Hearing loss testing

Hearing test ear examination

A hearing test is an easy and painless method of evaluating your hearing that can not only determine if you have hearing loss, but also the degree of hearing loss (mild, moderate, severe, and profound).

A thorough hearing evaluation performed by a qualified hearing professional also helps pinpoint the type of hearing loss you have and the available treatment options.

Hearing tests are valuable because hearing loss can affect anyone and often progresses so gradually it can be difficult to notice until you experience symptoms. Diagnosis benefits you sooner rather than later—even mild untreated hearing loss can impact your quality of life and is linked to cognitive decline.

Getting a baseline hearing test is the first step to better hearing health.

What will happen during my hearing test?

Your hearing health history

After you're checked in, your hearing care provider will take a hearing history, which typically includes questions related to your prior noise exposure, history of hearing loss in your family, and any symptoms of ringing in the ears (tinnitus). They'll also review your medical health, medication use and whether you have any ear-related conditions including allergies, head colds, ear infections and impacted earwax. This will give the hearing healthcare professional some insight into what concerns you may have, the symptoms you are experiencing and how they are affecting your daily life. Once your hearing health registration and case history is completed, your hearing test will begin.

Hearing tests for adults

The hearing professional will begin with a thorough examination of the outer ear – comprised of the pinna (the outer ear), the ear canal and part of the tympanic membrane (eardrum). They will evaluate the condition of the outer ear through the use of an otoscope–a device used to look into the ear, and determine if there is any wax in the ear canal that may restrict testing, or any swelling due to conditions like allergies.

If earwax buildup is a restriction for testing, the hearing professional will perform earwax removal in the clinic or refer you to a medical professional who is specialized in cerumen management. Some general physicians perform earwax removal, so be sure to ask your doctor if they do at your next visit. 

Next, your hearing professional will proceed to evaluate the middle ear. This is where the three smallest bones in our body are located and also where conductive hearing loss may be detected. A tympanometer (timp-o-nom-it-er) – a device that sends a “puff” of air and sound to the eardrum is used to measure how the eardrum “bounces back”. To do this, the hearing professional will insert a soft rubber tip into your ear and in just a few seconds the device will generate a result. This evaluation helps determine if there are any abnormalities in the middle ear space. 

Pure-tone testing

Your hearing professional will proceed to perform pure-tone air-conduction and bone-conduction testing as well as speech testing. This typically takes place in a sound-treated booth. You'll put on special headphones or earplugs that connect you to the provider, who sits outside of the booth. 

In pure-tone air-conduction and bone-conduction testing, you will be presented with a series of sounds and your hearing professional will ask you to press a button (or raise your hand) to indicate the softest tone you can hear (or threshold). These tones may change in pitch (frequency). Some will sound like a low bass note and others will sound like a high treble note.

Testing your ability to hear speech and speech in noise

In speech testing, they will ask you to repeat a list of words given at different volumes. Speech testing helps the hearing professional gauge how well the auditory nerve is responding to word discrimination ability – or how well you can decipher words that sound similar. They may also play a series of sentences spoken over increasingly noisy backgrounds. Together, these results will enable the hearing professional to determine the best treatment plan for you, if one is necessary. 

Your results are plotted on an audiogram

The entire process takes approximately 20 minutes to complete. Once the testing is complete, your hearing professional will review the results with you immediately and answer any questions you may have.

The hearing professional will record these results on a graph called an audiogram. The audiogram will show if there is a hearing loss and to what extent. It's a good idea to keep copies of your audiograms as they can be useful to see how your hearing has changed.

In simple terms, hearing loss is measured on the audiogram in two ways:

1. How loud a sound needs to be before you can hear it. This is known as volume and it's measured in decibels (dB).
2. Your hearing ability across different frequencies, often referred to as pitch. It's measured in Hertz (Hz).

Pitch is charted on the x-axis by frequencies from low to high, and volume is charted on the y-axis. Near the top are the softest sounds, such as leaves rustling or water dripping from a faucet, which usually register under about 25 dB. The higher pitched sounds are to the right, such as birds chirping or children speaking. For a person who has high-frequency hearing loss, which is common, they'd see a dip in their chart on the right side of the audiogram. 

Degrees of hearing loss are generally sorted into these categories:

• Normal hearing (you can hear sounds as quiet as 0 to 25 dB HL)
• Mild hearing loss (26 to 40 dB HL)
• Moderate hearing loss (41 to 70 dB HL)
• Severe hearing loss (71 to 90 dB HL)
• Profound hearing loss (greater than 91 dB HL)

Hearing tests for babies and children

Hearing loss in childhood is especially important to identify early on and seek intervention. If left untreated, it can have implications for speech and language development, social development and success in education. There are many causes of hearing loss in children. These could be (but not limited to) congenital factors, head trauma, chronic ear infections, malformations of the ear, illness in childhood and medications.

How are newborns screened for hearing?

Most hospitals are equipped with tools that appropriately and accurately screen an infant’s hearing at birth. The Infant Hearing Screening Program (IHP) assesses newborns in the hospital and will refer the family to the appropriate facility for further testing if the initial screening indicates any hearing issues.

There are several tests that may be performed on babies:

1. Tympanometry: The test of the middle ear space (See earlier paragraph description)
2. Otoacoustic emissions (OAE): This doesn't require the baby to respond in any way, making it an easy way to test very young babies. During this test, the hearing specialist holds a device to the baby's ear that plays sounds. Any sounds that are “echoing” back from the inner ear can provides information about the health of the inner ear. 
3. Acoustic brainstem response (ABR): This is another non-behavioural test that is now more commonly being done as a screening process in hospitals during the IHP. In this measurement, electrodes are placed on the baby’s forehead and back of the ears. Sounds (clicks and beeps) are presented to the ears and the output is a measurement of what the brain is hearing. These results will help determine what the baby can hear via the brain (or inner ear’s response/cochlea). These results can often give a more detailed, specific level of hearing thresholds than the OAE, but do require more time and compliance from the baby (for best results, it is recommended to test while the baby is sleeping).

Testing in toddlers and kids

When testing children in a hearing center, testing processes are similar to adults. The hearing professional will begin the hearing assessment by reviewing the case history. Depending on the age of the child, this may be completed with the parent or caregiver, with the child or both. This will help determine the nature of the visit.

Next, the hearing professional will complete a thorough examination of the outer ear and proceed to the tympanometric assessment of the middle ear space – the function of the eardrum.

Finally, depending on the age of the child, pure tone audiometry and age-appropriate word testing are completed and recorded on the audiogram. If the child is of age where they can respond reliably to the pure tone “beeps” using a traditional method like a button press, then the hearing professional will test them in this way. If the child is less than 2 years of age or unable to complete the traditional method of testing, visual reinforcement audiometry (VRA) may be completed.

In VRA testing, the child typically sits on the parent’s or caregiver’s lap or in a child seat in a sound booth where speech sounds are presented through two speakers at opposite ends. The hearing professional will begin the test by playing a sound and displaying a visual display (i.e. video or lit-up teddy bear) simultaneously to stimulate the child to turn their head toward the direction of the display. This “trains” the child to respond by shifting their head toward the sound source. Once the child has learned what to do when they hear a sound, the hearing professional will continue to play sounds at different frequencies to determine your child’s hearing profile. The results are obtained right away and are reviewed with the parent or caregiver.

Testing times can vary depending on the cooperation of the child and the complexity of the hearing concern.

Hearing screenings

Hearing screenings are a quick and efficient way of assessing how well you hear different sounds. Screenings are not as involved as a hearing test, but are still valuable. Screenings are often performed to determine if someone will “pass” or “fail” at a certain level (i.e. within “normal” hearing limits of the audiogram).

An otoscopic examination – a visual inspection of the outer ear, ear canal and eardrum would be completed first. Then, headphones (or insert earplugs) are put in and the hearing professional and/or doctor will test a few frequencies (or tones) at a certain decibel level or loudness (intensity). If the patient responds, they will mark that tone as a "pass" and if they do not respond, they will mark it as a "fail." The hearing screening generates either pass or fail results. If you fail your hearing screening, we recommend you receive further testing with your hearing professional to evaluate if you have hearing loss. A hearing professional can provide you with a more comprehensive and thorough hearing test. This should be completed as soon as possible after the failed screening.

Ask your doctor for a hearing screening if you have concerns about your own hearing, your child’s, or someone you know.

School screenings

Should I have my child’s hearing checked at school?

School screenings are an efficient way of determining potential hearing loss in children that may otherwise have gone unnoticed. It is really important for early detection, especially at this critical age where speech and language is rapidly developing.

Screenings at school are often subject to fees. Many of them also have vision testing at the same time.

School screenings typically only take a few minutes to complete. Parents/caregivers should not panic if the result is a "fail" but it is advised to seek follow-up services and a more thorough examination of your child’s hearing.

Online hearing tests

Simplified hearing screenings are available online or via an application on mobile phones. Although they do not replace a thorough examination conducted in a hearing clinic, they are a quick and an easy place to start. If you are hesitant about booking a hearing test or completing a hearing screening at your doctor’s office, an online test may be a good introduction.

There are two types of online or mobile application-based hearing tests:

• Sound format: a series of tones are presented and a threshold – the quietest sound level you can hear— is recorded. This type requires a set of headphones or earbuds.
• Question format: a set of questions to determine if you are experiencing symptoms of hearing loss and if it is affecting your daily activities, such as the online hearing test on Hearing Directory.

These types of tests can give you a rough estimate of your hearing level or concerns, but should not be replaced by a thorough and comprehensive hearing assessment provided by a hearing healthcare professional. You can bring your online hearing test results to your next hearing test appointment so the hearing healthcare center can keep a record of it in your case history.

Understanding your hearing test results

Once your hearing professional has completed your hearing assessment and has reviewed the results with you, this is the time to ask questions. Hearing professionals typically allow for extra appointment time to consult with their clients in order to help them understand what is happening with their hearing health. It is also at this time that a prescription and/or recommendation(s) may be provided to you. Take the time to understand how your hearing loss is impacting the different areas of your life and review the treatment options. Be sure to book a follow-up appointment with your hearing professional if you have any more questions that come up after your visit.

Some hearing professionals will contact you within 48 hours of your hearing test to ensure you understand your results and ask if you have any further questions they can answer.

It is also helpful to discuss the results of your hearing test with friends or family, who can help you to see the bigger picture. They may be able to help you better understand your hearing test results, treatment options, and provide you support.

When should I start testing my hearing?

Getting a baseline hearing test is the first step to better hearing health, particularly if you are at higher risk of hearing loss. If you were exposed to loud noise, or have family members with hearing loss, you are at higher risk. Many people start to develop hearing loss in their 50s and 60s. If you think you do already have hearing loss, don't delay getting a test. 

Remember, hearing loss can affect anyone and is a common health concern. You are not alone and there is lots of help. Visit our directory to schedule a hearing test near you. We can help you in taking your first step to better hearing health.