Hearing loss diagnosis

In order to diagnose your hearing loss, your healthcare provider will likely begin by conducting a physical exam. He or she will look in your ears for possible causes of hearing loss, such as a buildup of earwax or inflammation caused by an infection.

You may be referred to a hearing specialist (audiologist) or other healthcare provider who is qualified to perform hearing tests if you have a history of exposure to loud noise, feel that your hearing has changed, or have family or friends that indicate you have difficulty hearing and communicating with them (as those around us can be the first to notice our hearing problems).

Hearing loss test

Some tests²⁹ that can be used to diagnose hearing loss include:

• General screening tests: One general method used to screen hearing capability that a provider or specialist may use is speech testing³⁰. One example of this is the “whisper test.” During this test, he or she will ask you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds. The accuracy of this test can be limited, however, and more in-depth testing may be required to provide a proper diagnosis.

• Tuning fork tests: Tuning forks are two-pronged metal instruments that produce sound when struck. Simple tests using tuning forks can help your provider or a specialist detect hearing loss. This type of evaluation may also reveal where in your ear your hearing damage has occurred.
• Audiometer tests: Audiometer tests are more thorough than general screening and tuning fork tests. During these examinations, you wear headphones through which sounds and words are directed to each ear. Each tone is repeated at faint levels to find the quietest sound you can hear, which helps an audiologist gauge the degree of your hearing loss. This testing may also be referred to as pure-tone testing³¹ or air conduction testing.

• Tests of the middle ear: Problems in the middle ear make it hard to sound to travel from the outer ear to the inner ear and the brain. An audiologist may conduct tests³² to determine how well your middle ear works, including a tympanometry, acoustic reflex measures, and static acoustic measures.

• Auditory brainstem response (ABR) testing: Also referred to as auditory evoked potential (AEP) tests, ABR tests³³ determine how well the cochlea and the brain pathways for hearing are working. During these tests, electrodes are stuck to the skin on your head and connected to a computer. These electrodes record brainwave activity in response to sounds you hear through headphones.

Screening for hearing loss in children

According to the CDC, children should have their hearing tested³⁴ before entering school or at any time there is a concern about the child’s hearing. The American Speech-Language-Hearing Association advocates for Early Hearing Detection and Intervention³⁵ (EHDI), the practice of screening every newborn for hearing loss prior to hospital discharge.

Oftentimes, young children respond to testing when it is presented in the form of a game. The most common forms³⁶ of testing a child’s hearing through play are visual reinforcement audiometry (VRA) and conditioned play audiometry (CPA).

Visual reinforcement therapy is the best hearing screening option for children between 6 months to 2 years of age. In this test, an audiologist teaches the child to look for where a sound that is presented has come from. When the child looks in the correct direction of the sound, he or she sees a moving toy or flashing light, rewarding the child for looking at the sound. In VRA, both ears are tested at the same time.

Conditioned play audiometry is well-suited for toddlers and preschoolers from 2–5 years old. In this testing, a child does something each time he or she hears a sound—for example, she might put a block in a box, put pegs in a hole, or put a ring on a cone.

Sometimes, auditory brainstem response testing is used during newborn hearing screenings. Only one level of loudness is checked when the ABR is used for this screening. The baby passes the test if his or her brain indicates that it is hearing the sound, and more specific testing is performed if he or she fails.

Middle ear testing³⁷ is especially important in children from 3–5 years old, as young children are more likely to have hearing loss due to middle ear problems (such as ear infections).