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Hearing Loss Tests

Contributed by , associate editor

The problem with hearing loss is that it can affect anyone. Often the hearing loss is so gradual an individual doesn’t even realize they have an issue. With hearing loss being the third most occurring chronic condition facing adults in the United States, it’s important to remain educated and proactive in hearing health.

An individual who has difficulty understanding what people are saying, especially in background noise, experiences muffled hearing, cannot find a comfortable volume level for the television or radio or has ringing of the ears (tinnitus), should schedule an appointment with a hearing health provider.

A hearing health history

To determine whether or not an individual is suffering from hearing loss, a hearing health practitioner will usually start by asking for a family or medical history. Because there are a number of causes of hearing loss, the hearing professional will want to consider anything inherited or genetic. Hearing loss also can be the result of a bad head cold, allergies and other common ailments, which would require a different method of treatment than other types. Also, your audiologist might ask if you’ve experienced any trauma to the head or ear structure recently. Any kind of harm or injury to the cranial area can result in temporary or permanent hearing damage.

family history, hearing loss, doctor consult
Your hearing healthcare professional may take a
history of your health before performing an exam.

In addition, the hearing healthcare professional also may discuss your exposure to loud noises or if you work in a loud environment. Noise-induced hearing loss is very common in the sound-filled world we live in and can sometimes be temporary, also requiring a different course of treatment.

Lastly, the hearing health professional might ask what types of hearing loss symptoms are being exhibited. It is important for the audiologist to know how much a hearing loss is affecting an individual and what kind of hindrance it is having on day-to-day life.

Once a thorough history has been taken, a hearing health provider will generally perform a hearing test or exam.

Getting a hearing test

The purpose of a hearing test is to determine not only whether or not an individual has a loss, but how severe it is and what course of treatment should be applied. Most hearing tests require individuals to be in a quiet, sound-treated room with special headphones or earplugs to wear. These headphones are usually connected to an audiometer. The sound-treated space is designed to keep out any other noises which might hinder an individual’s hearing exam scores, such as the heater, air conditioner or office environment.

A sound booth used for hearing evaluations is generally equipped with speakers for testing infants, small children and patients who are already wearing hearing aids or have cochlear implants. The sound field testing should be done with the patient sitting the acoustic center of the space.

Once in the booth, the individual will be asked to listen to a variety of tones and the test will keep track of what sounds an individual is struggling to hear. This part of the exam is usually known as the pure-tone audiometry. In the event a patient isn’t sure whether or not they hear a sound, they should respond, the hearing care professional will notify them if they’re responding too often. This part of the exam can help the audiologist decide whether or not a particular pitch or frequency is more troubling to the individual.

Speech audiometry is another way to test an individual’s hearing ability, but it uses recorded or live speech instead of pure tones. The speech portion of the exam evaluates the patient's threshold for speech sounds and how well an individual can understand and repeat back words that are presented at a level well above threshold. Sometimes practitioners may also use speech sounds to determine the individual's most comfortable listening level and the upper limits of comfort for listening.

As part of a hearing exam, the practitioner also may test a person’s tympanometry and acoustic reflexes. For these tests, a soft plug will be placed in the ear which will change pressure and generate noises. This will help gauge how your eardrum is moving and will measure the reflexive responses of the middle ear muscles.

Hearing tests for children

Newborn hearing screenings

A newborn hearing screening is mandated across all 50 states, requiring that newborn babies have their hearing screened as part of the litany of tests they receive before leaving the hospital. There are two types of newborn hearing screenings, both are painless and can be done while the baby sleeps:

  • Healthy Hearing Tip
    Did you know there are two types of newborn hearing screenings and all 50 states mandate atleast one as part of the testing at birth?
    Otoacoustic emission (OAE) screening: This test records tiny sounds that the inner ear makes in response to clicks or chirps that are delivered through a small, flexible plug placed in the infant's ear. The screening is done on each ear and a passing result confirms that the infant’s inner ears are receiving sounds.
  • Automated auditory brainstem response (ABR): This test records activity of the auditory nerve in response to clicks or chirps that are again delivered through a small, flexible plug placed in the infant’s ear. This screening is a more complete test of the auditory system but it requires the addition of little electrodes that are taped to the baby's scalp. The screening is again done for each ear and a passing result confirms that the infant’s brain is receiving sounds.

There are a large number of infants who fail their first hearing screening due to the fluid that may still be present in the ear canal right after birth. If an infant doesn't pass the initial hearing screening, a re-screen with a pediatric audiologist should be scheduled within a couple of weeks. The majority of these infants will pass the second screening quite easily. If the second newborn screening is failed, the pediatric audiologist will often commence a diagnostic hearing test immediately in order to investigate the possibility of hearing loss. 

Hearing testing for infants and young children

Pediatric audiologists can test infants as young as six months of age behaviorally in a sound-treated booth using a method of testing called visual reinforcement audiometry (VRA). VRA takes advantage of an infant’s reflexive head turn toward sound. In this test, a parent will hold their child on their lap while they sit on a chair in the center of the sound booth. The audiologist will play sounds or talk through speakers that are oriented to the left and right of the child. When the child hears the sound and looks toward it, he or she is rewarded with a visual reinforcement toy like a flashing light or dancing bear. The infant will usually stay engaged long enough for the audiologist to get a good indication of hearing ability for at least the better hearing ear.

As an infant ages into a toddler, the visually appealing toys lose their ability to hold the child’s attention. Around the age of two, social praise will work for behavioral testing. A pediatric audiologist will use a method of testing called play audiometry for toddlers and preschool children. Play audiometry is a hearing test that is made into a game for toddlers. The parent or assistant will sit on the floor in the booth with the child and train them to respond to any sound they hear by doing a certain task, like putting a block in a bucket. When the child correctly responds to a sound, the parent or assistant sitting with them will cheer with enthusiasm. Like the visual reinforcement described above, this age-appropriate social reinforcement will typically keep the child engaged long enough for the audiologist to get a good indication of hearing ability at least for the better hearing ear. If the toddler will wear earphones, ear-specific information can be obtained.

Once a child is school-aged, he or she can usually sit still, remain quiet and raise a hand in response to speech and tone stimuli in the sound booth. At this point, the child can easily wear headphones for ear-specific measurements and sit still for tympanometry and acoustic reflex tests, as described above for adult hearing tests. 

Understanding the hearing test results

An audiogram is depicted, with normal hearing shaded at the top portion of the graph and results plotted for each ear.
An audiogram plots hearing ability for each ear independently:
the right ear is indicated with red and the left ear is indicated with 
blue. Levels are recorded across several frequencies, or pitches. 

Once the hearing health practitioner has performed the necessary tests, they will counsel the individual on the results and will recommend treatment or further testing. Usually test results are presented on an audiogram. An audiogram is a graph that displays the softest sounds an individual can hear at different pitches. The vertical axis of an audiogram represents the intensity or level of the sounds. The horizontal axis usually depicts the frequency or pitch of the sound.

An individual’s results will be plotted as units of hearing threshold level (dB HL). These units are completely unique to hearing testing but are based on perception of sound pressure levels across all frequencies, or pitches. An audiogram is standardized so that “normal” hearing ability is equalized across all pitches. For each tone or word an individual recorded hearing, a mark will be made on the audiogram to indicate the response. Each ear is tested separately, which will be represented using two lines.

Generally the lines follow a similar pattern. In the event two ears have very drastic hearing differences, the practitioner may schedule further exams to determine the cause of this.

Once the hearing health professional has determined an individual’s type and degree of hearing loss, which can be normal (0-25 dB HL), mild (26-40 dB HL), moderate (41-70 dB HL), severe (71-90 dB HL) or profound (> 91 dB HL), they will advise the patient on the best course of treatment.

In the event an individual needs hearing aids, the hearing health professional will present and discuss many options. Hearing aids are generally selected not only depending on the loss experienced by the person, but the lifestyle they desire, and the budget and features they would like their devices to have.

While hearing aids cannot restore or cure hearing loss, they do make it easier for individuals to hear and communicate on a daily basis. Modern hearing aids are all digital and can be made in a variety of options to be more stylish or discreet.

Having a hearing test performed is the first step to treating a possible loss. If an individual suspects hearing loss, an appointment should be made with a hearing healthcare provider in the area as soon as possible.

References

  1. Hearing screening and testing, American Speech-Language-Hearing Association, http://www.asha.org/public/hearing/Hearing-Testing/
  2. Hearing loss: tests and diagnosis, Mayo Clinic, http://www.mayoclinic.com/health/hearing-loss/DS00172/DSECTION=tests-and-diagnosis

This content was last reviewed on: July 14th, 2014

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