Types of Hearing Tests

Pure-tone Testing

Pure-tone testing is one of the most common hearing evaluations. During this test, you’ll wear earphones that deliver sounds directly to each ear. These sounds are pure tones, which are simple sounds that occur at specific frequencies (pitches) and volumes. The test typically covers a range of frequencies from low (250 Hz) to high (8000 Hz)—it’s like starting by listening to a low-pitch tone from a tuba and then listening to a high-pitch tone from a flute. The tested frequencies cover the sounds needed for understanding speech.

As the audiologist plays the tones, they’ll ask you to respond whenever you hear a sound by raising your hand, pressing a button, making some other movement, or just saying “yes.” The audiologist records your responses on an audiogram, a graph that displays the softest sounds you can hear at each frequency. This visual representation helps to diagnose a hearing loss and its severity.

Sound-Field Testing

In some cases, such as with young children or people who can’t tolerate earphones, audiologists use sound-field testing. They play sounds through speakers in a sound-treated room. Although this method assesses hearing ability, it doesn’t provide ear-specific information because both ears receive the sound at the same time.

Testing Your Ability to Hear Speech

Speech testing assesses how well you can hear and understand spoken words. You’ll listen to words or sentences at different volumes and repeat them back or point to pictures. This test helps the audiologist evaluate your ability to comprehend speech, especially in noisy environments. Audiologists often use it alongside pure-tone testing to provide an overall view of your hearing abilities.

Bone-Conduction Testing

When it’s possible that something is blocking the **outer or middle ear - **such as earwax or fluid - an audiologist will perform a hearing test using bone conduction. Bone-conduction testing is similar to pure-tone testing - but instead of using earphones, you wear a headband that rests behind one of your ears.

A small device called a bone oscillator is placed behind your ear or on your forehead. This device sends vibrations directly to the inner ear (cochlea), bypassing the outer and middle ear. By comparing results from air conduction tests (i.e., tones presented through earphones or a loudspeaker) and bone conduction tests, audiologists can determine the type of hearing loss you are experiencing:

• conductive hearing loss — problems in the outer or middle ear
• sensorineural hearing loss — problems in the inner ear or auditory nerve
• mixed hearing loss — a combination of both

Tests of the Middle Ear

Your ear is made up of three parts—the outer, the middle, and the inner ear. Middle ear tests examine how well your eardrum and middle ear structures function. This kind of testing is especially important for children. Young children are more likely to have hearing loss due to middle ear problems—like ear infections. Problems in the middle ear make it hard for sounds to go from your outer ear to your inner ear and brain. Tests of the middle ear include tympanometry, acoustic reflex test, and static acoustic impedance test:

Tympanometry

Tympanometry is a quick and easy way to see how well your eardrum is working. During the test, an audiologist will gently place a small probe—kind of like an earbud—into your ear. This probe changes the air pressure inside your ear just a little, and a machine records how your eardrum responds. You’ll see a graph pop up on the screen, called a tympanogram, but all you have to do is sit still and let the machine do the work.

The shape of the graph shows the audiologist whether your eardrum is moving the way it should. For example, it can show if the eardrum is too stiff, is too floppy, has a hole in it, or has fluid behind it—like what happens during an ear infection. This test is especially helpful for figuring out if children are dealing with middle ear problems.

Acoustic Reflex Test

Your ears have a built-in reflex when you hear a loud sound. It’s called an acoustic reflex and involves a tiny muscle in your middle ear that tightens up automatically. You don’t feel it happening, but it helps your ears protect themselves from loud noise.

The acoustic reflex test uses the same kind of probe as tympanometry. The audiologist plays sounds through the probe, and the equipment measures how your ear reacts. If your ears respond to the sound, that’s a good sign. If they don’t—or if the sound must be very loud before your ears respond—it could mean there’s hearing loss.

Static Acoustic Impedance Test

The static acoustic impedance test checks how much air is in your ear canal. That might sound strange, but it’s actually helpful in spotting problems like holes in the eardrum or fluid behind it. If you have ear tubes to treat infections or hearing problems, this test can also tell if the tubes are still open or if they’re blocked.

Like the other tests, it’s quick, painless, and done using a small probe in the ear. It gives audiologists valuable information while you sit back and relax.

Otoacoustic Emission (OAE) Test

The otoacoustic emissions test checks the function of the inner ear—or cochlea. An audiologist places a small probe in the ear canal; that probe makes sounds. The hair cells that line the inner ear respond to these sounds by vibrating. The vibration produces a very quiet sound—called an otoacoustic emission (OAE)—that echoes back into the middle ear.

If the cochlea is functioning properly, it will produce these echoes. If these echoes do not occur, it may indicate a hearing loss greater than 25–30 decibels (dB)—a mild hearing loss or greater. The severity of a hearing loss is measured in decibels.

This test can also show if you have a blockage in your outer or middle ear. If you do, sounds won’t be able to get through to the inner ear. In turn, nothing will echo back.

Auditory Brainstem Response (ABR) Test

The auditory brainstem response test measures how the auditory nerve and brain pathways respond to sound. The audiologist places electrodes on your head and ears; these electrodes detect electrical nerve activity in response to sounds you hear through headphones. This test is useful for infants or people who cannot participate in standard hearing tests. It can help diagnose neurological issues affecting hearing.

Newborn hearing screening programs use auditory brainstem response tests as a screening tool. A screening is a test that you either pass or fail. When the ABR is used for screening, only one loudness level is checked. The baby passes if the screening shows that they hear the sound. If the baby fails the screening, more specific testing will be done.

Testing for Hearing Loss in Young Children

In some hearing tests, audiologists use specialized techniques that can help ensure accurate results when testing young children as well as other individuals:

• Visual reinforcement audiometry (VRA) can be used with different ages and is ideal for children ages 6 months to 2 years. The child practices looking toward a sound source, and when they do, they’re rewarded with a visual stimulus—like a flashing light or an animated toy.
• Conditioned play audiometry (CPA) is suitable for toddlers and preschoolers ages 2–5 years. The audiologist teaches the child to perform a simple task, such as placing a block in a box, each time they hear a sound.

These playful methods make the testing process engaging and effective for young children. They may also be helpful when testing other age groups.

Importance of Regular Hearing Tests

Seeing an audiologist for regular hearing testing helps to identify hearing problems early. Early identification leads to timely intervention. Children should have their hearing screened at key developmental stages, and adults should have periodic screenings—especially if they notice changes in hearing or have risk factors for hearing loss. especially if they notice changes in hearing or have risk factors for hearing loss.

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