Hearing Evaluations and Testing

Audiologists are the professionals trained to identify, treat, and prevent hearing loss.

Their role is both a clinical and a counseling one. Holding a doctoral degree (required for new audiologists since 2007) or a Master’s degree, they are well qualified to diagnose the severity and type of hearing loss and to determine whether medical evaluation is necessary.

A comprehensive hearing evaluation typically includes:

  • A review of personal and family hearing history
  • A review of medical history and medications that may affect hearing
  • An ear exam to rule out earwax, infection, and other ear canal or eardrum abnormalities (sometimes earwax may be removed)
  • Pure tone thresholds—measurement of the softest level each ear can hear tones of various pitches, first with earphones and then with a device placed on the bony area behind your ear
  • Speech recognition thresholds—measurement of the softest level each ear can understand speech (usually easy two-syllable words)
  • Word recognition scores—measurement of the percentage of special one-syllable words each ear can understand when the volume is just right.

Sometimes the evaluation may include other painless procedures. These are the most common:

  • Most comfortable and uncomfortable listening levels—often done as a quick measure of whether the inner ears have an abnormal response to increases in loudness
  • Tympanograms—measurement of how well the eardrums move, to determine the health status of the eardrum and middle ear space
  • Acoustic reflex thresholds—determination of whether a protective reflex can be triggered by brief sounds at expected levels
  • Reflex decay—a ten second measurement of the acoustic reflex to see if the muscle contraction it causes can be sustained over time
  • Speech-in-noise testing—often done by having you repeat sentences as background voices get louder

At the conclusion of the evaluation, the results will be reviewed with you, and recommendations will be made.

Medical and/or Surgical Treatment

Audiologists will recommend medical evaluation as necessary, but as a rule, a physician right away if you have:

  • Pain or discomfort in one or both ears
  • Active drainage from one or both ears
  • Sudden or ongoing dizziness
  • Sudden hearing loss in both, or especially in only one ear (you may have a rare kind of sensorineural hearing loss that might be helped with medication if started soon enough).

If medical evaluation is recommended, your primary care physician is usually a good place to start. He or she may be able to remove earwax, treat common disorders like ear infections, and determine whether referral to an ear specialist is necessary. An ear specialist (otologist or otolaryngologist) is primarily a surgeon and can determine whether surgery is necessary. The specialist can also evaluate and treat more unusual ear disorders and remove deeply impacted earwax.

Hearing Aids:

If medical or surgical treatment won’t help in your case, or doesn’t help enough, the odds are that hearing aids will help. Ninety to ninety-five percent of sensorineural hearing loss can be helped with hearing aids, at least to some degree. About eighty percent of hearing aid users wear hearing aids in both ears. People often put off getting hearing aids, but once they have been successfully fit with hearing aids, they don’t want to be without them. Successful fitting requires careful selection, precise programming, counseling and follow-up fine-tuning as the brain adjusts to hearing well again. Please see our hearing aids page for a thorough discussion of this topic. You may also want to see the frequently asked questions section.


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