One of the first steps in diagnosing hearing loss is undergoing specific hearing-related tests.
These tests are usually non-invasive, quick, and administered by an audiologist or other hearing professional.
Together, we’ll discuss the parts of the ear that help us hear sounds, what happens when those parts are damaged, and the audiology tests that your doctor or audiologist can perform to determine the degree of hearing loss a person may have.
How Does Hearing Work?
Three separate parts of your ear must work together for you to hear sound.
Outer Ear
The visible part of your ear, the pinna, and the ear canal make up your outer ear.
The outer ear collects sound waves and sends them to the middle ear.
Middle Ear
The middle ear comprises the eardrum and the three small bones of the ear, the malleus, incus, and stapes.
Sound waves that travel from the ear canal vibrate against the eardrum. The eardrum vibrates against the three tiny bones, sending sound waves to the inner ear.
Inner Ear
Your inner ear contains the cochlea, the semicircular canals, and the auditory nerve.
The vibrations of the three bones against the cochlea cause the fluid inside to move.
That movement causes tiny hair cells located inside the cochlea to interact with neurons.
This interaction changes the sound waves into electrical signals sent through the semicircular canals and delivers them to the auditory nerve.
The auditory nerve then sends the electrical signals to the brain, interpreting them into the sounds we hear.
What Types of Hearing Loss Exist?
Hearing loss occurs when one or some of the structures in the different parts of the ear become damaged or destroyed. There are two different types of hearing loss.
Conductive Hearing Loss
This type of hearing loss occurs when the structures in the outer or middle ear are damaged, resulting in a loss of hearing.
This can happen from accidents, trauma, or genetic abnormalities.
Conductive hearing loss can be permanent or temporary. A buildup of earwax in the ear canal, for instance, will cause a temporary hearing loss that is alleviated when the earwax is removed.
Recurrent ear infections may also cause conductive hearing loss.
Sensorineural Hearing Loss
You have sensorineural hearing loss when hearing loss occurs because of damage to the inner ear.
The tiny hair cells inside the cochlea do not regenerate, so when they are damaged or destroyed, no replacement cells are made, resulting in hearing problems and hearing loss.
Age-related hearing loss, called presbycusis, is a form of sensorineural hearing loss.
Hearing loss due to long-term exposure to noisy environments is also sensorineural hearing loss.
What Are the Signs of Hearing Loss?
Unlike sudden hearing loss, which can happen with an extremely loud noise, hearing loss that occurs gradually can make it hard to identify symptoms.
It may seem like your hearing hasn’t changed.
If you suspect you may have hearing loss, you can look for signs like:
- Asking others to repeat themselves or speak up
- Frequently turning up the volume on the radio or television
- Having trouble hearing conversation when background noise is present
- Feeling like others are mumbling or not speaking clearly
- Avoiding social situations where you think it might be difficult for you to hear
- Feeling depressed or isolated
You may have only one of these symptoms of hearing loss or several. It’s important to take these symptoms seriously and have your hearing screened.
Prevention is key to keeping your remaining hearing intact and preventing early-onset dementia, a risk factor for hearing loss.
Talking to your healthcare provider about your hearing health concerns is great for diagnosing hearing problems.
How Is Hearing Loss Diagnosed?
Your primary care physician may ask questions about your hearing to understand whether you need a referral to an audiologist.
When you meet with an audiologist, their goal will be to help determine what kind of hearing loss you have and your degree of hearing loss.
Here, we’ll discuss seven tests they may use to understand your hearing better.
1. Pure-Tone Audiometry
One of the first tests your audiologists will likely administer is a pure-tone test, also known as an air conduction test.
During this test, you’ll wear headphones and respond as different frequencies of sound play in each ear.
This test measures the functionality of the outer, middle, and inner ears and their ability to work together to produce the sounds you hear.
2. Bone Conduction Testing
The bone conduction test uses vibrations played directly into your inner ear to determine whether or not your hearing loss is conductive or sensorineural.
The vibrations play via a headset, and the test is non-invasive.
The ability to hear sounds better during this test usually indicates an outer or middle ear issue.
If your hearing is relatively the same during the pure-tone and bone conduction tests, your hearing loss may be sensorineural.
3. Rinne and Weber Test
Older tests that are still sometimes used are the Rinne and Weber tests. These tests use a tuning fork placed directly against the bones of the skull.
This test may be administered to determine the location of your hearing loss, although most providers will opt for bone conduction testing for this diagnosis.
4. Auditory Brainstem Response (ABR)
This test furthers your doctor’s ability to identify the source of your hearing loss.
This test measures the ability of your inner ear to send electrical signals to your brain via the auditory nerve.
Minimally invasive, the ABR test involves placing electrodes to the sides of your head using a temporary adhesive material.
The electrodes connect to a computer which measures the ability of the brain to receive electrical signals.
5. Otoacoustic Emissions Test (OAE)
This type of test involves the placement of small, rubber-tipped devices inside the ears.
Soft noises play in the ears, and a special part of the cochlea echoes back barely audible clicking sounds.
This test aims to measure the inner ear’s response to sound.
6. Tympanometry
A test that specifically measures the functionality of the middle ear is called a tympanometry test.
This test measures the health of your eardrum to determine if it is damaged, perforated, or otherwise compromised.
This test involves using a device placed inside the ear canal to measure eardrum vibrations.
7. Online Hearing Tests
Online hearing tests are not designed to diagnose hearing loss but can be a useful place to start if you have trouble hearing.
These tests usually ask that you listen to sounds through earphones and record whether or not you can hear them.
Taking an online hearing test may convince you that you should see a doctor for a hearing screening.
Understanding Your Audiogram
Hearing test results are usually delivered via audiogram.
These are reports that show your level or degree of hearing loss.
Sound is measured in decibels, and your audiogram will show you how many decibels of sound you can no longer hear and how loud sounds must be for you to hear them.
Degrees of Hearing Loss
The degree of your hearing loss is important because it can help you determine the best treatment options to help you hear better.
Normal hearing is usually considered the ability to hear sounds between -15 and 20 decibels.
- Mild hearing loss. A person has mild hearing loss if sounds must register between 26 to 40 decibels.
- Moderate hearing loss. A moderate hearing loss involves the loss of ability to hear sounds under 41 to 55 decibels.
- Moderate to severe hearing loss. The marker for moderate-severe hearing loss is 56-70 decibels, which means you’ll need sound to be this loud before you can hear them.
- Severe hearing loss. Severe hearing loss involves a significant amount of hearing loss. You won’t be able to hear sounds below 71-90 decibels without a hearing aid or cochlear implant.
- Profound hearing loss. Someone with profound hearing loss is usually considered deaf. Sounds under 91 decibels, including fire alarms and emergency sirens, cannot be heard.
Your degree of hearing loss may require different treatments, but most experts agree that it’s a good idea to consider a hearing aid once you have moderate hearing loss.
Healthy Hearing
Protecting your hearing is important, and you can make decisions that protect your hearing health by wearing earplugs or headphones when exposed to loud noises and getting regular, routine hearing tests.
For more information and to learn more about hearing loss, treatment options, and how to retain your hearing, check out the USA Rx Hearing Loss Blog.
You’ll find information about hearing tests, hearing devices, and other hearing-related issues here.
References, Studies and Sources:
What is an Audiogram? – Understanding Hearing Test Results | Babyhearing.org
Otoacoustic Emissions (OAE) Testing|Nationwide Childrens.org
Weber Test – StatPearls – NCBI Bookshelf
What is tympanometry?|Healthy Hearing.org
