What does it suggest if bone conducted sound is heard longer than air conducted sound in Rinne's test?

Rinne's test is a simple clinical test used to assess hearing, specifically to differentiate between conductive and sensorineural hearing loss. During this test, a tuning fork is struck and placed on the mastoid bone (bone conduction) and then moved in front of the ear canal (air conduction).

If bone conduction is heard longer than air conduction, this indicates that sound is traveling better through the bone than through the air, which is characteristic of conductive hearing loss. In this scenario, the conductive pathway in the outer or middle ear is compromised, preventing adequate sound transmission through air. As a result, this leads to an enhanced perception of sound when transmitted through bone.

Normal hearing would present a situation where air conduction should be better than bone conduction, while sensorineural hearing loss typically results in both air and bone conduction being diminished, but air conduction remains better than bone conduction. A middle ear infection may lead to conductive hearing loss, but the Rinne's test itself does not isolate infections. Instead, it focuses on the manner of sound transmission, making the identification of conductive loss through increased bone conduction relative to air conduction clearer.