Do you suspect you have a hearing loss? How can you be sure? Hearing loss can affect anyone and often progresses so gradually, it can be difficult to notice until you experience symptoms. Hearing loss has far-reaching effects on your health, so getting a baseline hearing test and annual follow-up tests can help you catch it early.
The purpose of a test for hearing loss is to determine not only if you have a hearing loss, but how mild or severe it is. A thorough hearing test can also help define the type of hearing loss you have: conductive, sensorineural or mixed and whether it will respond best to medical treatment or hearing aids.
A hearing health history
When you visit a hearing healthcare professional, their first step will be to get to know your personal hearing health and medical history and find out what concerns you have. There are many potential causes of hearing loss, so the history helps determine if you could have anything inherited or genetic in your family. Medical conditions like allergies, head colds, ear infections and even impacted earwax (cerumen) can also contribute to hearing loss. Also, the hearing health practitioner might ask if you’ve experienced any trauma to the head or ear structures recently. Any kind of injury to the cranial area can result in temporary or permanent hearing damage.
Finally, your hearing health professional might want to discuss the symptoms you are experiencing and how they are affecting your daily life. They will want to understand your lifestyle and the types of work, hobbies and social situations that are important to you.
After your hearing health history is complete, the hearing test can begin.
Getting a hearing test
Hearing tests are painless and non-invasive. Most occur in a quiet, sound-treated room (booth) or enclosure designed to keep out any other noises which might affect your hearing exam scores, such as the heater, air conditioner or office environment. You will be asked to wear headphones or soft earplugs with wires connected to an instrument called an audiometer that is used to conduct the test.
The sound-treated booth may also be equipped with specially-placed speakers used for testing infants, small children or people who need to be tested while wearing hearing aids or cochlear implants.
Once in the booth, your hearing care professional will communicate with you and provide instructions through your headphones. You will be asked to listen to tones at different pitches and volumes and push a button or raise your hand when you hear them. You will have to focus and listen carefully because you need to respond even if the tone sounds very soft and you can barely hear it. The test measures the very softest sounds you can hear at each frequency tested. This part of the test is called pure tone audiometry.
Speech audiometry is another component of most hearing tests, and it uses recorded or live speech instead of pure tones. The speech portion of the exam evaluates the softest speech sounds (threshold) you can hear and understand. You will then be asked to repeat back words that are presented at a level well above threshold to see how well you can understand them accurately. Some practitioners use speech sounds to determine your most comfortable listening level and the upper limits of comfort for listening.
If necessary, the practitioner may perform tympanometry and a test of your acoustic reflexes. For these tests, a soft plug that creates pressure changes and generates sounds will be placed in the ear. This will determine how well your eardrum is moving and will measure the reflexive responses of the middle ear muscles.
What to expect during a hearing test
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 before leaving the hospital. There are two types of newborn hearing screenings, both are painless and can be done while the baby sleeps:
- 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 delivered through a small, flexible plug placed in the infant’s ear. This screening is a more complete test of the auditory system, and it requires small electrodes to be 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 two types of newborn hearing screenings and all 50 states mandate at least one as part of the testing at birth.
A significant number of infants fail their first hearing screening due to fluid that may still be present in the ear canal right after birth. If your infant doesn't pass the initial hearing screening, schedule a follow-up screening with a pediatric audiologist within a couple of weeks. The majority of infants will pass the second screening quite easily. For those who do not pass the second newborn screening, a diagnostic hearing test from your pediatric audiologist will investigate further.
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 test 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.
The visually-appealing toys lose their ability to hold the child’s attention once they are toddlers. 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 your hearing test results
Test results are presented on a graph called an audiogram that displays the softest sounds you can hear at different pitches or frequencies. The vertical axis of an audiogram represents the intensity or volume of the sounds. The horizontal axis depicts the frequency or pitch of the sound.
Your results will be plotted in decibels of hearing threshold level (dB HL). These units are unique to hearing testing but are based on the perception of sound pressure levels across all frequencies. For each tone you heard during the test, there will be a mark on the audiogram at the appropriate decibel level. Each ear is plotted separately and represented by two different lines. The lines may be quite similar and follow the same pattern or they may be very different.
Hearing loss is measured in decibels (dB) and in the following categories:
- Normal hearing (0 to 25 dB HL)
- Mild hearing loss (26 to 40 dB HL)
- Moderate hearing loss (41 to 70 dB HL)
- Severe hearing loss (71 to 90 dB HL)
- Profound hearing loss (greater than 91 dB HL)
Although some people talk about hearing loss in terms of percentage, it is not an appropriate or meaningful measure of hearing loss. It is very common to have more hearing loss at some frequencies than for others, so the percentage of hearing loss would be different at each test frequency, making it virtually meaningless when describing the overall hearing loss or determining a course of treatment. In a clinical setting, hearing loss is not described in percentages. However, it can be expressed in percentages for specific legal situations. In these cases decibels of hearing loss are converted using a recognized formula to create a "percentage of hearing loss" for legal purposes.
Online hearing tests
Online hearing tests are available, and thanks to technology, they are getting more advanced all the time. There are generally two types of online hearing tests:
- Some use audio samples to determine a range of hearing loss.
- Some ask questions to determine if you’re having enough trouble to see a hearing healthcare professional.
Online hearing tests are by no means a replacement for a thorough diagnostic hearing evaluation, but they can be a good place to start if you are hesitant about making an appointment. Not sure where to start? Visit the Healthy Hearing online hearing check!