Adult Hearing Tests

An in-depth audiology evaluation uses a series of different tests to measure different aspects of your hearing. After our audiologist takes a case history, reviews your medical history and hearing health history, and completes otoscopy you may be given any of the following tests.

The Difference Between a Test with an Audiologist and a Test at a Hearing Test Store

Pure Tone Audiometry

Pure tone audiometry is a behavioral test used to determine hearing sensitivity. During testing, you will be seated in a sound-treated room, and will be wearing either foam inserts or headphones. You will be asked to press a button each time you hear a sound. The quietest sounds that you hear, called a threshold, will be graphed on an audiogram. The audiogram displays the results of your hearing test showing the type, degree, and configuration of hearing loss present.

If hearing loss is identified, it is imperative to understand the type of hearing loss present in order to determine if the loss can be surgically or medically treated. Hearing loss is defined as one of three types: conductive, sensorineural, or mixed. A conductive hearing loss involves the outer or middle ear. A sensorineural hearing loss involves the inner ear. A mixed hearing loss is a combination of a conductive hearing loss and sensorineural hearing loss. Conductive and mixed hearing losses may be surgically or medically treatable. Sensorineural hearing loss is most likely permanent.

Determining the type of hearing loss involves use of a bone oscillator, which sends vibrations into the inner ear, bypassing the outer ear and middle ear. Conductive hearing loss is identified when the patient hears better by bone conduction than air conduction. Sensorineural hearing loss is identified when bone conduction thresholds are equal to the air conduction thresholds. A mixed hearing loss occurs when there are both conductive and sensorineural components present.

Speech Audiometry

Speech audiometry is a measurement of your ability to hear and understand speech. Speech audiometry consists of two different types of speech tests, a speech reception threshold and word recognition testing. Speech audiometry is performed using foam inserts or headphones.

The softest level at which you are able to repeat the correct word 50% of the time, called the speech reception threshold, is recorded for each ear. The speech reception threshold is the lowest volume at which you are able to hear and recognize speech.

Word recognition testing measures your ability to understand and distinguish spoken words, measuring optimum performance in a controlled and standardized condition, with no visual or contextual cues. Word recognition testing provides information to determine if the results are consistent with the pure tone findings, identifies an unusual asymmetry that would not be predicted from the pure tone results, allows performance to be monitored over time through sequential testing, and assists in making amplification recommendations.


Tympanometry is an objective test of middle ear function. It is one of several tests that provide information regarding the status of the middle ear system.

While you are seated, a small probe-type tip is placed at the opening of the ear canal, creating a seal. You may hear a humming sound and feel a change in pressure in your ear. The results of the tympanogram provide information on the compliance of the middle ear system, ear canal volume, and middle ear pressure.

Acoustic Reflex Testing

Acoustic reflex testing is an objective test used to measure an involuntary reflexive response that occurs in the middle ear in response to a high intensity sound. This test is most commonly completed simultaneously with the tympanogram.

You will be asked to sit quietly while loud sounds of different pitches are sent into the ear canal. The level at which a reflex occurs is called the acoustic reflex threshold. This level will be recorded for each of the different pitches.

The results of the acoustic reflex test provide additional information about one’s hearing. The results are useful in determining consistency of hearing test results, especially if the reliability of other responses are questionable. The results also give insight into patients with central nervous system dysfunction.

Otoacoustic Emissions

Otoacoustic emissions testing is an objective test used to provide information related to the function of the outer hair cells of the inner ear. The two types of otoacoustic emissions (OAE) used clinically are Distortion Product otoacoustic emissions (DPOAE) and Transient-Evoked otoacoustic emissions (TEOAE).

During OAE testing, you will be asked to sit quietly and keep still. A series of sounds will be presented through a small probe that fits in your ear canal. The probe contains a tiny speaker that generates the sounds, and a microphone, that measures an echo produced by the inner ear in response to these sounds.

Otoacoustic emissions, in combination with tympanometry, provide information about cochlear function, including early detection of inner ear abnormalities. Otoacoustic emission testing is often used in testing for cochlear hearing loss, in patients with tinnitus, in monitoring for possible ototoxicity, and in difficult to test patients, such as persons who are unable or unwilling to volunteer reliable behavioral responses.

Speech in Noise Testing

Speech-in-noise tests consist of recorded sentences that measure sentence recognition in background noise. Speech-in-noise testing is often completed in a communication needs assessment and in a cochlear implant candidacy evaluation.

During the speech-in-noise test, you will be seated in a sound-treated room. Testing will take place either with you facing a speaker or with foam inserts or headphones. You will be asked to repeat sentences that you hear. The results of the test help quantify how much distortional loss there may be, assist in hearing aid selection decisions, and provide insight into what may be the most appropriate amplification strategy. The results also provide more accuracy in providing realistic expectations with amplification.