• CLINICAL NEUROLOGY

The tuning-fork is firmly established in the neurologist’s diagnostic armamentarium, having taken its pride of place for the investigation of hearing long before that of vibration sense. And is it any surprise? Sleek burnished steel, brandished by the neurologist at the faintest mention of hearing loss, is struck exuberantly against the elbow with a satisfying ping, echoing the confidence of the examiner that the ensuing tests will definitively distinguish a conductive from a sensorineural loss. We would argue, however, that the best use of cranial nerve VIII is the examiner’s own eighth nerve to take a history of the patient’s hearing loss, rather than the use of an antiquated technique of limited value.

The tuning-fork’s origins can be traced to the court of King James II. John Shore, the Sergeant Trumpeter, is credited with its invention in 1711 for tuning the lute; he apparently quipped before each of his performances, “I never go anywhere without my pitchfork” (clearly an 18th century Beach Boys predecessor (figure 1).1 Potential medical …