In conductive hearing loss, the Weber test typically shows lateralization to which ear?

Explanation

## Weber Test Principle in Conductive Hearing Loss **Key Point:** In conductive hearing loss, the Weber test lateralizes to the **affected ear** — the ear with the conductive deficit. ### Mechanism The Weber test uses a vibrating tuning fork placed at the midline of the skull. Sound travels through bone conduction to both cochleae. 1. In the **normal ear**, air conduction and bone conduction are both intact — sound reaches the cochlea efficiently via both routes. 2. In the **affected ear with conductive loss**, air conduction is blocked (ossicular chain disruption, cerumen impaction, etc.), but bone conduction remains intact. 3. Because the affected ear **cannot hear via air conduction**, it relies more on bone conduction vibrations from the skull. 4. The brain perceives the bone-conducted sound as louder in the affected ear, causing lateralization **toward the conductive loss**. ### Clinical Correlation This is the **opposite** of sensorineural hearing loss, where Weber lateralizes to the **better ear** (away from the sensorineural deficit). **High-Yield:** Remember: **Conductive loss → lateralize TO the bad ear; Sensorineural loss → lateralize AWAY from the bad ear.** ### Comparison Table | Test | Conductive Loss | Sensorineural Loss | | --- | --- | --- | | **Weber** | Lateralizes to affected ear | Lateralizes to normal ear | | **Rinne** | Bone > Air (BC > AC) | Air > Bone (AC > BC) | | **Mechanism** | Air conduction blocked; bone conduction preserved | Cochlear/nerve damage; both pathways affected | [cite:Dhingra 8e Ch 3]