Thanks Anthony for your sharing, would you provide published articles supporting your opinion.

Glad to see a queston on tuning fork tests. We see this as a lost art and yet as a qualitative tool to understand the progression of pathologies as well as to verify patient verbal and case history complaints, tuning fork testing serves a vital need. In my work, which for the past half dozen years has been almost all in behavioral medicine (still some consulting for otolayngology and audiologist clinics), I find using the tuning fork tests (Bing, Schwabach, Rene) invaluable at finding impending heart issues. The heart sinus node tone of the vagus nerve branch in the 3.5-4.5 Hz region can be detected by matching patient complaint of a "high pitch ring" to the 4KHz fork, and from there help in deciding whether to refer to a cardiologist first or to start first with the audiologist to determine if hearing loss is at root of the complaint. We find, and this is anecdotal and relies upon other information, that a tinnitus complaint at about 4KHz and thresholds are perfectly normal at 4KHz in audiometric testing, that pericardial sac inflammation is suspected and points to the need for a thorough cadiac investigation. This may seem a bit off topic, but is pertinent to both the need for tuning fork testing as a quick screening procedure and the need to refer for a complete audiological battery. 

Yes, I've written and give these items in some of my CE/MCE courses. I need to sit down and write a complete review for an article, so many projects in the pipeline. I wrote a short how to manuel for dispensing audiologists about ten years ago called the Lost Art of Tuning Fork Testing in Dispensing Practice. Its about 70-80 pages long and still in print. It is amazing how incoming professionals are unaware that tuning forks were the origin of much of what they do today in diagnostics, and is still the best portable quick-test there is for sorting out a lot of conditions, and reducing patient's verbal descriptions to something more concrete.

Thanks Max for your sharing but please, you would clarify  what you have said "I find using the tuning fork tests (Bing, Schwabach, Rene) invaluable at finding impending heart issues. The heart sinus node tone of the vagus nerve branch in the 3.5-4.5 Hz region can be detected by matching patient complaint of a "high pitch ring" to the 4KHz fork, and from there help in deciding whether to refer to a cardiologist first or to start first with the audiologist to determine if hearing loss is at root of the complaint."  Would you add your reference which support your opinion? 

Hazem, I'm packed on my patient schedule at the moment, and will have to go back into the literature--many of the connections we make between ear issues like tinnitus and hearing loss vs hypertension and developing cardiocascular disease are inference drawn by several fields of research. The cardiovascular field will not the existence of a heart sinus node tone (that's why they implant vagal stimulators when hearing aids will do the same thing to a degree in cases where hearing loss and percardial swelling co-occur), the audiology field will note that hypertension co-occurs with sensorineural loss (particularly in older males), or the otolaryngology field will track vagal functions along with the other cranial nerves, reflexes, and effects of vagal artifacts on voice etc., while yet the dermatology field will map mechanoreceptor cascades from Merkyl discs onward. But the entire picture remains obscurred to each discipline, not knowing that we are all in this together and need to be sharing our observations (most anecdotal, some qualitative, some quantitative) so we can work together better for our patients' well being. If a well fitted hearing aid with enough high frequency energy to create inhibition of a 4KHz tinnitus (the most common of human tinnitus, incidentally), both blood pressure and perrcardial tension are relieved to varying degrees--then cardiology staff realize the value of testing for and correcting hearing loss, and the hearing professions realize the value of their work as it affects CV health. For now, I hope this sparks some thought for us until I can sit down and give you the long answer. But the truth is we all need each other to serve our patients optimally.

Thanks Max for clarification and waiting the details & possible supportive articles.