A hearing evaluation is performed to determine if a hearing loss is present, and if so, to detail 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 a physician or audiologist in making appropriate treatment recommendations. Individuals often self-refer for hearing evaluations because they notice they are not hearing well and would like to confirm their hearing levels. Others are referred for a hearing evaluation by their physician for a hearing evaluation. The following are the most common reasons for a hearing evaluation.

  • General worsening of hearing and speech understanding over many years, often attributed to aging
  • Unexpected, sudden hearing loss over a short period of time
  • Ringing or buzzing in one or both ears
  • Full or plugged feeling in one or both ears
  • Active ear infection
  • Delayed speech and /or poor academic performance in a child
  • Seeking hearing aids

What Tests Will Be Done?

Several tests, all of them painless, will be performed to determine the degree of hearing loss, the type of hearing loss and the conditions of middle ear versus the inner ear.

A comprehensive hearing evaluation includes otoscopy, pure-tone testing, bone-conduction testing, speech test and tympanometry.


Using a special magnifying instrument with a light, this test allows a healthcare provider to determine the health of the ear canals and ear drum. They examiner can visualize whether excessive cerumen (ear wax) is present or if a perforation of the ear drum is present.


Using a specialized instrument, this test evaluates how well the ear drum vibrates, the pressure behind the ear drum and whether a perforation or hole in the ear drum is present. This test is important to determine the health and functionality of the middle ear.

Pure-Tone Air and Bone Conduction Testing

Pure-tone air conduction testing determines the quietest tones that a person can hear at different frequencies from a deep, bass frequency (think of a fog-horn) up to more high-pitched frequencies (think of a whistle or tea-kettle sound). Using headphones, this test measures sound as it travels from the opening of the ear, down the ear canal, through the ear drum and middle ear space to the hearing nerve. This test is somewhat similar to an eye exam in which an optometrist is evaluating the smallest letters that each eye can detect clearly.

Bone-conduction testing tests the same tones but with a different headphone. A specialized headset named a bone-vibrator is placed behind one ear and sound is transmitted, through vibration from behind the ear directly to the hearing nerve.

These two different measurements determine if hearing loss originates from the ear canal and ear drum space or from the hearing nerve deep inside the brain.

Speech Testing

Under headphones, the examiner will present a list of words at a comfortable listing level that you will be asked to repeat back. This test assesses how well you understand speech in a quiet listening environment. This test is important to determine treatment options, as some people report they can hear sound, but they cannot understand speech, that it sounds distorted.

Additional Testing

Other tests may include:

  • Otoacoustic emissions (OAE) testing. Using a special instrument, this test determines how well specific inner ear nerve receptors named “outer hair cells” are functioning. This test is highly sensitive to changes in hearing that often are not detected by simple pure-tone and bone conduction testing. It is also widely used on newborns to screen for hearing loss.

What Can I Expect During a Comprehensive Hearing Evaluation?

The evaluation will be approximately 30-40 minutes in length. The audiologist will first ask you to complete a brief ear, hearing and balance history and articulate your primary concern(s). The results will be immediate and the audiologist will review the test results with you. He will provide you with information and referrals/treatment options if indicated.

If a recommendation is made for hearing devices, he will discuss your options.