What to Expect at a Hearing Exam

Your health and hearing history

To prepare for a hearing test, make sure you know your history, Stamper says, like whether you had ear infections as a child or have a family history of hearing loss. You’ll also be asked about exposure to loud noises or medications that can affect hearing and about your current hearing concerns — including whether you have ear pain or ringing in your ears (tinnitus, which is often linked to hearing loss).

An ear exam

The next step is a physical exam of your ears, with a lighted scope. The exam can find problems that explain or contribute to hearing loss, including infection or earwax build-up, Stamper says. Liacouras says she uses a video hookup during the exam so patients “get to see what I’m seeing.”

Tympanometry test

The audiologist places a probe called a tympanometer into your ear to do this test. The device sends air and sound into your ear to measure the pressure and how your eardrum moves. If it doesn’t move normally, you could have wax or fluid buildup or a hole in your eardrum, all of which can cause hearing problems.

Acoustic reflex testing

Using the same probe, the audiologist might also send a loud noise into your ear so a machine can measure contractions from a tiny muscle in your middle ear. A weak response is a sign of poor hearing.  

Otoacoustic emissions test (OAE)

The audiologist places a small earphone in your ear connected to a device that makes sounds. The device measures echoes produced by the tiny outer hair cells in your ear's cochlea.

For the next series of tests, you’ll sit in a soundproof booth and wear headphones or in-ear earphones. 

Pure-tone testing

During a pure-tone test, you listen for a series of tones and press a button, raise your hand or say something every time you hear one, no matter how soft the sound. “You listen for low base tones all the way up to very shrill, high-pitched tones” played at different volumes, Stamper says. “We are looking for the softest level that you're just barely able to hear” at various pitches, she says.

According to ASHA, low-pitched sound is something like thunder, a tuba or the “oo” sound in “who.” A high-pitched sound is something like a bird chirp, whistle or the “s” sound in “sun.” The test can be modified for people who have trouble moving their hands or speaking, Liacouras notes. For example, she says, they might flutter their eyelids.

Speech tests

The speech test is similar, but using real words spoken at different loudness levels, with and without background noise. The audiologist will say words, and you repeat ones you hear. You might also be asked to repeat sentences.

In one version of the test, you might be asked to repeat sentences as background noise gets louder and louder, Liacouras says. “My patients have said to me, ‘Wow; that's like being in a restaurant. That's the most realistic test I've had,’ ” she says.

Bone conduction testing

To test your hearing another way, your audiologist might place a device behind your ear or on your forehead. The device sends vibrations to your inner ear, bypassing your outer ear. Again, you press a button, raise your hand or speak up when you hear the tones produced by the vibrations.

This test is used to help pinpoint the location of your hearing loss.

Understanding your hearing test results

Immediately after the tests, your audiologist will explain the hearing test results to you, including any fixable ear health problems detected. They’ll also show you an audiogram, a graph that shows how loud sounds had to be for you to hear them at various frequencies. So you might see that you heard the lowest pitches even when they weren’t very loud but needed the high-pitched sounds to be much louder for you to hear them. That’s a typical pattern for hearing loss related to age or medication, Stamper says.

You’ll also learn how severe any hearing loss is, on a scale that typically includes slight, mild, moderate, moderately severe, severe and profound. For example, a mild loss is hearing sounds at 26 to 40 decibels, while a severe loss is hearing them only at a much louder 71 to 90 decibels.

These scores aren’t the sole measure of how serious your hearing loss is, Stamper and Liacouras say. What’s important, they say, is how you function day by day.

“Everybody functions differently with a hearing loss,” Liacouras says. “Some people with very mild hearing loss may not even notice an issue, while other people are very affected by it.”

Following up on a hearing test

Follow-up depends on the results of your hearing test:

• If you have one-sided hearing loss, signs of infection , fluid or an eardrum perforation , your audiologist might refer you to an ear, nose and throat doctor, if you aren’t already seeing one.
• If you have age-related hearing loss, the audiologist will discuss strategies you and the people around you can use to improve communication. You’ll also likely talk about whether hearing aids might be right for you, now or in the future. If you're ready, the audiologist will tell you how to get started. If not, you’ll likely be asked to return for another hearing test in no more than a year or two.
• If your hearing test finds no problems, you can wait longer for a retest, unless you develop new concerns, Stamper says. If you’re 50, you could probably wait a decade, she says, but after 60, three to five years would be better, she says.