![]() ![]() In all other situations, it is just one of the tools in the armamentarium but not the sole instrument on which to make radical treatment decisions. The most important clinical question nowadays concerns only the accuracy of these tests in diagnosing idiopathic sudden sensorineural hearing loss. The foundation of their use-the occlusion effect (bone conduction gain on occlusion of the auditory meatus) and the phenomenon of lateralisation of bone conduction into the occluded ear-were solidly documented by multiple authors with a rather ‘universally’ reproducible outcome. Thus, their purpose at that time was-obviously-completely different from current reasons to use tuning fork tests. At first, these tests were used for different types of hearing loss to give a ‘rough’ indication, as the best available diagnostic tool for that moment. Tuning fork tests were invented at a time when there was neither electric audiometer nor micro-otoscopy. 5 However, most ENT clinicians consider tuning fork testing to be an appropriate and easy-to-use first step in acute situations to distinguish between conductive and perceptive hearing loss. Their standard use in a neurological setting may lead to ‘bad vibrations’. 5 They are indeed not 100% accurate, 1 and we, like most people, agree that referral for audiometry is the preferred option in the non-acute setting. 3 And still there are occasional reports citing exceptions to the rule that tuning forks do not lie 4 and the renewed discussion about their usefulness. Tuning fork tests have been under attack since their first descriptions. Moreover, anyone who has forgotten how the tests work can easily experience the effect by occluding one ear canal while holding a tuning fork on the forehead. However, a tuning fork fits in every white coat, the tests are easy to use, accurate, non-invasive and inexpensive for acute unilateral hearing loss, they can assist in triage. The gold standard-audiometric testing with adequate masking-is often not directly available in primary care. General practitioners can use otoscopy and the tuning fork tests to differentiate between conductive and perceptive hearing loss. Thus, general practitioners must refer patients with acute perceptive hearing loss urgently to an Ear, Nose and Throat (ENT) clinic for further diagnosis and treatment. 2 These treatments need to start as early as possible, since the best results follow a rapid diagnosis. High-dose corticosteroids are the standard treatment 1 and these might be even more effective when combined with hyperbaric oxygen. ![]() Another point is assigned if the correct timing of dampening of the vibration is perceived (vibration “off ”).Ħ.Idiopathic sudden sensorineural hearing loss is a devastating disease with limited effective treatment. One point is assigned for each vibration sensation perceived (vibration “on”). ![]() ![]() Ask the patient to tell you when the vibration stimulus is stopped, and then dampen the tuning fork with your other hand.ĥ. Ask if the vibration sensation is perceived.Ĥ. With the patient’s eyes closed, apply the tuning fork to the bony prominence situated at the dorsum of the first toe just proximal to the nail bed. Apply the base of the tuning fork to the patient’s forehead or sternum and ensure that the vibration sensation is understood.ģ. Strike the tuning fork against the palm of your hand hard enough that it will vibrate for approximately 40 seconds.Ģ. Their conclusion was that the risk of foot ulcers, which is associated with diminished vibratory sensation, can therefore be detected earlier and more accurately with the CTF test.ġ. It was also found to identify severe neuropathy, even in the presence of a normal result with the 10-g monofilament test. they found the 128 Hz tuning fork test to be reproducible and accurate. This is a very important but often underutilized examination tool, much like the 10-gm monofilament it is cheap and easy to perform. Another inexpensive but very valuable tool in the examination of the diabetic foot for loss of protective sensation is the 128Hz tuning fork. ![]()
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