A 38 year old gentleman repos of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork the Rinne's test without masking is negative on the right ear and positive on the left ear. With the Weber's test the tone is perceived as louder in the left ear. This patient MOST likely has:

In unilateral sensorineural hearing loss, when hearing test is conducted with 512Hz tuning fork, the Rinnie's test (without masking) may be false or negative but Weber's test will be lateralized to the normal ear. In this patient with right sided hearing loss, Weber's test was lateralized to the left ear so this ear is normal and patient has right sided sensorineural hearing loss. When unilateral conductive deafness is present in the and the other ear is normal, sound of the tuning fork lateralizes in the ear with the conductive hearing loss. Rinnie's test is positive when air conduction is greater than bone conduction and it is negative when bone conduction is greater than air conduction. Negative Rinnie's test indicate conductive deafness. An exception is when one ear is not hearing at all, when we get a false negative Rinnie's test.