Audiometry

Hearing tests are used to assess your ability to hear different sounds and to determine if there are any problems.

Why are hearing tests needed?

Hearing tests are carried out for two main reasons:

• as a routine part of a baby’s or young child’s developmental checks
• to check the hearing of someone who is experiencing hearing problems or has hearing loss

It's important hearing tests are carried out so the right support and treatment can be provided.

Hearing tests are carried out at regular intervals during childhood, starting with the Newborn Hearing Screening Programme (NHSP) within a few weeks of birth.

Your child's hearing may also be checked during a general health review when they are a few years old and before they start school for the first time.

If you're worried about any hearing problems, you can ask your GP for a hearing test.

Hearing tests are carried out regularly during childhood to identify any problems as soon as possible. Adults can also ask their GP for a hearing test.

In the past, many children born with hearing loss were not diagnosed until they were 18 months or older. But identifying hearing loss late can have a negative impact on a child's language development, social skills and self-confidence.

If hearing problems are diagnosed early, appropriate support can be provided for the child and their family.

It's also important to identify hearing loss in adults early, as treatment is more likely to be effective the earlier problems are diagnosed.

Newborn hearing screening

All newborn babies are offered a hearing test as part of the Newborn Hearing Screening Programme (NHSP).

This test is carried out in the first few weeks following birth. It will either take place in the hospital maternity unit or in your home.

Read more about the newborn hearing test.

Sometimes, premature babies pass this test but are still felt to be in a high-risk group for hearing loss. In these cases another hearing test is recommended for when they are between six and eight months old.

Later childhood tests

There will also be further opportunities to check your child’s hearing as they get older. For example:

• a child may have their hearing checked as part of their general review when they are about two-and-a-half years old
• all children have a hearing test when they are between four and five years old before they start school 
• your GP can arrange for your child to have a hearing test at any age if you feel that their hearing is not right (see below)

The age at which routine tests or assessments are carried out may vary between different areas. Your GP or health visitor should be able to advise you.

Reporting problems to your GP

If you think your child may have a hearing problem, take them to see your GP as soon as possible. Hearing tests can be used at any time to help diagnose or rule out other health conditions. In some cases, hearing loss may be the cause of delayed speech and language development.

Many children who experience hearing problems turn out to have a common and temporary condition called glue ear, in which mucus blocks the ear.

Less commonly, other explanations for a child apparently having hearing difficulties include behavioural problems such as attention deficit hyperactivity disorder (ADHD).

Adult hearing tests

Adults can also request a hearing test from their GP if they are concerned about their hearing.

Hearing loss in old age is a common and usually gradual process. It often begins with difficulty hearing other people clearly, particularly when there is a lot of background noise. At first you may not realise you have a hearing impairment and other members of your family may be the first ones to notice.

However, there are other reasons why adults might lose their hearing, such as ear infections, ear disease or prolonged exposure to excessive noise.

You should visit your GP if you experience hearing loss in one or both ears, or if you have:

• tinnitus – ringing or buzzing in your ears
• vertigo – dizziness or loss of balance
• severe ear pain that lasts for more than 24 hours
• discharge – fluid or blood coming out of the ear

You may also need to have a hearing test if you have a head injury, because it could damage your inner ear or your hearing bones.

Older people with permanent hearing loss may benefit from having a hearing aid. If you have a hearing aid fitted, you will receive advice and support from your local audiology department, including advice about changing the battery, repairs and upgrades.

You are more likely to benefit from a hearing aid if your hearing loss is diagnosed early. Ask your GP to arrange a test if you are at all concerned about your hearing.

What happens during a hearing test?

Although your GP or practice nurse can examine your ears, you will usually be referred to a specialist for a hearing test.

A number of different tests are used to check how well the ears are functioning and their ability to detect different levels of sound.

Common hearing tests include:

• automated otoacoustic emissions (AOAE) tests – a computer attached to an earpiece plays clicking noises and measures the response from the ear
• automated auditory brainstem response (AABR) tests – sensors are placed on the head and neck to check the response of the nerves to sound played through headphones
• pure tone audiometry tests – sounds of different volumes and frequencies are played, usually through headphones, and a button is pressed when they are heard
• bone conduction tests – a vibrating noise generator sensor is placed behind the ear and presses on the bone to test how well the hearing nerve is working

Generally, different tests are used for adults and children but they are all completely painless.

The results of some of these tests are recorded on a graph called an audiogram, so that the type of hearing loss can be identified.

• A hearing test is usually carried out after your ears have been examined and you have been referred to a specialist.

  Examination

  Your GP or practice nurse will first ask about any symptoms you may be experiencing, such as:

  • pain or discharge (fluid)
  • tinnitus – noise in one or both ears
  • vertigo (dizziness)
  • hearing loss
  • previous, relevant medical problems

  Your ear will be examined using an instrument called an auriscope (otoscope). An auriscope is a small hand-held torch with a magnifying glass which allows the doctor to see the eardrum and the passageway that leads to it from the outer ear. It can be used to look for:

  • discharge – fluid coming out of the ear
  • a bulging eardrum – indicating that there is infected fluid in the middle ear
  • a dull eardrum – indicating uninfected fluid in the middle ear (glue ear)
  • a retracted eardrum – indicating the Eustachian tube is not working properly
  • perforated eardrum – a hole in the eardrum, with or without signs of infection
  • ear wax or foreign bodies that might be blocking the ear

  Your GP may also carry out simple tests using their voice to help determine the extent of your hearing loss. If there are any concerns, you or your child may be referred to an ear, nose and throat (ENT) specialist for further tests.

  Hearing tests in children

  A range of different techniques are used to detect hearing problems. Some hearing tests are mainly used for children, including:

  • automated otoacoustic emissions (AOAE) tests – a computer attached to a small earpiece plays quiet clicking noises and measures the response from your child's ear
  • automated auditory brainstem response (AABR) tests – sensors are placed on your child's head and neck to check the response of their nerves to sound played through headphones
  • play audiometry tests – sounds of different volumes and frequencies are played to your child and they carry out a simple task when they hear them

  Read more about how hearing tests for children are carried out.

  However, some tests, such as pure tone audiometry, speech perception and tympanometry (see below) can be used to test adults and well as children.

  Hearing tests in adults

  There are a number of different ways to test adult hearing. Some of these are briefly described below.

  Pure tone audiometry

  Pure tone audiometry (PTA) tests the hearing of both ears. During PTA, a machine called an audiometer is used to produce sounds at various volumes and frequencies (pitches). You listen to the sounds through headphones and respond when you hear them by pressing a button.

  Speech perception

  The speech perception test, also sometimes known as a speech discrimination test or speech audiometry, involves testing your ability to hear words without using any visual information. The words may be played through headphones or a speaker, or spoken by the tester.

  Sometimes, you are asked to listen to words while there is a controlled level of background noise.

  Tympanometry

  The eardrum should allow as much sound as possible to pass into the middle ear. If sound is reflected back from the eardrum, hearing will be impaired.

  During tympanometry, a small plastic bung seals your ear and the machine gently changes the pressure in your ear canal. The test can be used to confirm whether there is any fluid behind the eardrum and can indicate if the Eustachian tube is working normally.

  Tympanometry measures the movement of the eardrum and the pressure behind the eardrum.

  Whispered voice test

  The whispered voice test is a very simple hearing test. It involves the tester blocking one of your ears and testing your hearing by whispering words at varying volumes. You will be asked to repeat the words out loud as you hear them.

  Tuning fork test

  A tuning fork produces sound waves at a fixed pitch when it is gently tapped and can be used to test different aspects of your hearing.

  The tester will tap the tuning fork on their elbow or knee to make it vibrate, before holding it at different places around your head.

  This test can help determine if you have conductive hearing loss, which is hearing loss caused by sounds not being able to pass freely into the inner ear, or sensori-neural hearing loss where the inner ear or hearing nerve is not working properly.

  Bone conduction test

  A bone conduction test is often carried out as part of a routine pure tone audiometry (PTA) test in adults.

  Bone conduction involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.

  Bone conduction is a more sophisticated version of the tuning fork test, and when used together with PTA, it can help determine whether hearing loss comes from the outer and middle ear, the inner ear, or both.

  Bone conduction measures how well your inner ear and hearing nerves are working. The vibrations from the tuning fork go straight to the hearing nerve and bypass any problems in the ear canal, eardrum or hearing bones.

  Hearing test results

  The results of some hearing tests are plotted on a graph called an audiogram.

  An audiogram is used to record the measurements of different volumes and frequencies (pitches) of sounds you are able to hear.

  As well as showing a comparison between your ears, an audiogram can also help to determine what type of hearing loss you have, if any.

  The type of hearing loss you have is important because it determines what help or treatment is most suitable for you.

Hearing problems

The ear is made up of three main areas:

• the outer ear – sound enters the outer ear and passes down the ear canal to the eardrum (a thin membrane), which vibrates
• the middle ear – this air-filled cavity contains three tiny bones that pick up and carry the vibrations from the eardrum to the inner ear
• the inner ear – this contains the vestibular system (the balance organ) and the cochlea (the hearing organ), which is a coiled fluid-filled tube that turns the vibrations into electrical signals that are fed along the auditory nerve to the brain

A problem in any of these areas will require a hearing test to determine the type of hearing loss you have.

Conductive hearing loss

Your hearing may be affected if sounds don't reach the inner ear efficiently. This is known as conductive hearing loss. Conductive hearing loss can be caused by problems such as:

• a blockage in your ear canal, such as a build-up of earwax
• a blockage in the middle ear – for example, glue ear
• an infection of your outer ear (otitis externa) or middle ear (otitis media)
• a hole or tear in the eardrum (perforated eardrum)
• otosclerosis, which is an abnormal growth of bone in the middle ear
• disruption of your hearing bones caused by injury or disease

Conductive hearing loss caused by these problems is often temporary and reversible.

Sensori-neural hearing loss

If sounds reach the inner ear but are still not heard, the fault lies in the inner ear or (rarely) in the hearing nerve. This is called sensori-neural hearing loss.

Sensori-neural hearing loss may occur for a number of reasons, most commonly as a result of age-related change. This sort of hearing loss is nearly always permanent.