What’s Included in a Hearing Evaluation?

By Stephanie Nance, Au.D., CCC-A, of Hearing Life Greensboro

     Have you worried that you are not hearing as well as you once did and may need a hearing evaluation? Or perhaps you even have been told that you should have an audiogram? If so, you may wonder what is involved in having your hearing tested.

The answer: It is a simple, easy process that can be performed in our office in about an hour.

It starts with a conversation

The first step is for us to gather background on you and your health. An audiologist who has a doctorate degree in audiology will sit down with you to get a thorough history, asking questions about your overall health, ear injuries, any history of ear infections, and exposure to noise at work and at home.

Examination of the auditory canal

The next step is a visual inspection of your external auditory canal and your eardrum, also known as the tympanic membrane. That is followed by tympanometry, a simple test that determines how the middle ear functions. The results will indicate if there is fluid or pressure in the middle ear that might be causing hearing difficulty.

Air and bone pure tone testing

Next, we perform hearing tests. For the air pure tone test, you will wear earphones in a sound isolation booth and press a button or raise a hand each time you hear a tone. The tones range in pitch or  frequency from 250 Hz to 8K Hz, the range that encompasses the primary speech sound frequencies. The audiologist will move the sound level up and down based on your response to determine the softest sounds you can hear at each frequency. The audiologist also may perform a similar test called bone pure tone testing without headphones, where a bone oscillator is placed outside your ear to generate sound. These tests not only reveal if there is a loss of hearing, but also pinpoint the frequencies that are impaired.

Type of hearing loss

After the pure tone testing, the audiologist knows if you have hearing loss and, if so, where it originates – in the outer or middle ear, which indicates conductive hearing loss, or in the inner ear/ auditory nerve, which indicates sensorineural loss. The latter is the most common kind of hearing loss and is associated with noise and with the aging process. Some people have a mixed loss, which is a combination of conductive and sensorineural loss.

Speech recognition testing

To further understand your hearing loss, the audiologist also conducts speech reception threshold testing. You will listen to a series of “spondee” words – words that are pronounced with equal emphasis on the first and second syllables, such as toothbrush, cowboy or hardware – through headphones and will be asked to repeat what you hear. The words gradually get softer. The decibel level at which you correctly repeat the words 50 percent of the time is your speech recognition threshold.

Word recognition testing

The final test is called word recognition scoring. While in a sound isolation booth, you listen to and repeat a series of words, all spoken at the same decibel level. This test, which indicates a percentage of word or speech understanding, helps us determine what treatment would be best for you. Would hearing aids help? Would another intervention be a better choice?

Results and recommendations

At the end of your evaluation, we will sit down with you to share your results and explain what they mean. After making our recommendations, we then work with you to provide the help you desire, with no pressure to purchase a product.

Stephanie Nance, Au.D., CCC-A, is an audiologist at Hearing Life 

Greensboro. She is a doctor of audiology, with extensive experience in

evaluating hearing loss and fitting patients with hearing aids and other

technology to help them maximize their hearing ability.