Diagnostic Hearing Evaluation

If you or someone you know has been referred for a diagnostic hearing evaluation, it means that hearing loss needs to be ruled out or further examined. The diagnostic hearing evaluation may be recommended for individuals who did not pass an initial hearing screening.

The evaluation is done to determine if a hearing loss is present, and if so, to determine the type and severity of the hearing loss. It also may provide insight into the cause of the hearing loss as well as provide guidance for the audiologist in making appropriate hearing loss treatment recommendations.

What Tests Will Be Done?

The specific tests done during the evaluation will depend on the patient’s age, and what is known already about their hearing status. These various tests will determine the degree of hearing loss, the type of hearing loss, and the conditions of the ear canal and middle ear. The audiologist will also determine if the hearing loss is conductive (middle or outer ear problem) or sensorineural (inner ear problem or central processing difficulty of the brain).

A diagnostic hearing evaluation typically includes pure-tone testing, bone-conduction testing, and speech testing.

Pure-tone Air and Bone Conduction Testing

Pure-tone air conduction testing determines the quietest tones that a person can hear at different frequencies, both low and high. Bone conduction testing is similar to pure-tone air conduction testing, except during bone conduction testing, a different type of headphone is used. The test results help the audiologist determine if the hearing loss is originating from the outer/middle ear or from the inner ear. The patient will be asked to respond each time they hear a tone by either pushing a button, raising their hand or verbally responding.

Speech Testing

A speech reception threshold (SRT) test is often used to confirm the results of a pure-tone test. This test determines the softest level at which the patient can recognize words or speech stimuli.  The patient will be asked to repeat a series of words back to the audiologist. The audiologist’s voice will continue to become softer and softer, until the patient can no longer hear their voice to repeat back the words being said.

Additional Tests:

The audiologist will also perform otoscopy (examining the ear canal) and tympanometry (test of the middle ear) to determine the health of the ear canal and the middle ear.  Another test that the audiologist will also perform is a test for a patient’s acoustic reflex, which is an auditory reflex to loud sounds and can provide the audiologist more insight into the patient’s hearing loss.

Specialized tests exist for infants and young children, as well as children and adults with developmental and cognitive impairments. These more-specialized tests allow the audiologist to test the auditory system when the patient is not able to actively participate in the tests or evaluation.

Other tests may include:

  • Auditory brainstem response (ABR)
  • Otoacoustic emissions (OAE) testing

Visual reinforcement and conditioned play audiometry for children

For children, it is important to have a diagnostic hearing evaluation whenever hearing loss is suspected.  Early diagnosis can be critical for speech and language development in children.

Visual Reinforcement Audiometry (VRA) and conditioned play audiometry (CPA) are techniques used to perform diagnostic hearing evaluations on young children. VRA testing is typically performed on babies that are able to turn their heads back and forth. The test consists of training the baby to look at toys or digital picture screens in response to hearing tones and speech.  CPA testing is done with young children who are not quite ready to do a traditional diagnostic testing. The child will use toys (like blocks) and drop them into a bin/bucket every time they hear a tone.

What Can I Expect During a Diagnostic Hearing Evaluation?

The evaluation will likely last about 30 to 40 minutes in length. You should also allow for time to review test results and ask any questions with the audiologist.

If the determination is made that you need hearing aids, you may be set up with an appointment to discuss hearing aid technology with the audiologist.

It is recommended that you bring a family member with you to the evaluation appointment. Most audiologists agree that hearing loss does not just effect the person who has the hearing loss, but effects their family and friends as well. It helps to have another supportive person at the appointment to help you understand the information and any recommendations that are being made.

Before your appointment, a complete medical history will be completed and the audiologist will want to hear about any complaints you have about your hearing. They will pay special attention to any concerns you have about any exposure to noise, tinnitus, and balance problems you may report. Make sure that you take a full list of any medications and supplements you are taking with you to your appointment.

The diagnostic hearing evaluation is a good chance to establish a relationship with your audiologist. Audiologists are specialists in hearing, hearing rehabilitation and balance. Never hesitate to ask your audiologist for clarification or further information on anything you do not understand. You will want to be clear on any information you receive so that you can be an active participant in finding the best hearing solutions that will work for you and your listening needs.