Tests for Hearing Loss

Hearing tests are used to evaluate the sensitivity of your hearing at different volumes, pitches, and frequencies. About 13% of people ages 12 and above in the United States have hearing loss in both ears. As you get older, the chances of you developing hearing loss become higher. 

Roughly 14% of people between the ages of 45 and 64 have a type of hearing loss, but that increases to 30% in people ages 65 and above. This is why it is advisable to go for a hearing checkup once every 10 years until the age of 50, then every three years afterward.

You may experience hearing loss if there is a problem with your outer, middle, inner ear, or the auditory channels in your brain. 

Read more to find out the different types of hearing tests for the different sections of the ear and when to detect you need a test. 

Signs You Need a Hearing Test

If you notice any of the following symptoms, then you may need a hearing test:

• Difficulty in hearing what other people are saying in a noisy environment
• Asking people to repeat themselves multiple times
• Difficulty hearing high-pitched sounds such as birds chirping or a child's voice
• Straining to hear spoken words
• Constantly turning up the volume on your TV or stereo to hear better
• Dizziness or ringing in your ears

Ear Anatomy

Your ears are the parts of your body responsible for all the sounds you hear. It also helps you with balance. All these functions depend on special cell receptors called hair cells.

The ear is anatomically divided into three parts: the outer ear, middle ear, and inner ear:

• Outer ear: The outer ear is made up of the ear canal and the pinna. The ear canal protects the ear from impurities through the secretion of wax, which traps the impurities. The pinna is the part that is visible to other people and is commonly referred to as the ear. 
• Middle ear: They are three small bones called malleus, incus, and stapes. Their job is to transfer sound waves from the eardrum to the inner ear. The role of the middle ear is to balance the air pressure between the outer and inner ear using the eustachian tube. It also provides passage for infection to travel through the ear.
• Inner ear: Also known as the labyrinth, the inner ear is in charge of your body’s balance and hearing. The labyrinth consists of two types: the bony labyrinth and the membranous labyrinth. The cochlea, which is responsible for hearing, is housed in your inner ear. It looks like a snail and is made up of three fluid chambers. The cochlea converts the vibrational energy of sound into an electrical impulse that sends that signal to your brain for interpretation. 

Outer Ear Tests

These are tests that are carried out on the outer part of your ear (pinna) to check the level of hearing loss. Outer ear tests include pure-tone and bone conduction.

Pure-Tone (Audiogram)

This kind of test is also called audiometry, or an audiogram. For this test you will need to wear headphones so that different sounds may be played into your ear.

An audiologist—a doctor who specializes in auditory (hearing) disorders and vestibular (spatial balance) problems —will change the intensity and volume of the sound at different intervals. They will tell you to signal when you hear a sound either by raising your hand or pressing a button. Sometimes, you may barely hear anything. This helps them to find out the lowest tones you can hear at different frequencies.

Take note that these pure-tone tests can be taken online or on an audiogram.

Bone Conduction

Ear specialists use bone conduction tests to check if wax or any fluid is blocking your ear canal. A small device is placed either behind your ear or on your forehead. The sound causes your skull to vibrate a little. 

This vibration travels to the inner ear directly. Results from this test will show your healthcare provider how well you can hear and if the problem is from the outer or middle ear.

If your provider suspects the reason for your hearing loss is from the middle ear then they would carry out some of the following tests to confirm.

Middle Ear Tests

A problem in the middle ear inhibits sounds from traveling from your outer ear to your inner ear. Tests to assess the middle ear include tympanometry, speech test, acoustic reflex measures, and static acoustic measures.

Tympanometry

Tympanometry scans your ear to know how your eardrum moves. Your healthcare provider (often an audiologist) will place a small device into your ear canal. The device pushes air into the canal, which makes the eardrum move. A machine records the movement on a tympanogram, a device that depicts the results in graph form.

The device will show if your eardrum moves correctly if it's too stiff, too wobbly, or if there is a hole in it. Essentially, the test is used to detect if you have an ear infection, blockages in the canal, or a hole in your eardrum.

Speech Test

Your doctor may try speech tests to determine how well you can hear spoken language. 

You’ll put on a pair of headphones and the audiologist will speak to you through the headphones, asking you to repeat certain words all at different volumes. They will record the lowest word you were able to hear.

Acoustic Reflex Measures

Also called middle ear muscle reflex (MEMR), acoustic reflex measures are used to test how well you can hear loud sounds. Normally, a tiny muscle called the stapedius contracts when you hear a loud sound. This process is called the acoustic reflex and it occurs automatically. 

During the MEMR test:

• The ear doctor will place a soft rubber material inside your ear.
• Different loud sounds will be conducted through the tip while the machine records the response.
• If hearing loss is severe, the sound might have to be increased for the stapedius to contract. In other cases, there would be no reflex.

Static Acoustic Impedance 

In this test, the amount of air in the ear canal to see whether there is a hole in the eardrum. After the test, your doctor will discuss the results with you. They will then decide if further tests are needed depending on the result.

Inner Ear Tests

There is only one type of inner ear test that is used to test for hearing loss. It is called otoacoustic emissions, or OAE.

Otoacoustic Emissions (OAE)

Otoacoustic emissions tests, or OAE tests, can tell you how well your inner ear (cochlea) is working. It measures OAEs, which are sounds that your inner ear releases when it receives sound waves. There are hair cells within your inner ear that vibrate when sound waves hit them. These vibrations give off quiet echoes back to your middle ear. The echoes are what are being recorded during an OAE test.

People with unaffected hearing will have OAEs. People whose hearing loss is more than 30 decibels (dB) will not have these emissions.

Your doctor can also use this test to see if there is a blockage in the outer or middle ear. If there is, no sound will pass through to the inner ear; this automatically means no echoes or emissions. 

To carry out the test, a small earphone is put in your ear. This transmits sounds into your ear and records the ones that come back. Even though the earphone is in your ear, this is not an invasive or painful test. You do not have to do or say anything while the person assessing your hearing is doing this test.

General Tests

General screening tests are carried out to find out what ear is involved in the hearing loss. These tests can also help determine the type of hearing loss you're experiencing—conductive, sensorineural, or mixed.

Tuning Fork Test

A tuning fork is a metallic device with two prongs that produce a sound when it vibrates. Your audiologist will place the tuning fork behind your ear or on your head and hit the fork to make a sound. 

Your doctor will ask you to inform them when you hear a sound, and where you heard it—left ear, right ear, or both. The position of the fork helps to detect the type of hearing loss.

Brain Tests

These tests target your inner ear and brain pathways. Its goal is to find out how well your auditory channels (the passing of sounds through the hearing nerves and to the brain) are working. 

Auditory Brainstem Response (ABR)

The ABR test, also known as brainstem auditory evoked response (BAER) or auditory evoked potential (AEP), describes how the cochlear, inner ear, and auditory channels in the brain are performing. The test is mainly for children or infants who are not able to complete a standard hearing test. The ABR is also recommended if it is suspected that your hearing loss might be from the brain.

To complete this test, a healthcare provider will apply different electrodes to your or your child's head and connect them to a computer. These electrodes track brainwave performance when you hear sounds. All you or your child needs to do is close your eyes and sleep during the test. The provider will print out the results when the test is complete.

What to Expect

A typical hearing test may last for about 30 minutes, and it doesn’t hurt.

You may be asked to wear headphones and pay attention to different sounds at different volumes in each ear. The way you respond to each sound in your ears will show whether you have hearing loss or not, and the type of loss.

During some tests, your doctor may also ask that you listen to words or sounds at various volumes, which will be played in one ear after the other. After listening, you will be asked to repeat what you heard. This test is carried out in a soundproof room to avoid background noises, which affect some people. 

When to Talk to Your Doctor

If you notice that for some reason you aren’t hearing as you used to, then it is important you reach your doctor as soon as possible. 

Although it may not be easy to explain what your experiences are, getting professional medical care is the best way to prevent any further problems. Some tips that you can use when talking to your doctor include:

• Telling your doctor the problems you faced
• Asking questions to learn more about what you're experiencing and what happens next
• Finding out what ways can help you protect your hearing
  

Summary

As you get older, the chances of you developing hearing loss increase. Depending on your age and the symptoms you experience, different hearing tests will be used to diagnose your loss. There are many tests used to detect hearing loss, including tests for the outer, middle, and inner ear.

Tests for the outer ear include pure-tone and bone conduction. Middle ear tests include tympanometry, speech test, acoustic reflex measures, and static acoustic measures. The otoacoustic emissions test is the only test used to detect hearing loss in the inner ear. Other tests are used for general hearing loss and hearing loss associated with the brain.

A Word From Verywell

It can be alarming to realize that you're not hearing as well as you used to (or that your child is having hearing issues). Thankfully, hearing tests are painless, quick procedures. Once you know what is affecting your hearing, there are many options for how to move forward in your care. Therefore, it’s best for your long-term auditory health to speak to your healthcare provider if you notice anything out of the ordinary.