Audiometry: A Complete Guide to Hearing Tests

Audiometry is a painless, non-invasive way to measure your hearing ability. These tests can determine if you have hearing loss, how severe it is, and which frequencies are affected. Hearing loss occurs when you struggle to hear sounds clearly—often in specific pitch ranges—and can be caused by aging, noise exposure, infections, injury, or certain illnesses.

Many people don’t notice gradual hearing loss until it significantly impacts daily life, leading to communication difficulties, social isolation, or frustration. Audiometry is the crucial first step in identifying the cause and exploring the best treatment options, from hearing aids to medical interventions.

In this comprehensive guide, we’ll cover the different types of audiometry tests, how they’re performed, result interpretation, preparation tips, and even the option of at-home testing.

What Is Audiometry and Why Does It Matter?

Audiometry involves a series of specialized tests performed by an audiologist or ENT specialist to assess hearing levels, identify the type and degree of loss, and evaluate nerve function.

Key goals:

• Early detection of hearing issues

• Determining type and severity of loss

• Checking middle ear and auditory nerve performance

• Monitoring treatment or hearing aid effectiveness

• Screening newborns, children, and adults

Types of Audiometry Tests

Pure Tone Audiometry

In this test, the patient sits in a soundproof booth and listens to tones of varying frequency and intensity through headphones. They respond by pressing a button or raising a hand whenever they hear a sound.

Application: Precise diagnosis of hearing levels in each ear separately.

Result: Hearing thresholds across different frequencies (typically 250 to 8,000 Hz).

Speech Audiometry

Words or sentences are played through headphones, and the patient repeats them. This test evaluates speech understanding at different volume levels.

Application: Assessing the ability to comprehend speech in quiet or noisy environments.

Tympanometry

This test examines the function of the eardrum and middle ear. A device called a tympanometer changes air pressure in the ear canal and measures the eardrum’s response.

Application: Detecting issues like middle ear infections, fluid buildup behind the eardrum, or eardrum perforation.

Acoustic Reflex Testing

This measures the middle ear muscle’s (stapedius) response to loud sounds.

Application: Evaluating neural pathways between the ear and brainstem.

ABR (Auditory Brainstem Response)

A non-invasive test that records neural responses to sound. Electrodes are placed on the head and ears to capture brainwaves in response to clicks or tones.

Application: Diagnosing hearing loss in infants, assessing auditory nerve function, and identifying tumors or brainstem lesions.

Factors Affecting the Cost of Hearing Tests

The cost of audiometry may vary depending on the following conditions:

Type of Test Performed

Audiometry includes several types of tests that may be performed individually or in combination. Some of these tests include:

1. Pure Tone Audiometry: The most common type of test, for examining hearing thresholds at different frequencies.
2. Speech Audiometry: For evaluating speech comprehension.
3. Tympanometry: Examining the condition of the middle ear and eardrum.
4. Acoustic Reflex: Assessing auditory nerve and middle ear function.
5. Specialized tests like ABR or OAE (mostly used in infants or neurological examinations).

Each of these tests has its own separate fee, and depending on the doctor’s diagnosis, one or more may be required.

Steps for Performing Audiometry Test at Dr. Saeedi Clinic

Familiarizing yourself with the process of audiometry can help reduce patient anxiety and improve the accuracy of results. In this section, we’ll explore the various stages of the test, from initial preparations to how it’s conducted in the clinic.

Preparation Before the Test

Although audiometry typically doesn’t require special preparation, following a few simple tips can significantly impact the precision of the results:

• Avoid exposure to loud noises: It’s best to steer clear of noisy environments, such as concerts, workshops, or industrial settings, for 24 hours before your appointment. Being around intense sounds could temporarily affect your actual hearing performance.
• Inform the doctor if you have an infection or cold: Inflammation in the middle ear or temporary blockage in the ear canal might influence the test results.
• Disclose any medications you’re taking: Some drugs may affect the auditory system, so the doctor needs to be aware of this.
• Keep your ears clean: Excessive earwax (cerumen) can block sound waves. If necessary, the doctor will examine and clean your ears before starting the test.

How the Test Is Performed in the Clinic

Upon arriving at the audiology clinic, the audiologist will explain the test steps to you. The general process is as follows:

1. Initial ear examination: The audiologist first uses an otoscope to check the condition of the ear canal and eardrum to ensure there are no infections or blockages.
2. Entering the soundproof booth: To eliminate any environmental noise, the test is conducted in an isolated, sound-insulated booth. You’ll sit in a comfortable chair, and special headphones will be placed over your ears.
3. Performing the pure tone test: Sounds of varying frequencies and intensities are played through the headphones. Your task is to respond by pressing a button or signaling whenever you hear a sound.
4. Speech test (if needed): In this part, words or sentences are played through the headphones, and you must repeat them to assess speech comprehension.
5. Supplementary tests: Depending on the need, tests like tympanometry or acoustic reflex may also be performed to evaluate the middle ear condition and auditory nerve function.
6. Analysis and presentation of results: At the end, a chart called an “audiogram” is prepared, which shows your hearing status across different frequencies. The audiologist or ENT specialist will interpret the test results for you.

How Are Audiometry Test Results Interpreted?

One of the most important parts of the audiometry process is the correct interpretation of its results. These results help the doctor or audiologist accurately diagnose the type and severity of hearing loss and, if necessary, proceed with treatment or the use of hearing aids.

The test results are presented as a chart called an audiogram, which displays the individual’s hearing levels across various frequencies and intensities. Below, we’ll learn how to read this chart and about the types of hearing loss.

Normal Hearing Ranges

In the audiogram chart, the horizontal axis represents sound frequency (from low to high pitches, typically 250 to 8,000 Hz), and the vertical axis represents sound intensity in decibels (dB). The lower the markers on the chart, the greater the intensity needed to hear the sound, indicating more hearing loss.

Common hearing ranges are classified as follows:

• Normal hearing: 0 to 25 decibels
• Mild hearing loss: 26 to 40 decibels
• Moderate hearing loss: 41 to 55 decibels
• Moderate to severe hearing loss: 56 to 70 decibels
• Severe hearing loss: 71 to 90 decibels
• Profound hearing loss: Above 90 decibels

Types of Hearing Loss in Audiometry Results

By examining the patterns in the audiogram, the type of hearing loss is also determined. This is crucial for selecting the appropriate treatment method.

1. Conductive Hearing Loss

   In this type of disorder, sound transmission from the outer ear canal to the middle ear is impaired. It’s usually caused by issues like earwax buildup, eardrum perforation, or middle ear infections. In the audiogram, there’s a gap between air conduction thresholds and bone conduction thresholds, but bone conduction remains normal.

2. Sensorineural Hearing Loss

   This type of hearing loss results from damage to the hair cells in the inner ear or the auditory nerve. It may be due to genetic factors, aging, excessive noise, or ototoxic medications. In the audiogram, both air and bone conduction thresholds are reduced and roughly align with each other.

3. Mixed Hearing Loss

   In this type, both conductive and sensorineural components are damaged. Both air and bone conduction thresholds are reduced, but there’s also a gap between them.

What Information Is Obtained from Audiometry?

• Hearing levels in each ear separately
• Frequencies with the greatest hearing loss (e.g., speech or high frequencies)
• Need or lack of need for hearing aids
• Prediction of the patient’s response to speech in everyday situations
• Assessment of possible neurological or central auditory disorders

At the end of the test, the audiogram, along with other clinical information, is referred to the ENT specialist or audiologist. After a thorough review, they can decide if drug treatment, surgery, hearing aid prescription, or further evaluations are needed.

Who Needs a Hearing Test?

Audiometry is not just for those who feel they have hearing loss; this test is often recommended as a preventive or diagnostic measure for various age and occupational groups. Early detection of hearing disorders can play a key role in preventing secondary complications like academic performance decline, speech disorders, or communication and social issues.

Below, we’ll explore the groups for whom audiometry is essential or recommended:

Adults

As age increases, the likelihood of gradual hearing loss rises. This type of hearing loss is usually progressive but permanent and may go undetected for a long time. The following indicate when adults should undergo audiometry:

• Difficulty understanding speech, especially in crowded environments
• Turning up the TV or phone volume excessively
• Frequently asking “What did you say?” in conversations
• Feeling ringing or buzzing in the ears (tinnitus)
• Being over 50 years old (annual check-ups are recommended)

Hearing tests in this group can serve as an effective tool for early detection of age-related hearing loss (presbycusis) and preventing its progression.

Children

Good hearing in children is a vital prerequisite for speech, language, and learning development. Any delay in identifying hearing issues can have long-term effects on the child’s academic and social skills.

Signs that suggest the need for audiometry in children include:

• Delay in starting speech or unclear speech
• Lack of response to sounds or their name
• Poor school performance or constant inattention
• History of recurrent middle ear infections
• Unexplained behavioral problems

In many countries, hearing screening tests are mandatory upon school entry to identify hidden hearing disorders.

Newborns

One of the most important target groups for audiometry is newborns. Early identification of congenital hearing problems is key to successful intervention and the child’s natural language development in the future.

It’s recommended that all newborns undergo hearing screening tests before the end of their first month. These tests include OAE (otoacoustic emissions) and, if needed, ABR (auditory brainstem response).

Newborns in high-risk groups (such as premature babies, those with severe jaundice history, or family history of hearing loss) require follow-up and more specialized evaluations.

Workers Exposed to Loud Noises

Individuals working in noisy environments, such as:

• Industrial factory workers
• Heavy machinery drivers
• Airport or construction project staff
• Musicians and DJs
• Military personnel or those involved in shooting and explosions

Are at risk of noise-induced hearing loss (NIHL). This type of hearing loss is often gradual and irreversible.

For these individuals, periodic audiometry tests (annually or semi-annually) are essential so that if any loss is observed, protective or corrective measures can be taken promptly. Using ear protection devices is also recommended as an occupational necessity.

Benefits of Performing Audiometry

Audiometry is not just a simple diagnostic tool; it’s a key method in hearing health care. Whether as periodic screening or in response to suspicious symptoms, timely testing can have a significant impact on quality of life, daily communications, and mental health.

In this section, we’ll discuss the most important benefits of audiometry:

Early Detection of Hearing Problems

Many hearing disorders, especially in early stages, lack clear symptoms or progress gradually, such that the individual or those around them may not notice the hearing decline for a long time. Audiometry, by precisely measuring hearing function across frequencies and intensities, can identify even the smallest changes in hearing levels.

Early detection of issues such as:

• Sensorineural hearing loss due to aging
• Noise-induced hearing loss in work environments
• Middle ear infections in children
• Congenital disorders in newborns
• Auditory nerve damage from medications or trauma

Allows for more effective treatments and prevents disease progression.

Preventing the Progression of Hearing Loss

If ignored, hearing loss not only progresses but can lead to complications such as:

• Social isolation and reduced quality of life
• Speech disorders, especially in children
• Cognitive impairments in the elderly
• Occupational or academic problems
• Ear ringing and constant stress

Regular audiometry, particularly for at-risk individuals, can prevent reaching advanced stages of hearing loss. Additionally, upon timely identification, the doctor can control or halt the hearing decline process with supportive measures like prescribing hearing aids, medications, infection treatment, or occupational protections.

In fact, audiometry can be considered one of the important preventive tools in hearing health, which, with minimal time investment, can prevent broader problems in the future.

At-Home Audiometry

Today, with advancements in medical technology and the expansion of home health services, at-home audiometry has gained attention as a suitable, quick, and reliable way to assess hearing in a calm and familiar environment. This service is especially useful for the elderly, patients with mobility issues, newborns, or those unable to visit a clinic.

In this section, we’ll learn more about the conditions, benefits, and how at-home audiometry is performed.

Who Needs At-Home Audiometry?

Home hearing services are particularly recommended for the following groups:

• Elderly individuals for whom transportation is difficult
• Newborns and young children, for screening in a calmer environment
• Patients with mobility limitations or bedridden at home
• Individuals with chronic illnesses or immune deficiencies for whom visiting medical centers is risky
• People who, due to work or time constraints, cannot attend in person

How Is At-Home Audiometry Performed?

In home audiometry, all steps are carried out by an experienced audiologist using portable equipment. The general process usually includes the following steps:

1. Initial coordination and request registration: Scheduling the home visit is done via phone or the clinic’s website.
2. Specialist’s arrival at home: The audiologist comes to the location with necessary equipment such as an otoscope, portable audiometer, standard headphones, and speech testing tools.
3. Ear condition examination: A brief ear exam is first performed to ensure no wax or infection is present.
4. Performing required tests: Depending on age and condition, various hearing tests including pure tone audiometry, speech, tympanometry, or OAE/ABR (for newborns) are conducted.
5. Presentation and interpretation of results: The results are interpreted immediately by the specialist, and if needed, treatment consultation or referral to a doctor is provided.

 Interpretation of Audiometry Results

The results of a hearing test are usually presented as an audiogram, a chart that shows the frequencies and intensity levels at which a person can hear sounds.

Degrees of Hearing Loss