Objective
To assess the diagnostic accuracy of the Rydel-Seiffer vs. the qualitative 128 Hz tuning fork for detecting axonal neuropathy.
Methods
100 consecutive patients seen at the Neurology Outpatient Electromyography (EMG) clinic at a major academic center were recruited and consented for this study. Study personnel who were blinded to results of nerve conduction studies, collected data on vibratory perception with both tuning forks at bilateral (a) great toe, and (b) distal inter-phalangeal joint on the second digit. Published normative data was used to determine abnormal scores for the Rydel-Seiffer tuning fork and the qualitative tuning fork; axonal neuropathy was determined based on our EMG laboratory standards.
Results
A total of 296 nerves from 100 patients were tested with tuning forks and compared to sensory nerve action potential obtained through EMG. The sensitivity and specificity of the Rydel-Seiffer tuning fork was 29% and 86% respectively, and the sensitivity and specificity of the conventional 128 Hz tuning fork was 21% and 88% respectively. The extended McNemar’s test showed no significant difference in sensitivity or specificity of the two tuning forks (χ2=0.83).
Conclusions
There is no difference in diagnostic accuracy between the Rydel-Seiffer and conventional tuning fork for detecting axonal neuropathies; however, the Rydel-Seiffer is easier to use, and superior for longitudinal assessments.
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