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To the Editor: The Rational Clinical Examination on hearing impairment by Dr Bagai and colleagues¹ provides valuable information, particularly the discussion of the usefulness of the whisper test in screening for hearing loss. However, to conclude that tests using tuning forks "are not recommended for routine screening and should no longer be part of the medical curriculum" is dismissive. Furthermore, the authors' discussion on the pathophysiology of sensorineural hearing loss omits both vestibular schwannomas and sudden sensorineural hearing loss. While neither condition is common, suspicion of either requires prompt referral to an otolaryngologist.

We agree that the Weber and Rinne tuning fork tests are poor independent screening tools for hearing impairment. However, the principal role for both the Weber and Rinne tests is not as a screening tool but to make an initial differentiation between sensorineural and conductive hearing loss in a patient who has complained of unilateral symptoms of . . . [Full Text of this Article]

Stephen M. Kieran, MRCSI
skieran@rcsi.ie

John E. Fenton, FRCSI(ORL-HNS)
Department of Otorhinolaryngology, Head and Neck Surgery
Mid-Western Regional Hospital
Dooradoyle, Limerick, Ireland

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