Hearing tests must be done in order to determine whether you have a hearing loss, what type of hearing loss you have, if there are any underlying medical conditions, and how best to treat your hearing loss. Any combinations of these tests below may be completed by your audiologist or HIP. Generally, hearing tests are free, but check with the hearing clinic you are dealing with. Most tests are done by an audiologist or HIP, but some are done in ENT clinics by their technicians. The tests are painless. Most take place in a sound proof cubicle. The cubicles have changed over the years and have more “windows”, so if you suffer from claustrophobia, let the test person know, and the door can be left open. The results of the hearing tests are recorded on an audiogram. Ask for a copy to keep for your personal files.

Otoscopy Test:
An otoscope (a metal thing with a light – you’ve probably had this done at your doctor’s office ) is used to look into ears to check to see if ear canals are clear and whether there are any problems with the eardrum or the middle ear. If there is significant wax build up or drainage, you will be referred to your physician prior to completion of the hearing test.

Pure Tone Test:
It is also known as pure tone audiometry. It uses air conduction to measure your ability to hear sounds at various pitches (frequencies) and volumes (intensities). A series of sounds at different tones and frequencies is transmitted, separately in each ear. The patient indicates with a pre-arranged signal (ie. pushing a buzzer or raising their hand) whether they hear the sound. The purpose is to measure the softest possible sound that you hear at each frequency that is important for speech understanding ability and then compare your results, to normal hearing levels at each of those frequencies.

Pure Tone Screener:
This is the most basic form of testing your ability to hear and is often referred to as a hearing screener. It is a quick and easy way to accurately know if you are experiencing hearing loss. Hearing screenings are generally pass-or-fail tests that determine if further testing is necessary. If the screening is passed, no further testing is necessary. If the screening is failed, then further hearing tests are done by the audiologist or HIP.

Bone conduction test:
This measures your inner ear’s response to sound. A bone conductor will be placed on the bone behind your ear (mastoid bone). It sends tiny vibrations through the bone directly to the inner ear. It is also a type of pure tone test, so you will once again hear a series of sounds of different frequencies and intensities, that you will need to respond to. The results of this test allows your audiologist or HIP to use this information to determine your type of hearing loss and whether further medical management is needed (eg. Referral to an ENT Specialist).

Speech testing (quiet):
This test determines how well you can hear speech at different intensity levels. It may be done with and without background noise. A speech reception threshold test measures the faintest speech, that can be heard half the time. You will be asked to repeat words made up of two syllables (eg. “rainbow”). The words will get softer and softer and the softest level that speech can be heard 50% of the time, is called your speech reception thresholds (SRT).

Speech discrimination (SD)
This test measures your ability to hear the last word of a sentence at a comfortable listening level, in quiet. Twenty-five sentences are used, resulting in a percentage score out of 100, in each ear. This information helps your audiologist or HIP determine how much improvement to expect with the help of hearing aids.

Speech testing (noise):
These tests are used to measure your ability to separate speech from background noise, which is the area that most hard of hearing individuals struggle with. There are numerous types of tests, such as HINT (Hearing in Noise Test), Quick-SIN (Quick Speech in Noise test) & LiSN-S (Listening in Spatialized Noise – Sentence test). Your audiologist or HIP will determine which test is best suited to your needs. You will be asked to repeat words and/or sentences in the presence of various types of background noise. The results will allow your hearing healthcare provider to recommend certain features within the hearing aids technology, that may benefit you in challenging listening situations.

Tympanometry test:
This test uses a bit of air to determine if you have fluid in the middle ear, a perforated eardrum, a tumour or excessive wax buildup. This determines how the middle ear is functioning and is especially important if you have a history of ear infections. During this test, you will experience a buildup of pressure in your ear and your audiologist or HIP will ask you not to swallow or talk while the test is being conducted. This test should not be painful, so let your hearing healthcare professional know if you are experiencing any discomfort.

Acoustic reflex test:
This test checks the function of a tiny muscle in the ear that reacts to sound and gives information of how your ears are functioning. This test measures involuntary muscle contractions of the middle ear and is used to determine the location of your hearing problem (the ossicles, cochlea, auditory nerve, etc.), as well as the type of hearing loss. You will hear a series of tones that will slowly increase in intensity, until the reflex is measured. Some of the tones can be very high pitch and loud.

Real Ear Measurement:
This test is not part of the Diagnostic Test Battery but is completed during the hearing aid fitting appointment. A small microphone is placed in the ear canal, while the patient is wearing their hearing aids and determines whether suitable amplification is provided for the patient’s specific hearing loss, in each ear. A frequency weighted sentence is repeated at different levels (soft, medium and loud), the results of which are measured against a prescribed target, determined by your audiologist or HIP. If targets are not approximated, your hearing healthcare professional will make adjustments to the hearing aid settings accordingly. This is a very important part of hearing aid fitting, since it ensures that the hearing aids are set up correctly. It is a test that is compulsory in the fitting of hearing aids in British Columbia, according to the College of Speech and Hearing Healthcare Professionals of BC.

Auditory Brainstem Response (ABR):
This type of testing is used to determine whether a specific type of hearing loss – sensorineural-exists. It is also frequently used to screen newborns for hearing problems. In an ABR test, electrodes are attached to your head, scalp or earlobes, and you are given headphones to wear. Your brainwave activity is measured in response to sounds of varying intensities.

Otoacoustic Emissions (OAEs)
OAEs are sounds generated by the vibrations of the hair cells in the cochlea of your inner ear. This type of testing uses a tiny probe fitted with a microphone and speaker to stimulate the cochlea and measure its response. Individuals with normal hearing will produce emissions; when hearing loss exceeds 25-30 decibels, no sound will be produced. This test helps determine whether there is a blockage in the ear canal, excess fluid in the middle ear or damage to the hair cells of the cochlea. OAE testing is often included in newborn hearing screening programs.


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