A thorough hearing test consists of 5 key parts:
1. The first step in the testing process is an otoscopic examination. During the otoscopic examination, your audiologist will look in your ear with an otoscope – which is an instrument with a bright light and a magnifying glass. The otoscopic examination will show whether or not the ear canals are free of earwax and whether or not the eardrum is intact. This is an examination of the external portion of the ear.
2. Next, a tympanogram will be performed. A tympanometer will be used to check the pressure in your ear as well as the movement of your eardrum. The otoscopic examination, together with tympanometry, can determine whether or not a medical referral is necessary.
3. Once the physical health of your external ear has been established, it’s time for the hearing test. You will be seated in a sound-treated environment, and headphones will be placed over your ears. You will respond each time you hear a tone, even when the tones become extremely soft. Your audiologist will record the very softest sounds you can hear on an audiogram. The softest sounds you can hear are referred to as hearing threshold levels.
4. Next, a device that measures hearing via bone conduction will be placed behind your ear, and you will once again respond each time you hear a tone. Testing through headphones measures what you hear when sound travels through the ear canal and vibrates the eardrum. Testing through bone conduction sends vibrations through the skull and stimulates the nerve in your inner ear, thus bypassing the external portion of the ear. If you hear better through bone conduction than through air conduction, you have what is called conductive hearing loss, which simply means something is physically blocking the sound from getting through. Conductive hearing losses can often be treated medically. If you hear equally well through bone conduction and air conduction and your responses indicate that you have hearing loss, you have sensorineural hearing loss, which means the nerve in your inner ear isn’t as sensitive as it should be. Sensorineural hearing loss is generally treated with hearing aids.
5. Finally – once hearing threshold levels are clearly established – you will be asked to repeat back a list of words. A score will be recorded that indicates how many words you were able to repeat correctly. The score is called a speech discrimination score and will give your audiologist an idea of how well you will do with hearing aids. Some people have a type of sensorineural hearing loss that causes poor speech understanding even if sound is made loud enough to hear well. People with low speech discrimination scores may struggle more with hearing aid use.