Better hearing begins with a test
The signs of hearing loss are usually subtle and develop over time. If people around you always complain that your TV is too loud, or if you struggle to follow conversations in a noisy environment, especially in group discussions, you will need a hearing test. Only a licensed hearing care professional (ear-nose-throat specialist, audiologist or any hearing aid acoustician) can use the proper techniques and equipment to yield accurate data. Based on your results, they’ll then recommend the correct treatment. In the case of tinnitus, they will also perform a test to evaluate your hearing.
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Types of hearing tests
Audiometry exams can help diagnose your type and degree of hearing loss. A hearing care professional will perform either a subjective hearing test, objective hearing test, or a combination of the two. Most of the time, it will require you to sit in a soundproof room with headphones or earphones on, connected to an audiometer. The specialist will transmit sounds to your ears and record your responses on an audiogram.
Subjective hearing test
This type of hearing test requires you to cooperate. During a subjective hearing test, the specialist will play sounds or words and ask you to make a gesture in response to these sounds.
A pure-tone or air-conduction test measures how well your outer and middle ear process sounds and finds the softest sounds you can hear. Wearing headphones or earphones, you will listen to “pure” tones at different volumes, and signal once you hear each tone. If the exam reveals hearing difficulty, a bone-conduction test (which transmits sounds through the skull to the inner ear via a device, without any interference from the outer or middle ear) can help to differentiate between conductive and sensorineural hearing loss.
By repeating two-syllable words while a tone gradually decreases to lower levels, this test will indicate the level at which you can hear and understand certain sounds. It may also include a word-recognition exam, where the specialist will ask you to repeat certain words. To test comprehension, you will listen to one-syllable words at a comfortable listening level and repeat what you hear.
Objective hearing test
Typically performed on newborns and infants, this type of test does not require you to cooperate. Objective hearing tests can help identify damage to the inner ear and assess your quality of hearing.
Otoacoustic emission (OAE) test
This hearing evaluation can reveal damage to the inner ear (cochlea). A specialist inserts a small device into the ear canal and measures if outer hair cells in the inner ear vibrate in response to the sounds. If nothing comes back, it may point to hearing loss.
Auditory brainstem response (ABR)
Electrodes attached to the head measures how hearing nerves respond to sounds in a specific frequency range. A computer will record the results.
Acoustic reflex test
This test helps to establish the severity of a hearing loss. It uses sounds to determine if the middle-ear muscles contract when stimulated.
A tympanometry exam allows specialists to diagnose problems in the middle ear and any disorders linked to hearing loss. A probe sends loud sounds into the ear canal to measure movements of the eardrum as the air pressure changes.
Produced by an audiometer, an audiogram is a graph that demonstrates your hearing threshold (the softest sound you can hear) at different frequencies (or pitches) in each ear. The audiogram’s ready-made form lists pitch horizontally (frequency ranging from low to high in Hertz, Hz) and volume vertically (from soft to loud in decibel, dB). It shows the sounds you can hear normally and the sounds that are missing.
How to read an audiogram
The top of the graph indicates normal hearing. The further down you go, the more challenging it may be for you to hear and understand certain sounds. For example, consonant sounds (t, s, f, th, k, sh, ch) are higher pitched and spoken more softly than vowels. If you’re missing sounds in the higher ranges, it means you can hear it, but can’t understand it (it sounds like mumbling). Some specialists will use the left side of the graph (volume in dB) to measure the severity of your hearing loss.
Air and bone conduction
In air conduction tests, headphones allow sound to travel from the outer to the inner ear, and in bone conduction tests, a device placed behind the ear transmits sound vibrations through the skull. When tones are poorly recognised via air but well recognised via bone conduction, the expert will refer to this as a conductive hearing loss. It can be because of a foreign body in the auditory canal, a middle ear effusion or an issue with sound transfer from the eardrum to the ossicles (three small bones in the middle ear). These causes are often treatable, but if not, hearing aids may be a good option.
In the case of a sensorineural hearing loss, you have trouble hearing high frequencies. The hearing curve on the audiogram will run parallel for both bone and air conduction, whereas the individual threshold will be well above the standard hearing threshold. This range requires higher volumes until the hearing threshold can be determined (common in people with age-related hearing loss). While medication and surgery don’t usually bring relief, wearing hearing aids can alleviate a loss of inner ear function.