Cranial Nerve VIII: Vestibulochochlear Nerve

Auditory Assessment:

  1. The patient is in sitting position
  2. The examiner stand behind the patient and covers one of the patient’s ears at at time
  3. At around 2ft / 60cm distance of the open ear, the examiner whispers a couple of numbers at the endow an exhalation and asks the patient to repeat them
  4. The procedure is repeated with the other ear In case deficits are observed, Rinne’s test and Weber’s test are performed

 

Rinne’s Test:

    1. The patient is in sitting position
    2. The examiner strikes a 256 or 512 Hz tuning fork and places it on the patient’s mastoid process
    3. The patient is asked to indicate once they no longer hear the buzzing sound
    4. The tuning fork is then immediately moved in front of the patient’s external auditory meatus to assess whether the patient can still hear the sound

 

Positive Outcome: Air conduction in the second step of the test should be greater than bone conduction in the first step. In a positive test, the patient can’t hear the sound when the tuning fork is placed in front of the auditory meatus

Weber’s Test:

    1. The patient is in sitting position
    2. The examiner strikes a 256 or 512 Hz tuning fork and places it in the middle of the patient’s forehead
    3. The patient is asked if the sound is louder in one ear or if it stays in the middle

 

Positive Outcome: The sound is more dominant in one ear

Vestibular Assessment:

    1. The patient is asked to maximally turn the head to one side
    2. The examiner observes the patient’s eyes for a nystagmus
    3. Alternatively, the examiner performs tests such as the Dix-Hallpike Maneuver

 

Positive Outcome: There is visible nystagmus and the patient describes symptoms such as vertigo, double vision, or nausea

Study

 Reliability Sn Sp LR+ LR-
Damadoran et al. (2014) NA NA NA NA NA
Kelly et al. (2018):
Rinne’s Test		 NA 16-91 50-100 NA NA
Kelly et al. (2018):
Weber’s Test		 NA NA NA NA NA