What are hearing tests?

Hearing tests measure how well you are able to hear. They can help diagnose hearing loss, how severe it is, and which part of your hearing isn't working properly.

Hearing depends on a series of steps that change sound waves into electrical signals that your brain understands as sounds. Hearing loss happens where there's a problem with any of these steps:

• Sound waves enter your outer ear and travel to your eardrum in your middle ear.
• The sound waves vibrate your eardrum, which sends the vibrations to tiny bones that make the vibrations stronger.
• The vibrating bones make tiny waves in the fluid that's inside your cochlea. The cochlea is a snail-shaped structure in your inner ear. It is lined with sensory cells that have hair-like structures. When the hair cells move with the fluid waves, they create electrical signals.
• Your auditory (hearing) nerve carries the electrical signals from your inner ear to your brain, which turns them into sounds you can recognize and understand.

There are three main types of hearing loss:

• Conductive hearing loss happens when sound waves can't reach your inner ear. Earwax or abnormal fluid in your ear may be blocking the path, or a hole in your eardrum may prevent it from vibrating. Medical treatment or surgery can often improve hearing.
• Sensorineural hearing loss (also called nerve deafness) happens when there's damage to the inner ear or the auditory nerve. This type of hearing loss ranges from mild (difficulty hearing certain sounds) to profound (not hearing any sound). The hearing loss is usually permanent, but it can improve with hearing aids or other devices.
• Mixed hearing loss is a combination of both sensorineural and conductive hearing loss.

Hearing loss in older adults is common. About one-third of adults over the age of 65 have some hearing loss, usually the sensorineural type. If you are diagnosed with hearing loss, there are steps you can take that may help treat or manage the condition.

Other names: audiometry; audiography, audiogram, sound test, audiologic tests

What are they used for?

Hearing tests are used to check for hearing loss. The tests are also used to find out how severe hearing loss is and what type it is.

Why do I need a hearing test?

You may need a hearing test if you have signs of hearing loss, such as:

• Having trouble hearing over the phone
• Having trouble understanding what other people are saying, especially in a noisy environment
• Needing to turn up the TV volume so loud that others complain
• Thinking that others always seem to mumble
• Having trouble hearing high-pitched sounds and voices
• Hearing a ringing or other unusual sound in your ears (tinnitus)

If your workplace is noisy, you may need to have your hearing checked every year.

If you use a hearing aid or had surgery for your hearing, you may need a hearing test to see whether your hearing has improved.

What happens during a hearing test?

Your primary care provider may use a general screening test to check your hearing. This is usually a whisper test to see how well you can hear whispered words in each ear.

If the test shows you may have a hearing problem or if you notice you have trouble hearing, your provider may do more hearing tests or send you a hearing specialist, such as:

• An audiologist, a health care professional who is trained to test your hearing, diagnose hearing loss, and provide hearing devices and services to improve hearing.
• An otolaryngologist (ENT), a doctor who specializes in treating diseases of the ears, nose, throat, and head and neck.

Hearing aid specialists can do basic hearing tests and fit you for hearing aids. If you have a hearing aid, tests can check whether it's helping you enough. If you're unsure where to have your hearing tested, talk with your primary care provider.

There are several types of hearing tests. These are some of the more common types:

Audiometry tests check your ability to hear tones or words at different pitches and volumes. For these tests, you'll put on headphones and sit in a soundproof room. The tests may include:

• A pure-tone test. This is the most common screening test for hearing loss. It tests for the quietest sounds you can hear at different pitches. During the test:
  • A series of high and low tones will be played in your headphones. Some will be loud, and some will be very soft.
  • Each time you hear a tone, you'll raise your hand, push a button, or say that you hear the sound.
• Speech test, also called a speech discrimination test. This test checks how well you can hear people talking. It can show how much a hearing aid might help you. During the test:
  • You'll hear simple words at different levels of loudness. Some of the words will be spoken over noise.
  • You will repeat the words that you hear.

Tuning fork tests, also called bone conduction tests. These tests can help tell the difference between nerve problems in your inner ear (sensorineural hearing loss) and fluid or wax that's making it hard to hear (conductive hearing loss). They can also show if one ear hears better than the other.

A tuning fork is a two-pronged metal device. When it's tapped, it vibrates and makes a sound. Tuning forks are mostly used by primary care providers. Audiologists and otolaryngologists may use special devices to do bone conduction testing. The general steps are the same:

• The provider will place the tuning fork or device behind your ear or on your head.
• The tuning fork or device will vibrate, which makes your skull bones vibrate gently.
• The vibrations travel through your bones directly into your inner ear, so your outer and middle ear aren't involved in hearing the sound.
• If you have trouble hearing the sound in either ear, a problem in your inner ear may be causing hearing loss.
• If the provider is using a tuning fork, you may have another test to compare how well you hear the tuning fork through:
  • Vibrations in the air that travel through your outer ear
  • Vibrations through your bones that go directly into your inner ear
  Normal hearing is better though air. If you hear better through bone vibrations, you may have fluid or wax blocking sound from reaching your inner ear.

A tympanometry test checks to see how your eardrum and bones in your middle ear are working:

• A small device will be placed in your ear.
• The device will send air and sound into your ear, which makes your eardrum move. You'll feel the air pressure inside your ear.
• A machine records the movements of your eardrum on graphs called tympanograms.
• If your eardrum doesn't move normally, you may have fluid or wax buildup in your ear, a hole in your eardrum, a tumor in your ear, a middle ear bones that don't vibrate well, or another problem in your middle ear.

An otoacoustic emissions test (OAE) checks for damage in the hair cells in your cochlea:

• A small device will be placed in your ear. It can make sound and measure sound.
• Sound from the device makes the fluid in your cochlea ripple, which moves the hair cells. When the hairs move, they make vibrations that have their own sound called OAEs.
• The device measures OAEs to see how well the hair cells are working. If the test shows little or no OAEs, you have sensorineural hearing loss.

Will I need to do anything to prepare for a hearing test?

You don't need any special preparations for a hearing test.

Are there any risks to hearing tests?

There is no risk to having a hearing test.

What do the results mean?

The results of hearing tests show if your hearing is normal or if you have hearing loss. You'll usually get your results right after your tests are done.

If you have hearing loss, the results will show how severe it is, which ear is affected more, and whether you have conductive, sensorineural, or both types of hearing loss:

• With conductive hearing loss, your provider may be able to treat the cause and restore your hearing. Your treatment will depend on what's blocking sound from reaching your inner ear. It may include removing wax, draining fluid, or surgery to fix problems with your eardrum or ear bones.
• With sensorineural hearing loss, your hearing loss can't be treated, but you may be able to use hearing aids or have surgery to implant a device to improve your hearing. If your hearing can't be improved, assistive devices are available to help with daily living. For example, there are devices to help you use the phone and to alert you to doorbells, alarms, and other sounds.

In certain cases, more tests may be needed to diagnose the cause of the hearing loss. If you have questions about your test results, talk with your health care provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about hearing tests?

Even mild hearing loss can make it difficult to understand normal speech. Because of this, many older adults will avoid social situations, leading to isolation and depression. Treating hearing loss can help prevent these problems. Treatment options include:

• Hearing aids. A hearing aid is a device that's worn either behind or inside the ear. It makes sounds louder. There are many styles of hearing aids available. You can get a hearing aid with or without a prescription:
  • Prescription hearing aids require a visit to a hearing health professional who will program your hearing aid to match your hearing loss. Prescription hearing aids may be necessary for more severe or complicated types of hearing loss, for example, if you can only hear loud sounds.
  • Over-the-counter hearing aids that you buy on your own are for people with hearing loss that is:
    • Mild, which means you can hear some speech, but soft sounds are hard to hear.
    • Moderate, which means you understand very little when another person talks at a normal level.
• Cochlear implants. These devices are put in your ear with surgery. They are usually used for people with severe hearing loss who don't benefit from hearing aids. Cochlear implants send sound directly to the hearing nerve. They don't restore normal hearing. But they can help with understanding speech after people have therapy to learn how to hear with their implant.