Types of Hearing Tests

Hearing testing is not just for when you are experiencing hearing problems. Your hearing is integral to your overall health in more ways than you may realize. A delay in hearing testing can cause permanent damage to your hearing and your mental and physical health.

Everyone should have hearing testing performed, especially all newborns and children. Adults of all ages, whether experiencing hearing loss or not, should also have routine hearing testing to determine a baseline of their hearing ability. This baseline becomes part of your health history and is used to repeatedly check whether hearing loss occurs over time, to measure the amount of hearing loss, and to monitor whether the loss progresses, stabilizes or gets better.

Hearing testing may start with your primary care provider. Audiometry is the term for the different hearing examination tests. Results of the audiometry tests are shown on an audiogram, which is a graph that indicates the softest sounds you can hear at different pitches and frequencies.

What should I expect during a hearing test?

Your provider will look at your ears’ structure and evaluate your ear and hearing health to establish your baseline. You may be examined for possible causes of hearing loss or damage, such as signs of an infection or ear wax buildup and also any structural abnormalities.

Your provider will perform simple screening tests. These should include a health history and questionnaire, voice recognition testing, a tuning fork test or tones through head phones. Your provider may refer you to an audiologist who will perform more thorough testing to more exactly measure your hearing.

Audiologists are licensed health care professionals who evaluate, diagnose, treat and manage hearing loss and balance disorders in both adults and children. Audiologists can determine the type of your hearing loss and the degree. You may also schedule a hearing exam directly with an audiologist. Call your insurance company first to see if you need a referral and if your audiology visit will be covered.

What do hearing tests measure?

Audiometry examination tests your ability to hear various sounds based on their intensity (loudness) and tone (speed of sound wave vibrations). You hear when sound waves stimulate the nerves in the inner ear, which then travel along the nerve pathways to the brain to interpret.

This type of testing helps determine if there is hearing loss, the type of hearing loss, and the degree of hearing loss. Hearing loss may be sensorineural, conductive or mixed.

What are the types of hearing tests?

Tuning fork tests

A tuning fork is a two-pronged, metal instrument that produces sound when struck. This test may indicate whether hearing loss is caused by damage to the vibrating parts of your middle ear and eardrum, or damage to inner ear nerves or damage to both. The Rinne and the Weber are the two main types of tuning fork tests.

The Rinne test involves striking then placing the tuning fork on the bone behind the ear, then next to your ear canal. You will tell the doctor when you no longer hear the sound in both places and the length of time is recorded.

In the Weber test, the tuning fork is struck then placed on the middle of your head. You will tell the doctor where the sound is best heard – left ear, right ear or both.

Auditory brainstem response (ABR) test

The ABR test measures the hearing nerve’s response to sound by indicating how well the inner ear (cochlea) and the brain pathways for hearing are working. The test is used with newborns, children, people whose hearing loss is due to brain malfunction or anyone who cannot complete a typical hearing test. Auditory evoked potential (AEP) is another name for this test.

Electrodes enclosed in stickers are placed on the head and in front of the ears and connected to a computer. These electrodes measure how the ear’s nerves respond to sounds coming through earphones.

Pure tone test

You’ll wear earphones and possibly go into a sound booth. Each time you hear a beep or tone at different pitches, you’ll need to raise your hand, press a button or say “yes.” You will be required to respond even if the tone is very soft and you can barely hear it, so you will need to pay very close attention. Most people have had this test done as a health screening at some point in their lives.

Speech test

The speech test is often used instead of a pure tone test. Your ability to hear and repeat spoken words is measured during a speech audiometry test. This test determines your speech reception threshold – the softest sounds you are able to hear, understand and repeat – and may be performed in quiet or loud environments.

You will then be asked to repeat back words spoken above your threshold to see if you can understand them accurately. This test is sometimes used to determine your most comfortable listening level.

Bone conduction test

In cases where you may have fluid or wax blockage in the ear, a bone conduction test may be substituted for a pure tone test. A bone conductor or oscillator is placed behind the ear and no headphones are used. The bone conductor causes the skull bones to vibrate in response to different tones. The results are also shown on an audiogram.

Otoacoustic emission (OAE) test

Your ear’s hair cell function is measured with an OAE test. The ear contains small hairs that vibrate when sound enters the ear. They conduct the sound to the ear’s nerve pathway to the brain to interpret.

A small probe is inserted into the ear. If you have “normal” hearing, your inner ear should produce tones or clicking sounds in response to the probe. If you have hearing loss, your inner ear may not produce these sounds.

Middle ear testing / immittance testing

Immittance testing is used to assess the middle ear’s function by examining how the eardrum reacts to varying pressure in the ear canal. Your ability to hear correlates with eardrum sensitivity. Air is pumped through a probe inserted in the ear. This probe changes the pressure within the ear as different tones are produced. The three types of middle ear tests are:

  • Tympanometry: a probe is used to test how well the eardrum moves.
  • Acoustic reflex measures: records the strength of the middle ear’s response to a loud sound.
  • Static acoustic impedance: measures the volume of air in the ear canal to detect fluid behind the eardrum or a perforated or ruptured eardrum.

A microphone monitors how well the sounds are conducted in the ear under the various air pressures and requires no response from patients. This type of testing works very well with children.

What are my next steps?

Your provider or audiologist will share your test results with you. Audiometry test results are shown on an audiogram, which is a graph that shows the softest sounds you can hear at different pitches or frequencies. Your audiogram will also show the intensity of the sounds you hear.

If you are suffering from hearing loss, your audiologist may recommend further testing and discuss treatment options with you. Hearing aids may be recommended. Your treatment center will be able to help you choose the right option for your lifestyle.

If you have healthy hearing, you’ve done a great job protecting your hearing! Your audiologist will give you more information on ways to keep protecting your hearing and may recommend follow up at a certain time to keep monitoring your hearing health.

About Rachel Mcarthur