Evaluation of Hearing Loss
Several different aspects of hearing are tested during a comprehensive hearing evaluation. The combination of these tests will be able to identify the type and severity of hearing loss an individual has, which provides the audiologist with the information to make the best recommendation for treatment.
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Here are many of the tests audiologists will commonly administer during a comprehensive hearing evaluation.
Otoscopy: This is when an audiologist looks into your ears with a tool called an otoscope in order to evaluate the health of your outer ear and eardrum. It also makes it possible to visually identify whether there may be middle ear conditions present, as well as if there is any cerumen or foreign objects that need to be removed before further testing can be completed.
Tympanometry: Tympanometry uses small changes in air pressure in your ear canal to assess the mobility and function of your eardrum and middle ear system. It can help detect the presence of many middle ear disorders.
Acoustic Reflex Thresholds: This is a test which is sometimes performed in conjunction with tympanometry, which tests the integrity of your middle ear reflex response to loud noises. It is often conducted to determine if the hearing loss is conductive, cochlear, or stems from a nerve pathway in the brain, such as when there is a tumor.
Air Conduction Testing: Air conduction testing is what you most likely picture when you think of a hearing test, where you raise your hand or press a button whenever you hear a beep through a set of headphones. It tests the hearing thresholds of the entire system working together. These thresholds are typically indicated by the X’s and O’s on an audiogram.
Bone Conduction Testing: Bone conduction testing uses a bone oscillator to stimulate the cochlea directly by vibrating the bones of the skull. The audiologist will compare these thresholds with your air conduction thresholds to determine whether the hearing loss is conductive or sensorineural. These thresholds are indicated by angle or square brackets on your audiogram.
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Speech Reception Thresholds: This test determines the quietest level that you are able to understand speech, and is used as a cross check to confirm the accuracy of your air conduction hearing thresholds.
Word Recognition Scores: This is a test of your ability to understand speech when it is amplified loud enough to be comfortably audible. This is indicated on your audiogram by a percentage, which represents the percent of speech that will be able to make it to your brain when amplified enough to overcome your hearing loss. A low score on this test indicates lower functional ability and may mean that even with well-fit hearing aids, you may still struggle to understand speech. A higher score indicates that when speech is amplified loud enough, you will likely perform very well.
Speech-in-Noise Testing: This test measures how well you are able to understand speech in the presence of background noise. The results of this test are on a scale of 0 to 24, where a 0 indicates you can understand very well in background noise, while a 24 would mean that if you turned on a fan it would be very difficult for you to pick out speech. Audiologists use the results of this test to make the best recommendations for treatment in terms of hearing aid style and technology so you can hear your absolute best. They may also use this score to recommend whether you would benefit from assistive technology such as remote microphones.
Uncomfortable Levels (UCLs): This test determines the level at which sound becomes uncomfortably loud so that when your audiologist programs your hearing aids, they can customize the output so it never is loud enough to hurt your ears.
Most Comfortable Levels (MCL): This test determines the most comfortable volume that is the sweet spot between too soft and too loud.
A combination of these diagnostic tests paint a comprehensive picture of your hearing loss and what treatment would be most appropriate, whether it be hearing aids, a cochlear implant, or a bone anchored hearing aid. It can also indicate whether you should be referred to a physician such as an otologist or otolaryngologist (ENT) for medical treatment.
The accuracy of testing is critical for the correct diagnosis and treatment of hearing loss. It is recommended you only go to a licensed hearing care professional for testing, such as an Audiologist or Hearing Instrument Specialist. Online hearing tests may be convenient, but they are not reliable or accurate enough to make a treatment recommendation or to treat hearing loss. Additionally, they run a high risk of not identifying serious medical conditions that would be caught during a comprehensive auditory evaluation by a licensed hearing care professional.
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