Following a questionnaire to establish your general health and health history, your hearing specialist will conduct a painless visual examination of the ear with a manual or video otoscope. This examination will reveal obstructions or infections that might affect your hearing.
Next, your hearing professional will use an audiometer to conduct testing. This equipment emits sounds or tones, like musical notes, at various frequencies and at differing volume or decibel levels. Testing is usually done in a soundproof testing room.
During some of the tests, you will wear headphones to block distracting sounds. At the sound of a tone, you will be asked to use a gesture or a device to indicate when you hear tones. The audiologist will lower the volume and repeat tones until you can no longer detect them. This process is repeated over a wide range of tones or frequencies from very deep, low sounds, to very high frequency sounds. Each ear is tested separately because sensitivity to sound often differs from one ear to the other. There are seven tests of hearing and speech recognition.
Your hearing specialist may conduct some or all of the following tests: (Click to expand)
Tympanometry
Tympanometry is a test of middle-ear function. By applying a puff of air pressure into your ear canal, your hearing professional tests the mobility of your eardrum and conduction bones. This test provides information to distinguish if your hearing loss is conductive or sensorineural.
Pure-tone test
This is a subjective hearing test used to identify hearing threshold levels. You will wear headphones, through which the hearing specialist will play pure-tone stimuli. You simply indicate when you hear the tones in each ear. Pure-tone test thresholds determine the softest level at which you can hear at least 50 percent of tones. The results of this test will be printed on an audiogram.
Speech reception threshold
This test helps determine the lowest sound level at which you can detect AND understand speech. You’ll be asked to listen to and repeat words that are spondaic* (two syllables with equal stress, like “sidewalk” and “grandson”).
Most comfortable listening level
You’ll hear sounds through headphones, and you will indicate your most comfortable hearing level for certain sounds.
Uncomfortable loudness test
Like test #4, this is also administered via headphones to determine the loudest level you are able to listen to without pain.
Speech discrimination test
Sometimes called word recognition testing, this test determines how well you hear and understand speech when the volume of the headphones is set to your most comfortable listening level.
For this test, the hearing specialist will ask you to repeat 50 single-syllable words. The speech discrimination score is an important indicator of how much difficulty you will have communicating and how well you will respond to hearing aids.
If your speech discrimination score is 90 percent or more, it indicates that you heard and repeated words correctly. If the score is zero, it means you cannot understand speech no matter how loud. People with scores under 50 percent may not be helped by hearing aids.
Bone conduction test
This test is used to determine if your hearing loss is related to issues with your inner ear. A small oscillator is placed on the bone behind your ear to painlessly stimulate the bones of the skull, which in turn stimulate the inner ear. You will be asked to indicate when you can hear the sound as the tone is raised and lowered.
*Gelfand, S. (2009). Essentials of Audiology. New York: Thieme.
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