Hearing Exams

Comprehensive Hearing Evaluation

A comprehensive hearing evaluation (also known as a hearing evaluation, hearing exam or hearing test) is performed to determine if hearing loss is present, and if so, to detail the type and severity of the hearing loss, how well the ear drum and surrounding structures are functioning and ability to discriminate speech clearly. It also determines the type of 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 the following reasons:

  • General worsening of hearing and speech understanding over many years, often attributed to aging
  • Unexpected, sudden hearing loss over a short period of time, often only in 1 ear
  • Ringing, or other sound in one or both ears, often of sudden onset
  • Full or plugged feeling in one or both ears
  • Active ear infection
  • Recent vertigo or severe dizziness, often accompanied by nauseousness
  • Delayed speech and /or poor academic performance in a child
  • Seeking hearing aids

What Tests Will Be Done?

The audiologist will first collect a brief history of  your hearing and balance history to best understand the details of your primary concern(s).A comprehensive hearing evaluation will then be performed which includes otoscopy, pure-tone testing, bone-conduction testing, speech testing, tympanometry, otoacoustic emissions testing and if complaints of tinnitus, a tinnitus evaluation. The evaluation will take approximately 30-40 minutes in length.

Although all of these tests are painless and some subtests take as little as 10 seconds to complete, it is common for many patients to arrive anxious but to soon relax part way through the evaluation.  The results will be immediate and the audiologist will review the hearing test results with you and advise if a referral or /treatment is indicated.  If a recommendation is made for hearing devices, the audiologist will advise the details of that treatment plan for hearing loss.


Otoscopy is a magnifying instrument that shines a beam of with a light for a healthcare provider to visualize the health of the ear canal and ear drum. The examiner can visualize the general health of the ear canal, including whether excessive cerumen (ear wax) is present or if a perforation (hole) in the ear drum is present. Peninsula Hearing Services utilizes “video” otoscopy to that the patient can see on a monitor what their ear canal looks like!


A tympanometer is a handheld instrument that blows a gentle puff-of-air and several tones into the ear canal to evaluate how well the ear drum vibrates to sound, the pressure behind the ear drum and whether a perforation or hole in the ear drum exists.  The resulting information from the test is referred to as tympanometry. This test is important to determine the overall health and functioning of the middle ear.

Pure-Tone Air and Bone Conduction Testing

Using headphones usually in  a sound-treated hearing booth, pure-tone air conduction testing determines the quietest tones that a person can hear at different pitches or tones, all the way from a deep, bass frequency (think of a fog-horn) up to more high-pitched frequencies (think of a whistle or tea-kettle sound). The 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. It is somewhat similar to an eye exam in which an optometrist evaluates the smallest letters that each eye can detect clearly.

Using a different headphone, bone-conduction testing measures the same tones a pure tone air conduction. A specialized headset named a bone-vibrator is placed behind one ear and sound is transmitted, through vibration of the skull 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, speech testing measures how well you understand speech in a quiet listening environment. The examiner presents a standardized list of words at a comfortable listing level that you will be asked to repeat back. This test is important to assess the health of the hearing nerve and, if hearing loss is present, guide treatment options, as some people report they can hear sound, but the speech is distorted, no matter how loud the volume level.

Otoacoustic Emissions (OAE) Testing

Otoacoustic emissions testing measures how well specific inner ear nerve receptors named “outer hair cells” are functioning. Using a handheld instrument, a soft ear tip similar to an earbud is placed in the ear and gentle melody of tones presented to the ear.  The nerve receptors of a healthy hearing nerve will emit robust responses that are received by the instrument.  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 and for individuals undergoing life-saving treatments that can damage the delicate hearing structures before the patient or physician is aware of hearing loss (referred to as ototoxic hearing loss).

Tinnitus Assessment Testing

A tinnitus assessment is used to evaluate reports of a buzzing, ringing or a noise in the ear(s), referred to as tinnitus.  This help the healthcare provider identify  a) the specific tone or pitch of the reported tinnitus  b) the volume or intensity of the tinnitus  c) whether  “white noise” or static can make the tinnitus go away (a term known as masking).  The results of this test are useful for diagnosis of the problem that might be causing the tinnitus as well as prognosis for certain treatments, if needed.