Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
!
A reassuring fork test cannot exclude an emergency
Tuning-fork responses provide limited information at one frequency and can mislead when hearing is profoundly asymmetric.
Action: Recent sudden hearing loss with no adequate canal or middle-ear explanation still requires ENT or emergency assessment within 24 hours under NICE criteria. Do not postpone referral to repeat uncertain fork tests or arrange routine audiometry.
Synopsis
Perform and interpret paired tuning-fork tests, recognise cross-hearing and other limitations, and use the findings to support appropriate audiological and urgent ENT assessment.
Use a 512 Hz audiometric fork in a quiet setting and explain the listening task before testing.
Perform Weber first, asking where the midline tone is perceived without suggesting a preferred side.
For the BSA Rinne method, compare a brief air-conduction presentation with an immediate mastoid presentation and ask which sounded louder.
Key red flags
Sudden unexplained hearing deterioration over no more than three days, beginning in the previous 30 days, needs assessment within 24 hours even if bedside responses are equivocal.
Investigation priorities
01
Weber using a 512 Hz forkFirst step
Assess the perceived location of bone-conducted sound before undertaking Rinne.
Management branches
A consistent conductive patternFind the lesion and assess residual hearing
Weber is perceived towards the symptomatic ear and Rinne on that side shows bone louder than air.
Check for canal obstruction, inflammation, fluid, perforation or relevant ear surgery, and describe the examination rather than assuming one particular cause.
Arrange treatment or ENT assessment appropriate to the observed lesion and the patient's symptoms, using safe ear-care methods.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.