病历。最敏感WT频率为500 Hz, 灵敏度为94.49％（223/23, 置信区间90.76–97.03）。在1000 Hz EBO和500 Hz EBO之间没有显着差异（p¼.1655）, 在1000 Hz EBO和2000 Hz EBO之间趋向于显著差异（p¼.0578）, 并且灵敏度明显高于4000 Hz EBO（p¼.0163）。

结论：用于SSNHL诊断的最敏感的WT频率为500 Hz。但是, 此频率的灵敏度为94.49％。

意义：应该使用512或1024 Hz来更好地诊断SSNHL。即使WT偏侧于病耳, 也不排除SSNHL的诊断。怀疑有突发听力损失的病史的情况下, 虽然耳镜结果正常, 也应使用正式听力检查。

Keywords:

• Hearing loss
• sudden sensorineural hearing loss
• Weber test
• tuning fork

Ethical approval

This prospective cohort study was approved by the local institutional review board (0312-19-TLV).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, OJU. The data are not publicly available due to ethical restrictions.