Hearing Test: Types, Procedures & What to Expect

What Is a Hearing Test and Why Is It Important?

A hearing test (audiometry) is a comprehensive evaluation that measures your ability to hear sounds at various frequencies and volumes. It determines the type, degree, and configuration of any hearing loss, enabling audiologists to recommend appropriate treatment options. Regular hearing tests are essential because hearing loss often develops gradually, and early intervention leads to significantly better outcomes.

Hearing tests serve as the foundation for understanding your auditory health. Unlike vision problems that are often immediately noticeable, hearing loss typically develops so gradually that many people don't realize they're affected until it significantly impacts their daily life. The World Health Organization reports that nearly 1.5 billion people worldwide experience some degree of hearing loss, with this number projected to reach 2.5 billion by 2050.

The importance of hearing tests extends far beyond simply determining whether you can hear well. Research has consistently demonstrated that untreated hearing loss is associated with numerous health complications, including accelerated cognitive decline, increased risk of dementia, higher rates of depression and social isolation, and even an elevated risk of falls and accidents. Studies published in The Lancet have identified hearing loss as one of the most significant modifiable risk factors for dementia, accounting for approximately 8% of cases worldwide.

From a physiological perspective, hearing tests evaluate the entire auditory pathway, from the outer ear canal through the middle ear bones to the delicate hair cells of the inner ear and the auditory nerve connections to the brain. This comprehensive assessment allows healthcare providers to pinpoint exactly where problems occur, which is crucial for determining the most effective treatment approach.

Understanding the Auditory System

To fully appreciate what hearing tests measure, it helps to understand how normal hearing works. Sound waves enter the ear canal and cause the eardrum to vibrate. These vibrations are amplified by three tiny bones in the middle ear (the malleus, incus, and stapes) before reaching the cochlea, a fluid-filled structure in the inner ear. The cochlea contains thousands of microscopic hair cells that convert mechanical vibrations into electrical signals, which travel via the auditory nerve to the brain for interpretation.

Problems can occur at any point along this pathway. Conductive hearing loss results from issues in the outer or middle ear that prevent sound from being efficiently transmitted. Sensorineural hearing loss stems from damage to the inner ear or auditory nerve. Mixed hearing loss involves both components. A comprehensive hearing test can distinguish between these types, which is essential because each requires different treatment approaches.

What Are the Different Types of Hearing Tests?

The main types of hearing tests include pure tone audiometry (testing ability to hear tones at different frequencies), speech audiometry (measuring understanding of spoken words), tympanometry (assessing middle ear function), and otoacoustic emissions testing (evaluating inner ear health). Each test provides unique information about different aspects of your hearing.

Audiologists have access to a range of sophisticated testing methods, each designed to evaluate specific aspects of hearing function. Understanding these different tests helps patients know what to expect and appreciate the comprehensive nature of a complete hearing evaluation.

Pure Tone Audiometry

Pure tone audiometry is the most fundamental and widely used hearing test. During this test, you wear headphones in a soundproof booth while an audiometer generates pure tones at specific frequencies and volumes. The frequencies typically range from 250 Hz (low-pitched sounds) to 8000 Hz (high-pitched sounds), covering the range most important for understanding speech. You indicate when you hear each tone, usually by pressing a button or raising your hand.

The audiologist tests each ear separately, gradually decreasing the volume at each frequency until determining your hearing threshold—the softest sound you can reliably detect. Both air conduction (through headphones) and bone conduction (through a small vibrator placed behind the ear) are tested. Comparing these results helps identify whether hearing loss is conductive, sensorineural, or mixed.

Speech Audiometry

While pure tone audiometry measures sensitivity to sounds, speech audiometry evaluates how well you understand spoken language—often a more practical concern for daily life. This test involves listening to recorded words or sentences at various volume levels and repeating what you hear. The speech recognition threshold (SRT) identifies the softest level at which you can understand speech, while word recognition scores measure clarity of hearing at comfortable listening levels.

Speech-in-noise testing has become increasingly important, as many people with hearing loss report particular difficulty understanding conversation in noisy environments like restaurants. This test specifically evaluates your ability to distinguish speech when competing sounds are present.

Tympanometry and Acoustic Reflex Testing

Tympanometry assesses the function of the middle ear system. A small probe is inserted into the ear canal, creating a seal, and varying air pressure is applied while a tone is played. The instrument measures how the eardrum moves in response to pressure changes, producing a graph called a tympanogram. This test can identify conditions such as fluid behind the eardrum, eardrum perforations, or problems with the middle ear bones.

Acoustic reflex testing evaluates the stapedius muscle reflex—an involuntary contraction of a tiny middle ear muscle in response to loud sounds. Abnormal reflex patterns can indicate problems with the middle ear, cochlea, auditory nerve, or even certain brainstem pathways.

Otoacoustic Emissions (OAE) Testing

Otoacoustic emissions are sounds produced by the outer hair cells in the cochlea in response to stimulation. A sensitive microphone in the ear canal detects these faint sounds, providing objective information about inner ear function. OAE testing is particularly valuable for newborn hearing screening and for evaluating hearing in individuals who cannot participate in behavioral tests.

How Should You Prepare for a Hearing Test?

To prepare for a hearing test, avoid loud noise exposure for 16-24 hours beforehand, don't use cotton swabs in your ears, bring a list of your medications and medical history, note specific situations where you have difficulty hearing, and ensure you're well-rested. Proper preparation helps ensure accurate, reliable results.

While hearing tests don't require extensive preparation like some medical procedures, taking certain steps beforehand can help ensure you get the most accurate results and make the most of your appointment.

The most important preparation involves protecting your hearing in the days leading up to your test. Temporary threshold shift—a short-term reduction in hearing sensitivity—can occur after exposure to loud sounds. Attending a concert, using power tools, or listening to loud music through headphones within 24 hours of your test could artificially worsen your results. Plan to avoid these activities and any other significant noise exposure before your appointment.

Earwax (cerumen) can also affect test results by blocking sound from reaching the eardrum effectively. However, you should not attempt to remove earwax yourself using cotton swabs, as this often pushes wax deeper into the ear canal and can cause damage. If you know you tend to accumulate excess earwax, mention this when scheduling your appointment—your healthcare provider may want to examine your ears beforehand and remove any blockage if necessary.

Information to Bring to Your Appointment

Gathering relevant information before your appointment helps the audiologist understand your complete health picture. Prepare a list of all medications you currently take, as some drugs can affect hearing. Note any history of ear infections, surgeries, injuries, or exposure to loud noise (occupational or recreational). If other family members have hearing loss, this information is relevant as some types of hearing loss have genetic components.

Think specifically about situations where you notice difficulty hearing. Do you struggle to follow conversations in restaurants? Have trouble hearing on the telephone? Need to turn up the television louder than others prefer? Find certain voices (like children's or women's) harder to understand? These details help the audiologist interpret your results in the context of your real-world experiences.

What Happens During a Hearing Test?

During a hearing test, you'll sit in a soundproof booth wearing headphones while listening for tones at different pitches and volumes, responding when you hear sounds. The audiologist will also test your ability to understand speech and may assess middle ear function. The entire process is painless and typically takes 30-60 minutes.

Understanding what to expect during a hearing test can help alleviate any anxiety and ensure you're prepared to participate fully in the evaluation process. A comprehensive hearing assessment typically includes several components, each providing valuable information about different aspects of your auditory function.

Your appointment will likely begin with a case history review. The audiologist will ask about your hearing concerns, medical history, noise exposure, and any relevant family history. This conversation helps establish context for interpreting your test results and identifies any factors that might affect testing or indicate specific conditions to look for.

Physical Examination

Before conducting hearing tests, the audiologist will visually examine your ears using an otoscope—a handheld instrument with a light and magnifying lens. This examination reveals the condition of your ear canal and eardrum, identifying any obvious problems such as earwax blockage, infection, perforation, or other abnormalities that could affect hearing or the testing process.

The Testing Process

For pure tone audiometry, you'll be seated in a soundproof booth or room to minimize background noise. You'll wear headphones (for air conduction testing) or have a bone oscillator placed behind your ear (for bone conduction testing). The audiologist will instruct you to respond in a specific way—typically by pressing a button or raising your hand—whenever you hear a tone, no matter how faint.

You'll hear a series of beeps and tones at various frequencies, starting at a comfortably audible level that gradually decreases until you can no longer hear it. This process is repeated at each frequency being tested. It's important to respond even when you're uncertain—the test is designed to find the very softest sounds you can detect, so guessing is expected and appropriate.

Speech testing follows a similar format but uses recorded or live spoken words instead of tones. You'll repeat back the words you hear, allowing the audiologist to determine your speech recognition threshold and word recognition abilities. Some facilities also conduct speech-in-noise testing to evaluate your hearing in more realistic conditions.

What Does the Test Feel Like?

Hearing tests are entirely painless. The only sensations you might experience are the slight pressure of headphones on your ears and, during tympanometry, a brief feeling of pressure change in your ear canal similar to what you might feel during airplane takeoff or descent. Most people find testing more boring than uncomfortable—sitting quietly and responding to faint sounds requires concentration but causes no physical discomfort.

How Do You Interpret Hearing Test Results?

Hearing test results are displayed on an audiogram showing your hearing thresholds at different frequencies. Normal hearing is 0-25 decibels (dB), mild loss is 26-40 dB, moderate is 41-55 dB, moderately severe is 56-70 dB, severe is 71-90 dB, and profound loss is 91+ dB. Your audiologist will explain what your specific pattern of hearing loss means for your daily life.

The audiogram is the primary document used to record and communicate hearing test results. Understanding how to read an audiogram empowers you to participate more fully in discussions about your hearing health and treatment options.

Understanding the Audiogram

An audiogram is a graph with frequency (pitch) displayed along the horizontal axis and intensity (loudness) along the vertical axis. Frequencies are measured in Hertz (Hz), with low frequencies (deep sounds) on the left and high frequencies (sharp sounds) on the right. The frequencies tested typically range from 250 Hz to 8000 Hz, though some tests extend further in either direction.

Intensity is measured in decibels (dB), with softer sounds at the top of the graph and louder sounds toward the bottom. This may seem counterintuitive at first, but remember that the audiogram shows your hearing thresholds—the softest sounds you can detect. A threshold near the top of the graph (low dB number) indicates good hearing at that frequency, while a threshold near the bottom (high dB number) indicates hearing loss.

Different symbols represent results for each ear and testing method. Typically, O represents right ear air conduction, X represents left ear air conduction, and bone conduction results use bracket symbols. Masking symbols may also appear when noise was presented to one ear during testing to prevent cross-hearing.

Configuration of Hearing Loss

Beyond the degree of hearing loss, the pattern or configuration across frequencies provides important diagnostic information. High-frequency hearing loss, with better hearing in low frequencies and worse hearing in high frequencies, is the most common pattern associated with aging (presbycusis) and noise exposure. This type of loss particularly affects ability to hear consonant sounds, making speech seem muffled or unclear.

Flat hearing loss shows similar thresholds across all frequencies and may indicate genetic causes or certain medications. Rising hearing loss, with worse hearing in low frequencies, is less common and may suggest specific conditions like Meniere's disease. Notched hearing loss, with a distinctive dip at certain frequencies (often 4000 Hz), is characteristic of noise-induced hearing loss.

When Should You Get a Hearing Test?

You should get a hearing test if you notice signs of hearing loss (asking people to repeat themselves, turning up TV volume, difficulty in noisy environments), have risk factors (noise exposure, family history, certain medications), or are over 50. Seek immediate testing for sudden hearing loss, as treatment within 72 hours yields the best outcomes.

Knowing when to seek hearing evaluation helps ensure problems are identified and addressed promptly. Some situations clearly warrant testing, while others represent good opportunities for preventive screening.

Signs That Indicate Testing Is Needed

Pay attention to changes in how you experience sound in daily life. Common signs of hearing loss include frequently asking people to repeat themselves, feeling that others mumble or don't speak clearly, having difficulty following conversations in restaurants or other noisy settings, needing to turn up the television or radio louder than others prefer, having trouble hearing on the telephone, and feeling exhausted after social events from the effort of trying to hear.

You might also notice tinnitus (ringing, buzzing, or other sounds in your ears) that wasn't present before, or find yourself unconsciously reading lips to supplement what you hear. Family members or friends may notice your hearing difficulties before you do, so take their observations seriously.

Recommended Screening Schedule

Even without obvious symptoms, regular hearing screening helps catch problems early when intervention is most effective. The American Academy of Audiology recommends baseline hearing testing for adults beginning at age 50, with follow-up testing every three years. Those with risk factors should begin screening earlier and test more frequently.

Risk factors for hearing loss include occupational or recreational noise exposure, family history of hearing loss, use of ototoxic medications (certain antibiotics, chemotherapy drugs, high-dose aspirin), diabetes, cardiovascular disease, and smoking. If any of these apply to you, discuss appropriate screening intervals with your healthcare provider.

What Treatment Options Are Available for Hearing Loss?

Treatment for hearing loss depends on its type and cause. Options include earwax removal and medical treatment for conductive loss, hearing aids (which help about 90% of cases), cochlear implants for severe sensorineural loss, bone-anchored hearing systems, and assistive listening devices. Early intervention leads to better outcomes and helps prevent associated complications like cognitive decline.

The good news about hearing loss is that most cases can be significantly improved with appropriate intervention. Treatment recommendations depend on the type, degree, and cause of hearing loss, as well as individual factors like lifestyle, communication needs, and personal preferences.

Medical and Surgical Treatments

Conductive hearing loss, caused by problems in the outer or middle ear, often responds well to medical or surgical intervention. Earwax impaction can be safely removed by a healthcare provider. Middle ear infections may require antibiotics or drainage. Perforated eardrums can often heal naturally or be surgically repaired. Otosclerosis, a condition where a middle ear bone becomes fixed, can be addressed with surgery to replace the affected bone with a prosthesis.

Some cases of sudden sensorineural hearing loss respond to high-dose corticosteroid treatment, particularly when administered within the first few days. This is why urgent evaluation of sudden hearing changes is so important.

Hearing Aids

For most people with sensorineural hearing loss, hearing aids represent the primary treatment option. Modern hearing aids are sophisticated digital devices that amplify sounds based on your specific hearing loss pattern. They can be programmed to provide more amplification at frequencies where you have greater loss while preserving more naturally audible frequencies.

Today's hearing aids come in various styles, from nearly invisible completely-in-canal devices to behind-the-ear models with advanced features. Many connect wirelessly to smartphones, televisions, and other devices. Features like directional microphones, noise reduction algorithms, and automatic environment adjustment help optimize performance in different listening situations.

Research consistently shows that hearing aids improve quality of life, reduce listening effort, and help maintain cognitive function. However, they require adjustment—both to the devices themselves and to the experience of hearing sounds you may not have perceived clearly for years. Working with an experienced audiologist and allowing time for adaptation are key to success.

Cochlear Implants and Other Devices

For severe to profound sensorineural hearing loss that doesn't respond adequately to hearing aids, cochlear implants offer another option. Unlike hearing aids, which amplify sound, cochlear implants bypass damaged hair cells and directly stimulate the auditory nerve. They consist of an external processor worn behind the ear and an internal component surgically placed under the skin.

Bone-anchored hearing systems (BAHS) transmit sound vibrations directly through the skull bone to the inner ear, bypassing problems in the outer or middle ear. These can benefit individuals with conductive or mixed hearing loss who cannot use conventional hearing aids.