{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:13:06Z","timestamp":1792782786789,"version":"4.5.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universiti Sains Malaysia","id":[{"id":"https:\/\/ror.org\/02rgb2k63","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study involved 75 children with conductive hearing loss aged between seven to twelve years old. Each subject underwent TFW (256\u00a0Hz and 512\u00a0Hz) and AW (250\u00a0Hz and 500\u00a0Hz) tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All subjects achieved high accuracy (&gt;\u200980%) in both TFW and AW tests. McNemar\u2019s test revealed there was no significant difference between the TFW and AW tests for both frequencies (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Using Cohen\u2019s Kappa, the lateralization responses in both tests demonstrate substantial to almost perfect agreement (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20090.78\u20130.92). with the predicted lateralization responses for both frequencies. Large air\u2013bone gap group also demonstrated higher accuracy for both tests compared to the small air\u2013bone gap group, although the difference was not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-026-10325-6","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T23:29:18Z","timestamp":1781047758000},"page":"5603-5608","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic accuracy of tuning fork weber test and audiometric weber test in school-aged children with conductive hearing loss"],"prefix":"10.1007","volume":"283","author":[{"given":"Tee Shao","family":"Peng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9800-0898","authenticated-orcid":false,"given":"Nik Adilah","family":"Nik Othman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Normani","family":"Zakaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Fariza Husna","family":"Nik Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"10325_CR1","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1016\/j.otc.2015.06.007","volume":"48","author":"W Dougherty","year":"2015","unstructured":"Dougherty W, Kesser BW (2015) Management of conductive hearing loss in children. Otolaryngol Clin North Am 48:955\u2013974. https:\/\/doi.org\/10.1016\/j.otc.2015.06.007","journal-title":"Otolaryngol Clin North Am"},{"key":"10325_CR2","doi-asserted-by":"publisher","first-page":"197","DOI":"10.2310\/7070.2007.0025","volume":"36","author":"A Behn","year":"2007","unstructured":"Behn A, Westerberg BD, Zhang H, Riding KH, Ludemann JP, Kozak FK (2007) Accuracy of the Weber and Rinne tuning fork tests in evaluation of children with otitis media with effusion. J Otolaryngol 36:197\u2013202. https:\/\/doi.org\/10.2310\/7070.2007.0025","journal-title":"J Otolaryngol"},{"key":"10325_CR3","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1055\/s-2007-997435","volume":"76","author":"H Feldmann","year":"1997","unstructured":"Feldmann H (1997) The history of the tuning fork. Part II: the invention of the classic tests of Weber, Rinne, and Schwabach. Laryngol Rhinol Otol 76:318\u2013326. https:\/\/doi.org\/10.1055\/s-2007-997435","journal-title":"Laryngol Rhinol Otol"},{"key":"10325_CR4","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1177\/000348945206100323","volume":"61","author":"DM Markle","year":"1952","unstructured":"Markle DM, Fowler EP, Moulonguet H (1952) The audiometer Weber test as a means of determining the need for, and type of masking. Ann Otol Rhinol Laryngol 61:888\u2013900. https:\/\/doi.org\/10.1177\/000348945206100323","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"10325_CR5","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/s0385-8146(96)80005-8","volume":"23","author":"JJ Haapaniemi","year":"1996","unstructured":"Haapaniemi JJ, Suonpaa JT, Salmivalli AJ, Virolainen ES (1996) C1-tuning fork tests in school-aged children. Auris Nasus Larynx 23:26\u201332. https:\/\/doi.org\/10.1016\/s0385-8146(96)80005-8","journal-title":"Auris Nasus Larynx"},{"key":"10325_CR6","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1017\/s0022215100102725","volume":"101","author":"JWR Capper","year":"1987","unstructured":"Capper JWR, Slack RWT, Maw AR (1987) Tuning fork tests in children (an evaluation of their usefulness). J Laryngol Otol 101:780\u2013783. https:\/\/doi.org\/10.1017\/s0022215100102725","journal-title":"J Laryngol Otol"},{"key":"10325_CR7","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1136\/bmj.283.6306.1576","volume":"283","author":"MW Yung","year":"1981","unstructured":"Yung MW, Morris TMO (1981) Tuning-fork tests in diagnosis of serous otitis media. Br Med J (Clin Res Ed) 283:1576. https:\/\/doi.org\/10.1136\/bmj.283.6306.1576","journal-title":"Br Med J (Clin Res Ed)"},{"key":"10325_CR8","doi-asserted-by":"publisher","first-page":"63","DOI":"10.4102\/sajcd.v21i1.401","volume":"21","author":"AK Thompson","year":"1974","unstructured":"Thompson AK (1974) Audiometric Weber and Rinne tests as compared to pure-tone thresholds. S Afr J Commun Disord 21:63\u201370. https:\/\/doi.org\/10.4102\/sajcd.v21i1.401","journal-title":"S Afr J Commun Disord"},{"key":"10325_CR9","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1002\/lio2.747","volume":"7","author":"SN Abdullah","year":"2022","unstructured":"Abdullah SN, Zakaria MN, Salim R, Md Daud MK, Nik Othman NA (2022) Comparing the diagnostic accuracy of audiometric Weber test and tuning fork Weber test in patients with conductive hearing loss. Laryngoscope Investig Otolaryngol 7:523\u2013529. https:\/\/doi.org\/10.1002\/lio2.747","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"10325_CR10","first-page":"163","volume-title":"Springer handbook of auditory research","author":"RY Litovsky","year":"2012","unstructured":"Litovsky RY (2012) Development of binaural and spatial hearing. Springer handbook of auditory research. Springer, New York, pp 163\u2013195"},{"key":"10325_CR11","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1177\/0194599813505828","volume":"149","author":"CA Mackechnie","year":"2013","unstructured":"Mackechnie CA, Greenberg JJ, Gerkin RC, McCall AA, Hirsch BE, Durrant JD, Raz Y (2013) Rinne revisited: steel versus aluminum tuning forks. Otolaryngol Head Neck Surg 149:907\u2013913. https:\/\/doi.org\/10.1177\/0194599813505828","journal-title":"Otolaryngol Head Neck Surg"},{"key":"10325_CR12","doi-asserted-by":"publisher","first-page":"239","DOI":"10.5152\/iao.2017.2745","volume":"13","author":"M Y\u00fcksel","year":"2017","unstructured":"Y\u00fcksel M, Kemalo\u011flu YK (2017) Acoustic analysis of used tuning forks. J Int Adv Otol 13:239\u2013242. https:\/\/doi.org\/10.5152\/iao.2017.2745","journal-title":"J Int Adv Otol"},{"key":"10325_CR13","doi-asserted-by":"publisher","first-page":"EL96","DOI":"10.1121\/1.4885771","volume":"136","author":"A Eichenauer","year":"2014","unstructured":"Eichenauer A, Dillon H, Clinch B, Loi T (2014) Effect of bone-conduction harmonic distortions on hearing thresholds. J Acoust Soc Am 136:EL96-102. https:\/\/doi.org\/10.1121\/1.4885771","journal-title":"J Acoust Soc Am"},{"key":"10325_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195233","volume":"13","author":"L Fr\u00f6hlich","year":"2018","unstructured":"Fr\u00f6hlich L, Plontke SK, Rahne T (2018) Influence of transducer types on bone conduction hearing thresholds. PLoS One 13:e0195233. https:\/\/doi.org\/10.1371\/journal.pone.0195233","journal-title":"PLoS One"},{"key":"10325_CR15","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1121\/AT.2020.16.2.48","volume":"16","author":"DA Russell","year":"2020","unstructured":"Russell DA (2020) The tuning fork: an amazing acoustics apparatus. Acoust Today 16:48\u201355. https:\/\/doi.org\/10.1121\/AT.2020.16.2.48","journal-title":"Acoust Today"},{"key":"10325_CR16","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1177\/0194599818770405","volume":"159","author":"EA Kelly","year":"2018","unstructured":"Kelly EA, Li B, Adams ME (2018) Diagnostic accuracy of tuning fork tests for hearing loss: a systematic review. Otolaryngol Head Neck Surg 159:220\u2013230. https:\/\/doi.org\/10.1177\/0194599818770405","journal-title":"Otolaryngol Head Neck Surg"},{"key":"10325_CR18","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1044\/jshr.1104.805","volume":"11","author":"ER Nilo","year":"1968","unstructured":"Nilo ER (1968) The relation of vibrator surface area and static application force to the vibrator-to-head coupling. J Speech Hear Res 11:805\u2013810. https:\/\/doi.org\/10.1044\/jshr.1104.805","journal-title":"J Speech Hear Res"},{"key":"10325_CR19","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1121\/1.381081","volume":"60","author":"SM Khanna","year":"1976","unstructured":"Khanna SM, Tonndorf J, Queller JE (1976) Mechanical parameters of hearing by bone conduction. J Acoust Soc Am 60:139\u2013154. https:\/\/doi.org\/10.1121\/1.381081","journal-title":"J Acoust Soc Am"},{"key":"10325_CR20","unstructured":"Dirks DD (1978) Bone-conduction testing. Handbook of clinical audiology, 2nd edn. Baltimore: Williams & Wilkins"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10325-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-026-10325-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10325-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:04:16Z","timestamp":1791939856000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-026-10325-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10325"],"URL":"https:\/\/doi.org\/10.1007\/s00405-026-10325-6","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"assertion":[{"value":"6 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study is approved by the Human Research Ethics Committees USM (USM\/JEPeM\/LL\/23030233) and Medical Research and Ethics Committee, Ministry of Health (NMRR ID-23\u201301153-NFX (IIR)). Parental consent and child assent were obtained before proceeding with the test.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Both written and verbal informed consent were obtained.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}