If you or those around you have concerns about your hearing, it's a good idea to have it evaluated by a professional, like an audiologist or a hearing instrument specialist (HIS). Here’s what you need to know about hearing tests.
In this article
Why is it important to test my hearing?
Hearing loss in adults is often a gradual process and can go unnoticed. Over the course of years, our hearing gets worse and we don’t realize that we are missing sounds. Instead, we turn up the volume on our devices, ask people to repeat themselves (insisting that ‘everyone mumbles’), stop going to restaurants because they are too noisy, and complain that our friend’s voices are too soft. If this sounds like you, it’s time to get your hearing tested. Early detection of hearing loss allows for timely intervention, treatment, and improved communication, and will ultimately improve your overall well-being.
Hearing loss is linked to dementia. Recent research shows that hearing loss is a modifiable risk factor for dementia, suggesting that addressing hearing loss through the use of hearing aids could help reduce the risk of dementia .
Acquired hearing loss can significantly affect your educational, professional, and social life. The ability to engage in effective communication is critical in all aspects of our daily life. As we lose our hearing, it can become more challenging to partake in larger group environments such as school, work meetings, religious gatherings, or entertainment events. This difficulty is often intensified due to a lack of communication access in our society. Consequently, individuals with hearing loss may begin to avoid certain situations or interactions as they can't fully enjoy and participate in these experiences. This avoidance can lead to social isolation, reduced mental activity, and in some cases, depression.
Chronic diseases, such as diabetes, heart conditions, and high blood pressure, are often accompanied by hearing loss. Research shows that hearing loss is associated with other health conditions, such as visual impairment, mobility restrictions, diabetes, cardiovascular diseases, stroke, arthritis, and cancer. If you are living with one or more of these conditions, it is crucial to monitor your hearing, as you may be experiencing undetected hearing loss. Early detection enables prompt intervention, treatment, and enhanced communication, which is particularly vital when managing a chronic disease.
Aging in place. Identifying and treating hearing loss early can help maintain your independence. Untreated hearing loss has been linked to several risks. One is an increased likelihood of falls - our hearing provides cues from the environment, assisting our balance. Hearing loss increases cognitive load, making it difficult to manage all factors required for moving around safely. Additionally, untreated hearing loss is associated with an elevated risk of depression and anxiety.
Early detection and management of hearing loss can enhance quality of life and promote overall well-being.
How often should I have a hearing test or a hearing screening?
Hearing loss is very common, affecting 1.5 billion people globally and over 50 million Americans. However, awareness of hearing loss, even among medical professionals, remains low, and it often goes undiagnosed.
How often you should have a hearing test or hearing screening depends on your age, family history, occupation, and risk factors, such as other health conditions you may have.
Given the significant impact of hearing loss on health and well-being, the World Health Organization (WHO) recommends regular hearing loss screenings for all adults, starting from the age of 50 :
Between the ages of 50 and 64: screenings should occur every 5 years .
Over the age of 64: screenings should occur every 1-3 years .
However, there are certain situations in which you should consider more frequent screenings or tests, even before the age of 50:
Changes in your hearing: If changes are noticed by you, your partner, children, or friends.
Noise exposure: If you are currently exposed to loud noise or have a history of such exposure.
Family history: If there is a family history of hearing loss or dementia.
Ototoxic medication: If you are currently using or have previously used medications that can negatively affect hearing.
Ear infections: If you have a history of ear infections.
Past ear or head trauma: If you have experienced ear or head trauma.
Health conditions: If you have certain health conditions, such as diabetes, vascular disease, Meniere's disease, autoimmune disorders, or migraines, that can increase your risk of hearing loss.
Vision difficulties: If you have vision difficulties, you might rely more on your hearing, warranting regular hearing checks.
Hearing loss of a spouse: If your spouse has hearing loss, it's advisable to get your hearing checked regularly. Unrecognized hearing loss in both partners can make communication challenging and even lead to resentment. Regular hearing tests can help ensure that potential communication barriers are recognized and addressed promptly.
Remember, this information is intended to be a guideline. It's always best to consult with an audiologist or healthcare professional to determine the appropriate frequency of hearing tests for your individual needs.
What is a hearing screening, what are its purposes, and how can you get one done?
A hearing screening is used to determine if a person has any hearing difficulties or hearing loss, but it is less detailed and accurate than a hearing test. Hearing screenings are used as a fast way to try and understand if you should pursue a diagnostic hearing test, or if you might have hearing loss but haven’t realized it. Hearing screenings intended for babies, children, and adults can be different. Note that the following information focuses on hearing screening for adults.
The WHO (World Health Organization) recommends screening for adults in two steps , the first step is by asking questions about your hearing status, and the second step is by using screening tests.
Step 1: Answer questions about your hearing status
Single-question screening: This type of screening might involve a question like, 'Do you have difficulty with your hearing?'. Your doctor may use this question to determine if they should refer you for a full hearing test. If you are using hearing aids or other technologies to aid your hearing, it's crucial to evaluate your hearing regularly while using these devices. For instance, you might be asked, 'How would you characterize your hearing when using your hearing aid or other hearing device?’
Questionnaires: There are various questionnaires designed to assist you, a family member, or a healthcare provider in determining if you might have hearing loss. Consider using the questions in the article 'Do I Have Hearing Loss? How to Self-Assess for Hearing Loss'. Alternatively, you could use the Hearing Handicap Inventory for Adults questionnaire , which has been modified by the National Institute on Deafness and Other Communication Disorders (NIDCD) for use with adults aged 18 to 64.
If your answers to the screening question or the questionnaire were positive, you should pursue an audiological hearing test.
If you do not report difficulty hearing, meaning you answered no to the single-question screening or no to most of the questions in the questionnaire, you should also complete a hearing screening test. Hearing loss may go unnoticed by the individual experiencing it since it often occurs gradually.
Step 2: Take a hearing screening test for adults
Online and app-based hearing screening tests: There are numerous free online and app-based hearing screening tests available. These tests typically involve a series of sounds played through a computer or smartphone speaker or personal headphones. You are asked to indicate when you hear each sound. However, many of these tests cannot produce an accurate hearing assessment, as they are unable to calibrate the sound on a local computer or a non-Apple smartphone. Currently, they primarily serve as screeners to identify potential hearing issues, indicating whether further evaluation by a hearing healthcare professional is necessary.
For iPhone and iPad users, we found the Jacoti Hearing Center app to be a reliable hearing assessment tool. The test takes about 5 minutes and can be performed from the comfort of your home. When you take the test make sure to be in a quiet part of your home and to have your EarPods available (EarPods are Apple’s classic wired headphones).
Online screening tools are helpful in that if you have concerns, you can get some information fairly quickly and often in the comfort of your own home. This can help reduce some anxiety around questioning if you are experiencing some hearing loss. However, these are just screening tools, not meant to replace a test with a qualified hearing healthcare professional trained to help identify hearing loss, and as importantly, how to speak to you about what you can do about it.
Screening by a healthcare professional:
Your physician: Some physicians may offer a hearing screening in their office. This is considered a routine test and will not be as comprehensive as one that is done in the office of an audiologist. You will be asked to wear a pair of headphones and listen to some beeps at different loudness levels and pitches. You will have to indicate that you heard the sound, even at the softest levels you hear. Because this is done in a typical exam room without controlling for ambient noise levels, the screening will not go below a certain level. If you don’t hear the sound at the lowest presentation level, your physician may refer you to an audiologist for further testing.
A hearing instrument specialist: A hearing instrument specialist (HIS) performs testing for the purposes of determining if you are a candidate for a hearing aid. The test should begin with a visual inspection of your ear canal and eardrum. Following that, you should be tested in a noise-controlled environment. For example, a sound-treated room or a booth, which is a space that has been specifically designed to control the acoustics within the room; by noise canceling headphones in a standard exam room; or in a room with some sound treatment where noise levels are monitored to ensure they stay within specified limits during the test. The HIS will test you to find the softest level you can detect a beep at different pitches in both ears and how well you understand speech at normal conversational levels or increased volumes based on your hearing loss. This may also include additional tests such as evaluating how well your eardrum is moving, and how you hear in noise.
Please be aware that hearing instrument specialists (HIS) are not qualified to diagnose hearing loss or diagnose or treat tinnitus (ringing or buzzing in the ears), hyperacusis (intolerance to loud sounds), auditory processing disorders (difficulty understanding speech even though we can hear it), or other auditory cognitive processing skills (for example difficulties with short term memory).
Understanding Hearing tests: the process and types of tests conducted by audiologists
Audiologists typically do not perform hearing screenings unless as part of a health fair. Instead, an audiologist should begin by gathering a thorough history of your health and perception of your hearing. Based on that history, the audiologist will begin to plan what type of tests are needed to gather the information to best understand your hearing. Different tests look at different parts of the ear and tell us different information. Together they help the examiner “see” into your ear and brain and help you understand why you may be having trouble hearing in different situations.
Understanding the three parts of your ear and how audiologists assess them
The ear is divided into three parts: the outer ear, middle ear, and inner ear.
1. The outer ear: Primarily responsible for collecting sound, the outer ear consists of the visible part on the side of your head, known as the pinna or auricle, and the external ear canal. The ear canal ends at the eardrum (tympanic membrane).
Tests for the outer ear: An otoscope, a lighted magnifying tool, is used to inspect the ear canal and eardrum for mechanical or structural issues.
Hearing loss related to the outer ear: Hearing loss related to a blocked or significantly narrowed external ear canal is called conductive hearing loss.
2. The middle ear: Primarily responsible for amplifying sound, the middle ear consists of the eardrum (tympanic membrane), an air-filled space behind the eardrum in which the three tiniest bones in your body are found (the hammer, stirrup and anvil, also known as ossicles), and concludes with the oval window. The middle ear’s ability to amplify sound relies on the movement of the eardrum and the tiny bones (ossicles) that are connected to it, as well as the presence of a gas that is similar in its composition to air, which enables the eardrum-ossicles structure to move effectively.
Tests for the middle ear: Tympanometry is used to assess the mechanical function of the middle ear. Evaluating if there is an issue in the middle ear that is causing the hearing loss is done by comparing air conduction and bone conduction pure tone thresholds.
Hearing loss related to the middle ear: Hearing loss related to an impaired function of the middle ear is called conductive hearing loss.
3. The inner ear: Responsible for both hearing and balance, the inner ear processes sounds for the hearing system. The hearing part of the inner ear is the cochlea, a snail-shaped organ that contains two types of functional cells - inner hair cells and outer hair cells. Inner hair cells convert sound into electrical impulses that are sent to the brain for interpretation as speech, music, or noise. Outer hair cells amplify sound waves.
Tests for the inner ear: Pure tone audiometry examines the hearing function of the inner ear and the otoacoustic emission test checks the outer hair cells and their ability to amplify the sound waves. Speech testing examines one’s ability to understand speech which is impacted by the presence or absence of hair cells.
Hearing loss related to the inner ear: Hearing loss related to an impaired function of the inner ear is called sensorineural hearing loss.
Understanding the tests used to assess your ear and your hearing
An otoscope is used to inspect the outer ear for mechanical or structural issues. An Otoscope is a lighted tool with a magnifier used to illuminate and view the ear canal and eardrum. The examiner will be looking at the shape of your ear and ear canal, for any irritation, earwax, or debris in your ear canal, and the appearance of the eardrum.
A test used to assess the mechanical function of the middle ear. This machine measures the volume of your ear canal, the pressure in your middle ear, and the movement of your eardrum. To do this, a small probe is placed in your ear, sealing your ear canal. The device then gently pushes air into your ear. Don’t worry, it doesn’t hurt. The test produces a graph that shows how well your middle ear is working and whether there are any potential issues that need attention. These could include, a hole in the eardrum, fluid behind the eardrum, eustachian tube dysfunction - abnormal pressure level in the middle ear, or problems with the tiny bones of hearing located in the middle ear space.
Air conduction and bone conduction pure tone thresholds (pure tone audiometry)
A test used to assess hearing through the three parts of your ear - your outer, middle and inner ear. If you take this test in an audiologist’s clinic you will be brought into a sound-treated room or booth. There are ANSI standards that require ambient noise levels to be at a particular level or below and the equipment used must be calibrated to assure your best responses to the softest sounds are detected. Your first time entering the room, you will “feel” the quiet. When this test is done remotely or without a sound-treated room, noise-canceling headphones should be used with calibrated equipment.
During the test, you'll wear headphones or earphones to receive sounds through your ear canal (air conduction) and a bone vibrator to send sounds through your skull (bone conduction). Sounds sent through air conduction measures the entire hearing “trail” - your outer, middle, and inner ear. Sounds sent through bone conduction measure the ability of your inner ear to process sound transmitted directly through the skull, bypassing the outer and middle ear structures. Comparing air conduction to bone conduction helps to determine if hearing loss is due to a problem with the outer or middle ear (conductive hearing loss), with the inner ear (sensorineural hearing loss), or a combination of the two (mixed hearing loss).
Different tones at various pitches will be played to each ear separately. Your task is to indicate when you hear a sound, either by raising your hand or pressing a button. The goal is to find the softest level at which you can hear each sound. The results will be plotted on an audiogram, a graph that shows which sounds you can hear and which you may miss. The audiogram's shape can reveal information about your hearing, such as noise exposure history, hearing problems you were likely born with, and which part of your ear is likely causing the hearing issue. Your audiologist can identify the type and severity of hearing loss and recommend appropriate treatment options.
Speech Reception Threshold (SRT)
This is a test to find what is the softest level you can repeat a list of words 50% of the time. It has been found that this level matches the quietest sounds you can hear in the range of pitches used in everyday conversation. The purpose of this test is to cross-check results across different tests to make sure the results are reliable. The tester will present you a list of two syllables words you may hear (baseball, airplane, ice cream, cowboy, etc). The word will get softer and softer. You need to tell them what you heard. Even when you just barely hear it - guess!
Word Recognition (WR or Discrim.)
This test aims to evaluate your ability to accurately understand single-syllable words in an ideal situation, presented at a comfortable listening level determined by your hearing loss. Your performance is measured as a percentage of correct responses.
It is important to note that the words in this test are presented at a level above your hearing threshold, which may be above or significantly above the level of normal conversation. Consequently, a high score on this word recognition test does not necessarily translate to ease in understanding people in real-life situations, even in quiet environments.
The test score is expressed as a percentage of correct responses and should not be confused with the misnomer "percentages of hearing loss".
Speech in noise testing
Most of us don’t live in a sound booth. Many people first seek out hearing testing because they notice they are having more difficulty listening in noise. Speech in noise testing is a way to assess how you are able to understand in more complex listening situations and where the breakdowns occur. It is extremely helpful in both validating a patient's complaint and personalizing counseling and treatments. Using a recorded speech with varying levels of background noise present, you are asked to repeat back everyday sentences. Your responses will help the examiner counsel you as to the impact of your hearing loss and what communication strategies may be most useful. If you are a candidate for a hearing aid, it will help you select the best amplification technology level and accessories to help you in your daily life.
A sensitive microphone is placed in the ear canal and a seal is obtained. Various frequencies are softly played into the ear canal. The microphone will pick up sounds generated by outer hair cells in the cochlea as they are stimulated. If a response is obtained we know that there is a normal and active population of hair cells, and the middle ear can deliver the sound they produce. Having already ruled out middle ear problems, seeing reduced or absent emissions at particular frequencies suggests that there has been some damage to the outer hair cells in the cochlea. Depending on the degree, this may be reflected on the audiogram with elevated thresholds to that same frequency region. Sometimes, people who don’t have elevated hearing thresholds on the audiogram can still have reduced or absent emissions. This could be a sign of damage that has occurred to the hearing organ and a precursor to hearing loss.
Auditory Brainstem Response
This is a passive test using electrophysical measures to assess hearing. For this test, there is no need for any hand raising or physical response of any kind - in fact, you have to lie very still for it. This test is used if someone isn’t able to complete a typical hearing test (infants, developmentally delayed adults, etc.). It is also used to assess the integrity of the hearing nerve as sound leaves the cochlea and travels to the brain. How is it done? Electrodes are stuck to your head in 4 different places. The electrodes are connected to a computer and earphones/insert earphones are put on/in your ears. Different sounds at different levels are put into your ears and the computer measures the brain activity in response to these sounds.
How much does a hearing test cost, and will my insurance cover it?
Just like many other services, there is no set fee for a hearing test. Depending on your history, complaints and preliminary findings, your audiologist will select the appropriate assessments to use to diagnose your hearing loss. As a result, costs may vary greatly.
The Affordable Care Act’s preventive care focus has led many insurances to cover “routine” hearing tests without copays or coinsurance. This means as long as there is no medical reason to seek a hearing test, most insurances will cover it. However, if you have a known hearing loss or medical diagnosis, it may be subject to deductibles, coinsurance and copays.
For enrollees in Medicare, if there is a medical reason for it (you think you may have hearing loss, your hearing or tinnitus has worsened), Medicare covers it. If your test is for the purpose of getting a hearing aid, Medicare will not cover it. Some Medicare Advantage plans have additional benefits that may include hearing healthcare and hearing aids. These tend to be very restrictive in terms of how you can access that care.
What Type of Hearing Test Should I Choose? A Guide to Finding the Right Professional
The appropriate location depends on the purpose of the test:
Are you just curious about your hearing? If so, you can start with an online test or consult your physician.
Do you work in a noisy environment and are concerned that you are losing your hearing? If so, find an audiologist with a background in occupational hearing conservation to assess your hearing and recommend protection.
Do you have a history suggesting a more thorough diagnostic evaluation is warranted? For example, a history of hearing loss in your family, ear infections, or taking or having taken ototoxic medications may indicate the need for a comprehensive evaluation. In such cases, consult an audiologist.
Is your main goal to get a hearing aid? If so, you can visit either an audiologist or a hearing instrument specialist.
Are you experiencing difficulty hearing at school, work, or in particular settings? If so, seek out an audiologist who works with various hearing devices and can optimize your hearing for those environments.
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