Test		Description	Hearing loss threshold	Sensitivity (%)	Specificity (%)	Likelihood ratio
						Positive	Negative
Clinical examination
	Finger rub test	Examiner gently rubs fingers together 6 inches from patient's ear; a positive result is failure to identify the rub in at least three of six attempts	> 25 dB	98	75	10	0.75
	Whispered voice test	Examiner stands at arm's length behind patient, and patient occludes one ear while examiner whispers letter/number combinations six times; a positive test is inability to repeat at least three of the six letter/number combinations	30 dB	95	82	5.1	0.03
Direct question		Yes or no question to patient about whether he or she has hearing loss	> 25 dB	67	80	3.0	0.4
			> 40 dB	81	72	2.5	0.26
Handheld audiometry		Examiner holds device in patient's ear, and patient indicates awareness of each tone; a positive test is failure to identify the 1,000-Hz or 2,000-Hz frequency in both ears, or the 1,000-Hz and 2,000-Hz frequency in one ear	30 to 45 dB	96	72	3.4	0.05
Hearing Handicap Inventory for the Elderly		10-item, self-administered questionnaire measuring social and emotional handicap due to hearing impairment; score > 8 is abnormal	> 25 dB	75	67	3.8	0.38
Tabletop manual audiometry		Various models of small, portable audiometers or audiometric program designed for portable electronic devices	≥ 40 dB	88	96	21.3	0.13
Tuning fork tests (512 Hz)
	Rinne test	Examiner strikes a tuning fork and places it on mastoid bone behind ear, then when patient indicates no further sound, the still-vibrating fork is moved to the ear (air conduction will be better than bone conduction); inability to detect air-conducted sound indicates conductive hearing loss	20 dB	65	95 to 98	2.7 to 62*	– 0.01 to 0.85*
	Weber test	Examiner strikes a tuning fork and places it midforehead; normal result is perceiving sound on both sides (no lateralization)	Lateralization to good ear indicates sensorineural hearing loss	58	79	1.6	0.7
			Lateralization to bad ear indicates conductive hearing loss	54	92	Not specified	0.5