We start by learning about you. Most people who are concerned about their hearing appreciate the opportunity to talk about it. We review the history of your hearing. We find out what sort of problems you are having (if any), when they started and how they are affecting your life. We talk about your routines and what impact hearing difficulty may have on your family life, your social life, or your work. We discuss whether you have looked into hearing care before, and whether you have any previous experience with audiology or hearing aids. This can often be an in-depth discussion, as it is sometimes the first real chance the patient has felt the freedom to discuss this problem. Other times it is more routine, as you are encouraged to share as much or as little as you wish. The important thing is, we start by getting to know who you are so we can make the process as specific, meaningful and comfortable as possible for you.

The hearing test provides specific information about your auditory status. We use the results of testing in combination with what we have learned about you personally, to counsel you. There are several tests which may be done, but all initial exams include some fundamental components.

This is a fancy way of saying we look in your ears. It seems simple enough but you would be amazed at how much we learn from that first peek. Most ears are fairly typical, showing a little normal wax accumulation, or maybe none at all. Other times we know immediately that you will need to have the wax removed from your ears, sometimes before continuing with the rest of the exam. We also learn a lot about the size and shape of your ear canals, something we keep in mind later if you are a hearing aid candidate. The physical nature of your ear canals is essential knowledge for choosing appropriate hearing aids. Sometimes we actually see something which seems abnormal, and we may refer you for further medical examination before we treat your hearing loss. Audiologists are trained to look for these sorts of things, and this is another reason why an audiologist should be your hearing care provider.

This is what most people think of when they imagine taking a hearing test. We assess your sensitivity for hearing certain tones. You are asked to press a button or raise your hand when you hear a tone. These become very soft as we determine your “threshold,” the softest level you can hear each tone. This produces a graph, called the audiogram, a visual representation of your hearing sensitivity. The audiogram is one of the tools we use to help you understand your hearing loss, and we explain it thoroughly to you after the exam. In your initial testing, the tones are usually presented two separate ways. The first way is through headphones (or earphones inserted into the ear canal). This is called “air conduction.” Afterwards, we do “bone conduction” with a vibrating device placed on the bone behind your ear. The combination of the air conduction and bone conduction results help us to understand more about the nature of your hearing loss.

We familiarize you with a short list of two-syllable words. Then we determine the softest level that you can hear and repeat words from that list. This is sort of the speech equivalent of the threshold test for tones, and is used as a way of helping to determine the reliability of tonal testing.

This assesses your ability to understand speech when presented at a level which is very comfortable for you to hear . . . not too loud, or too soft…. just right. This is important because the audiogram itself does not predict your ability to process speech. Even with the words presented loud enough and clear enough, with no distractions, many people are not able to repeat the entire list correctly. Others can. This helps to inform us about difficulties with your hearing that may go beyond problems with sensitivity. Most importantly, it is an important tool in our counseling when we discuss potential benefits and expectations of hearing aid use.

This is a quick test which involves placing a small probe in the ear canal and taking a measurement. It does not require any response from the patient but can give us a great deal of useful information. The tympanogram tells us whether your eardrum (the tympanic membrane) has the movement/mobility that it should. This can be useful in determining if you have a condition that may be helped through medical attention such as fluid in the middle ear (an ear infection), a blockage or “occlusion” caused by wax, or even a perforation (hole) in the eardrum. We do this test with almost all of our patients. It is routinely used with most pediatric patients who often develop fluid in the middle ear. Acoustic reflex testing, another diagnostic tool, may be used to supplement tympanometry and provide additional information.

It may surprise you to learn that your ears can provide information about your hearing without any response from you at all. We place a special probe in the ear canal, present a signal, and measure tiny emissions from the cochlea (the sensory organ of hearing) in response to that signal. While this is not a substitute for the tones and speech testing, it can provide very useful information in cases when regular testing is difficult or impossible. It is also useful for supplementing the more traditional tests as a cross-checking of results. This kind of testing is also used to screen the hearing of newborns before they are discharged from the hospital. This universal screening of newborn babies using OAE’s allows for early detection of hearing loss, and as a result, early intervention.

As you can see, there is much more to a diagnostic hearing test appointment than you may have thought. When you become a patient here at Auditory Services, your evaluation will be thorough and thoughtful. This is how we learn about you as a person and as a patient, and it is the only way that the process of getting help can successfully begin.