What happens during a hearing test?

Before we get into what happens in an audiology appointment, I should probably share why you should schedule an audiology appointment.

Below are some common signs of of hearing loss:

  • Difficulty hearing everyday conversations
  • A feeling of being able to hear but not understand
  • Having to turn up the TV or radio
  • Asking others to repeat often
  • Avoidance of social situations that were once enjoyable
  • Fatigue after a day of listening to other people
  • Increased difficulty communicating in noisy situations like restaurants, social gatherings, in the car or in group meetings
  • Tinnitus, or ringing and/or buzzing sounds in the ears

As we age, hearing loss becomes more likely. About 2 percent of adults aged 45 to 54 have disabling hearing loss. The rate increases to 8.5 percent for adults aged 55 to 64. Nearly 25 percent of those aged 65 to 74 and 50 percent of those who are 75 and older have disabling hearing loss.1

What happens in an audiology appointment?

An appointment can take anywhere from 30 minutes to 2 hours, depending on the purpose and outcome of the testing.

When I have a new patient scheduled for an appointment, I want to make sure they are comfortable, with both myself as the audiologist, and what the appointment is going to entail.  I do think it is important to bring a family member or friend to this appointment, as you will be receiving A LOT of information, and I always say, four ears are better than two.

After introductions, we complete a detailed medical history and needs assessment.  I’m sure most of you have completed medical histories at one time or a million ;-).  A needs assessment gives me an idea of just what concerns you have about your hearing, what your current environment is like, where you are experiencing some challenges, and what goals you have for yourself and your hearing.

Once the history and needs assessment has been completed, I will perform an otoscopic exam, which is a fancy term for looking into your ears to check for healthy looking ear canals, tympanic membranes (ear drum) and make sure cerumen (ear wax) is not excessive or blocking the ear canal.  If there is an issue during the otoscopic exam, the hearing test may need to be postponed until after the issue is cleared up.  Some issues can be dealt with at the Audiologists office (excessive wax, foreign object in the ear canal) but others may need to be referred (active draining ear).

Now the hearing testing begins.  You are seated in a quiet area, usually an Audiometric Booth.  Ear inserts or headphones will be placed in or on your ears.  You will be instructed to repeat all the words you hear, testing each ear separately.  I use recorded voice for this test, called Speech Reception Thresholds, because not only is this considered Best Practices, but my Philadelphia accent doesn’t hold up well in South Carolina 😉  Also, a fun fact (or a word to add to your Scrabble vocabulary)…the words presented to you during this test are called ‘spondees’.  A spondee is a two syllable word with equal emphasis on each syllable.

The next test is called Pure tone Air Conduction.  This is the famous ‘beep’ test.  We are trying to find out where your thresholds (at what level you can just hear the pure tones) are for each of the frequencies we are presenting.

We follow this up with Speech Discrimination testing.  We will be asking you to repeat recorded words back to us again, but this time they are one syllable words and are presented at a level that is comfortable for you to hear.

UCL (Uncomfortable Loudness Level) is performed to determine how loud tones can be turned up before they are too loud FOR YOU.  MCL (Most Comfortable Level) may be performed to find out what levels are most comfortable FOR YOU.

Speech in Noise is also performed to see how you hear words when your brain is being ‘stressed’ by background noise.  There are numerous tests that can be performed to evaluate this, with SIN 50, QuickSin, and AZ Bio being a few of them.  Most of these speech in noise tests are performed in the sound field, which means you aren’t wearing inserts or headphones, but hearing the speech and noise from a speaker(s).

Bone Conduction Testing: Also another ‘beep’ test.  But instead of putting the inserts or headphones over the ears, we put what’s called a ‘bone conductor’ behind the ear and ask that you respond to the beeps.  What is the difference between air and bone?  With air conduction, the beep travels through the whole ear, including the external ear canal, ear drum, middle ear, and into the cochlea.  With bone conduction testing, we are bypassing the outer and middle ear, and directly stimulating the inner ear.  If we see a difference between air and bone scores, we will want to conduct further testing.

If results from the previous tests don’t indicate a red flag, we may stop there in the testing.  How ever, if we see some concerns (air bone gap, difference in pure tone results between left and right ear, etc) or items from their medical history history of sudden or rapidly progressive hearing loss, acute or chronic dizziness, unilateral hearing loss,  we will also include the following tests:

Tympanometry helps us determine the integrity of the eardrum.  We are looking for normal ear canal volume, normal middle ear pressure, and normal static compliance.  Basically, is the eardrum intact and is it moving the way it should be.  A probe is put in the test ear, and you will feel some ear pressure, as if air is pushing into your ear and then vacuumed out.

Acoustic Reflex testing is usually performed in conjunction with Tympanometry.  While Tympanometry is looking at the eardrum for the most part, Acoustic Reflex testing is looking for the level of intensity it takes to contract the stapedius muscle in the middle ear.  This can be used to provide information about the type (conductive, sensory, neural) and degree of hearing loss.  For this test, a probe is placed in your ear and you will feel that pressure sensation.  You will then hear a series of loud beeps in the same ear (ipsilateral) or a sound probe is placed in the opposite ear while the reflex is being measured in the other ear (contralateral).

The Acoustic Reflex Decay test measures whether a reflex contraction is maintained or weakens during continuous stimulation (usually 10 seconds).  This is similar to acoustic reflex testing, but instead of short beeps, they are presented longer, and at only the lower frequencies

Otoacoustic emissions (OAEs) are sounds that are generated by movement of the outer hair cells in a healthy functioning cochlea in response to external stimuli.  The test does not  test hearing, and cannot estimate the type or degree of hearing loss, but it is a wonderful tool in both newborn hearing screening and diagnostic audiology for the differential diagnosis of various hearing conditions.  A probe is placed in the ear, one ear at a time, and you hear a loud sound and the equipment records a response from that ear. It’s important that while you are taking this test you sit quietly.The test can last up to 1 minute.

Again if we see any warning signs of ear disease (visible congenital/traumatic deformity of the ear, history of active drainage from the ear, history of sudden or rapidly progressive hearing loss, acute or chronic dizziness, unilateral hearing loss, an audiometric air-bone gap equal to or greater than 15dB, evidence of significant cerumen build-up, and/or ear pain or discomfort), we will refer you back to your physician who will possibly refer you to an Ear, Nose, and Throat Physician.

None of the tests mentioned above are invasive.  If any discomfort is reported, it usually has to do with the loudness of presented tones.

What happens if you are diagnosed with hearing loss?

As mentioned above, if there are any signs of ear disease, we will refer you back to your physician who will possibly refer you to an Ear, Nose, and Throat Physician.

If and when you receive medical clearance, we can continue.  If you are motivated, we can discuss treatment for your hearing loss, such as hearing aids, assistive listening devices, auditory training, etc.  I make recommendations based on test results, medical history, needs assessment, and what your communication goals are.

Types of Hearing Loss

There are different types of hearing loss:

  • Conductive hearing loss…when something in the outer or middle ear stands in the way of the sound getting to the cochlea, it’s considered a conductive hearing loss.  What would get in the way?
    • Ear wax
    • Perforated eardrum
    • Fluid in the middle ear
    • Eustachian tube not equalizing pressure
    • Swimmer’s ear
    • Disarticulation of the ossicles (think broken ear bones)
    • Otosclerosis (when overgrowth on the bones prevents them from moving)

GOOD NEWS!  Conductive hearing loss is usually treated with medication or surgery!

  • Sensorineural hearing loss… when there are hair cells missing or damaged.  This is the most common kind of hearing loss.  Typical causes are
    • Aging
    • Noise exposure
    • some medications
    • Virus
    • Illness
    • infection
    • Genetics

Treatment for sensorineural hearing loss, depending on the severity, will involve hearing aids or cochlear implants.

  •  Mixed Hearing Loss…I know you can figure this one out!  You’ve got it…this is a hearing loss that both conductive and sensorineural losses are present.  Perhaps a person with noise exposure history develops a swimmers ear?  Or an older adult diagnosed with sensorineural hearing loss also has wax.
  • Sudden Sensorineural Hearing Loss…is an unexplained, sudden hearing loss either all at once or over a few days. This frequently affects only one ear.  Often, people wake up in the morning and notice hearing loss.  Some will hear a loud ‘pop’ before the hearing goes away.  The ear may feel full, and experience some dizziness and/or tinnitus (ringing).  While some patients will spontaneously recover some of their hearing, THE IMPORTANT THING IS TO TREAT THIS AS A MEDICAL EMERGENCY AS SOON AS YOU NOTICE IT!!!  Contact an otolaryngologist and ask to be seen as soon as possible, as receiving treatment as quickly as possible will greatly increase the chance that you will recover  at least some of your hearing.

I feel knowledge is POWER!  It’s so much easier to do something unknown if you know what to expect.  While it may appear there are lots of options twist and turns in a hearing test, remember YOU do not need to decide what comes next.  That is up to your Audiologist whose expertise will help you navigate your hearing journey.

  1. Based on calculations performed by NIDCD Epidemiology and Statistics Program staff:  (1) using data from the 1999-2010 National Health and Nutrition Examination Survey (NHANES); (2) applying the definition of disabling hearing loss used by the 2010 Global Burden of Disease Expert Hearing Loss Team (hearing loss of 35 decibels or more in the better ear, the level at which adults could generally benefit from hearing aids).

Dr. Meg Kalady

Meg has been practicing audiology for the last 30 years. She received her doctorate in audiology in 2012 from AT Still University. She is board certified in audiology by the American Board of Audiology and licensed in South Carolina and is a Dr. Cliff Au.D. Approved Provider. You can find Meg at Kalady Audiology, SC.
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Dr. Meg Kalady

Meg has been practicing audiology for the last 30 years. She received her doctorate in audiology in 2012 from AT Still University. She is board certified in audiology by the American Board of Audiology and licensed in South Carolina and is a Dr. Cliff Au.D. Approved Provider. You can find Meg at Kalady Audiology, SC.
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