A 38 year old male presented with a suspected diagnosis of suppurative labyrinthitis. A positive Rinne's test and positive fistula test was recorded on initial examination. The patient refused treatment, and returned to the emergency depament after 2 weeks complaining of deafness in the affected ear. On examination, fistula test was observed to be negative. What is the likely expected finding on repeating the Rinne's test?

A positive Rinnie's test is seen in normal people and in sensorineural deafness, and a positive fistula test implies that the labyrinth is still functioning. Deafness and a negative fistula test means the labyrinth is dead and he is suffering from severe unilateral sensorineural hearing loss. If we try to do Rinnie's test in this patient, he does not perceive any sound of tuning fork by air conduction but responds to bone conduction testing. This response to bone conduction is, in reality, from the opposite ear because of transcranial transmission of sound. So it is a false negative test. Correct diagnosis can be made by making the non-test ear with Barany's noise box while testing for bone conduction.