What is a Hearing Test?

An audiologist in Red Oak, Iowa performing a video otoscope exam

An audiologist in Red Oak, Iowa performing a video otoscope exam

If you have never gotten a hearing test before, you might be a little hesitant to go without doing some research beforehand. You may be asking yourself questions like, “What actually happens in the test? Will I get hooked up to a machine? What are they going to ask me? Do I have to wear headphones?”

These are great questions and this article will help you further understand what goes on during a hearing test, what you need to know going in, why you might need the hearing test in the first place, and where you should get your hearing tested.

The first question we will address deals with what a hearing test actually is. At most audiologists or hearing aid provider’s offices, a hearing test is a series of surveys and audiometric tests including patient background information, pure-tone audiometer testing and speech testing. It can contain other tests and aspects such as a tympanogram which measures pressure in the ear canal or an otoscopy which is when a healthcare professional physically looks into your ears. By looking in your ears your provider can tell whether your hearing loss is maybe due to something like liquid in your ears or overbuild up of ear wax.

Your hearing is like a fingerprint, as it’s completely unique to you. Unlike a fingerprint however, it’s unique because it changes over time based on your life experiences. If you are in loud environments often, you will lose parts your hearing over time. Your lifetime of noise exposure results in a unique curve of damage to your hearing system, which is largely dependent on your age, whether you participate in loud activities frequently, and genetic pre-disposition. A patient background questionnaire will collect some of this information and gives the provider an idea of how your hearing may be affected.

Audiometric testing is something you are probably unfamiliar with if you have never had your hearing tested before. This part of the hearing test often uses pure tones played at different decibel levels directly into your ears. The results give a hearing provider very specific information as to which types of sounds and frequencies you have lost the most hearing in.

Results of audiometric pure-tone testing displayed on an audiogram

Results of audiometric pure-tone testing displayed on an audiogram

Audiometers perform best when they are calibrated to the room they are in as well as to the headphones you will wear to hear those tones. These tests are often much less accurate if the whole system isn’t set up properly. For instance, this is why you can’t just “do a test at home online” as well as why traveling hearing tests at health fairs or events aren’t as good as ones in a calibrated office.

Speech testing is also very important, because while pure tones may be specific, they aren’t something we encounter in real life very often. To do the speech testing, hearing providers use special word lists with spondee words that display syllables accurately and help give an idea of what frequencies you might have difficulty with. This sort of testing ties into the idea of a Speech Banana.

Shown below is the Speech Banana chart. The “Speech Banana” is a very powerful visual tool for showing where the sounds used in everyday speech occur on an chart. The parts of speech that are most often used are known as “phonemes” and include “ng”, “th”, or “s” as well every other sound you can imagine. When mapped out on a chart, these phonemes form a banana-like shape, which is where get the phrase “Speech Banana.

In the “Speech Banana” chart, it shows the commonly used sounds in everyday speech, that have a high frequency. The image bolds the letters and combination of letters “F”, “TH”, and “S” with the highest frequency because these sounds are the hardest to hear with a hearing loss. When given the speech test, you will be asked to say words containing some of these letters, to see if you have a high frequency hearing loss.

Hearing loss may come on so gradually, you may not even realize it’s happening, and in other cases it can occur very quickly, often due to situations like infections, inner ear problems and traumatic or extremely loud experiences. Although there are many ways to lose your hearing, the people around you are the most common reason the thought of getting a hearing test comes about.

Stereocilia are the micro hairs in the inner ear that vibrate and send information to your nervous system. Over time and with exposure to noise, these stereocilia die / break off, and your ear loses its ability to send clear signals to the auditory nerve. Hearing aids are programmed to send enhanced or amplified signals to the remaining stereocilia that you have such that the signals are easily interpreted by your nervous system.

Generally, hearing loss isn’t something you discover on your own, since it typically happens gradually over a long period of time. It’s when you are trying to interact with others that a hearing loss becomes very apparent. You may notice yourself having difficulty understanding what someone is saying or having to ask “What?” or “Huh?” frequently. It is also common to only hear bits of what people are saying, missing out on much of the softer spoken parts of words or as shown in the Speech Banana words that contain “F”, “TH”, and “S”.

Young grandchildren can be especially difficult to understand with a hearing loss.

Young grandchildren can be especially difficult to understand with a hearing loss.

Something we see quite frequently is people trying to “hide” their hearing loss by learning how to read lips. This works some of the time, but has well known issues such as when you communicate over the phone, in a car, or with small children (or adults) who don’t know to look you in the eye when talking to you.

People that just “get by” with reading lips, or turning up the volume on their phone or television are not only delaying the inevitable, they are allowing their Auditory Nerve to die. Your auditory nerve sends signals picked up by your ear to your brain where you associate the noises with sounds you recognize. Your brain adapts to the reduced sound being sent to it by your nervous system and allows nerve endings to die when they are not used for a long period of time.

Once permanent nerve damage has occurred, it doesn’t come back. This means hearing aids become less effective (as they stimulate the nerve, even when your cochlea doesn’t work well enough to pick up the noises). This is why it is important to not delay seeking treatment for hearing loss, and to get your hearing tested to make sure you are not allowing your auditory to die off.

This is emotionally and scientifically why someone would get a hearing test done, and describes what having a hearing loss actually means. It is important to know that by taking action earlier rather than later, you can not only live a better life but save your hearing from becoming irreversibly damaged.


Other Hearing Tests and Hearing Loss that can be Recovered

The tympanogram is another test that could be performed in your hearing checkup. This test measures the eardrum and gives a good indicator of whether or not you have a perforated eardrum or an ear infection. Causes of a perforated eardrum are usually from injury, infection, or chronic tube disorders.

Sometimes a hearing loss can be “conductive”. A tympanogram can help identify this type of hearing loss. A conductive hearing loss is when problems occur within the ear canal, ear drum, or middle ear and its little bones (the malleus, incus, and stapes) and not within the nervous system. Generally, conductive hearing loss is treatable, and many patients make a full recovery.

Cut-Away of the Human Ear and Hearing System

Cut-Away of the Human Ear and Hearing System

When getting a hearing test done, it is best to make an appointment directly with an audiologist. An audiologist is a health care professional qualified to do a thorough evaluation of your hearing. The audiologist can determine your type and degree of hearing loss as described above. The audiologist is able to determine whether or not you can be helped by hearing aids and, if so, the best type of hearing aid for you.

As you can see, getting your hearing tested is not painful, it is not difficult and sometimes can even be free to get done. The hearing test involves a couple steps and tests, and usually takes roughly one hour. You will be asked some simple lifestyle questions to better understand your past experience with noise exposure and family history. A hearing test actually includes several tests that measure how well you hear a variety of sounds, such as tones and speech. After your hearing evaluation, an audiologist will review your results and suggest if hearing aids would be of help to you.