Diagnostic accuracy of tuning fork weber test and audiometric weber test in school-aged children with conductive hearing loss

PURPOSE: While the application of tuning fork Weber (TFW) test in adult is well-documented, its accuracy in the paediatric population remains uncertain although conductive hearing loss is frequently identified in children. Similarly, the effectiveness of the audiometric Weber (AW) test is ambiguous. Given evidence suggesting that age influences lateralization accuracy and understanding of instructions, this research specifically targets school-aged children to evaluate these diagnostic tools effectively. This study aims to explore the lateralization accuracy of TFW and AW tests in detecting conductive hearing loss in children and the agreement of these tests with the predicted lateralization responses based on audiogram. METHODS: This study involved 75 children with conductive hearing loss aged between seven to twelve years old. Each subject underwent TFW (256 Hz and 512 Hz) and AW (250 Hz and 500 Hz) tests. RESULTS: All subjects achieved high accuracy (> 80%) in both TFW and AW tests. McNemar's test revealed there was no significant difference between the TFW and AW tests for both frequencies (p > 0.05). Using Cohen's Kappa, the lateralization responses in both tests demonstrate substantial to almost perfect agreement (k = 0.78-0.92). with the predicted lateralization responses for both frequencies. Large air-bone gap group also demonstrated higher accuracy for both tests compared to the small air-bone gap group, although the difference was not statistically significant (p > 0.05). CONCLUSION: Both the TFW and AW tests showed high lateralization accuracy in either unilateral or bilateral CHL supported by substantial to almost perfect agreement with the respective PTA in school-aged children with conductive hearing loss.