What does a "positive" result on a Weber test suggest if sound lateralizes to one ear?

A positive result on the Weber test indicates sound lateralizes to one ear, suggesting potential underlying auditory issues. When sound lateralizes to one ear, it can indicate conductive hearing loss in that ear. In conductive hearing loss, sounds are perceived as being louder in the affected ear because of the reduced competing ambient sound that typically makes the sound softer in that ear.

This phenomenon occurs due to the mechanism by which the ear receives sound; in cases of conductive loss, the transmission of sound through the outer or middle ear is impaired, allowing the patient to hear the sound being conducted through the bone (which is tested in the Weber test) more clearly in the affected ear.

In contrasting situations, if sound were to lateralize to the opposite ear, this could indicate sensorineural hearing loss in the ear that did not hear the sound as strongly, but that does not apply to a positive result where the sound lateralizes to a particular ear.

Therefore, when interpreting a Weber test, sound lateralizing to one ear suggests that further evaluation is likely necessary to assess for conductive issues in that ear and can guide subsequent therapeutic or diagnostic steps.