The short answer: A diagnostic hearing test takes approximately 30 minutes to an hour including a full case history followed by an extensive battery of tests that will tell us more about your potential hearing loss.
But, it is important to understand the difference between a hearing screening assessment and diagnostic assessment as both are often advertised under the one banner of “hearing test”.
A screening assessment will go for up to 15 minutes and screens limited thresholds across the speech frequency range. This may not necessarily be completed by an Audiologist or Audiometrist in a clinic and instead can be done online from home using a pair of headphones.
Unlike a diagnostic assessment, screening won’t tell you if you have a permanent hearing loss, blocked ears with wax or fluid nor will it tell you whether you have an active infection. To do so, you will need a diagnostic assessment that will piece together your hearing health using several different tests.
Attune Hearing offers the full range of medical hearing services in more than 50 clinics Australia-wide. Built on a medical foundation, we’re here to help you on your way to better hearing health. Our accredited audiologists offer free 15-minute hearing assessments to determine whether a full diagnostic assessment is required.
A complete diagnostic hearing test consists of a battery of tests to give us a complete picture of your hearing. There are five key components of a diagnostic hearing assessment.
Before getting underway with testing, your audiologist will have a conversation with you to gain a better understanding of certain factors that may be affecting your hearing. This will help your audiologist start to gain a better understanding of the difficulties you’re having and what your communication requirements are.
Your audiologist will then use an otoscope, a small light with a magnifying lens and speculum, to examine your ear canal and eardrum for any abnormalities such as any build-up of wax, abnormal growths or perforations.
Typically after your ears have been examined, your audiologist will perform a test that measures your middle ear function. The test is called Tympanometry, whereby a small rubber tip connected to a probe will be inserted into your ear. You will feel slight pressure, but it is generally not painful.
Many people describe the sensation as similar to going up and down a hill or very briefly ascending and descending in a plane. Tympanometry tells you how the eardrum and bones in your middle ear moves and will detect whether there is a build-up of pressure or fluid behind your eardrum that may need further attention.
This is the body of your diagnostic hearing assessment as it tells your audiologist not only how well you can hear but also the configuration (what pitch of sound) and type (permanent or temporary) hearing loss you have.
In this test, your audiologist will assess your ability to hear soft sounds at different frequencies. They will place headphones on your ears and give you a button before proceeding to test each of your ears separately. You will be instructed to push a button for each beep you hear.
The beep will start at a comfortable level and progressively get softer until you can no longer hear the sound. While this sounds simple – it often isn’t and this is when you start to think, “Did I hear the beep or is it just in my head?”. By challenging your hearing with these soft sounds, the audiologist will produce an audiogram which tells us what your hearing thresholds are.
Your brain is an incredible thing – and can compensate for poor hearing. Sometimes it even plays tricks on you. It is common for people who have different hearing levels between each ear to require masking to obtain a true result. Masking is a white noise that is played to your better ear to distract it whilst you continue to press the button for all the beeps you can still hear on the other side.
(b) Bone-conduction testing
Bone conduction testing tells you what type of loss you have. For this test, a headband will be placed on your head with a small square box that sits directly behind your ear on your mastoid bone. This is called an oscillator and it will deliver the sound directly to your hearing organ, the Cochlear, by bypassing the middle ear.
This headband sits firmly on the bone to let the sound get through to the cochlear effectively and follows the same method of testing as air-conduction testing (pressing a button for the beep) so you will already know exactly what to do.
As this is testing the Cochlear directly, you will soon know if your hearing loss is permanent and results or nerve damage (sensorineural) or due to the bone in the middle ear not working as well as they should be (conductive). For example, if there is fluid in your middle ear.
Using the headphones, a series of standardised word lists consisting of 10 phonetically balanced words will be presented to you and you will be asked to repeat what you hear. The best part of speech tests is that you still get points for guesses! Guessing is encouraged, especially at softer levels and even if your guess seems silly (or rude), your audiologist will have heard it more than once before.
Two additional tests may be included in your diagnostic assessment at the discretion of your audiologist.
(c) Acoustic reflexes
Using the same tympanometry tip and probe as well as an additional one in the opposite ear, this test measures the involuntary contraction of the muscle in the ear in response to very loud sounds. That’s right, our ears have a built-in mechanism to protect us from loud noise exposure!
These reflexes can be useful in detecting central pathologies as well as helpful in confirming test results should there be concerns for the reliability in PTA testing. However this test isn’t for everyone, some people can be very sensitive to loud sounds or suffer severe tinnitus, in which case reflexes may not be tested to prevent any discomfort or making the tinnitus temporarily worse.
(d) Speech rollover
Quite simply, at louder levels, words may be heard louder but not any clearer. In fact, for some ears, they become significantly less clear. If you’ve ever been to a concert you will know all about this distortion if you’ve lucked out and got tickets right next to the speaker, everything is so loud far less clear than if you were further away.
For some pathologies, when words are presented at a level louder than that which you’ve already got the best score, a significant distortion effect can occur. This is called speech rollover and you will often require further medical investigation to rule out any underlying issues.
Once all your testing is complete, your audiologist will have a clear picture of your hearing health. They will discuss your results with you and make any recommendations for further management if needed. If you have a normal hearing you may be advised to have a review assessment in two years for ongoing monitoring or if you do have a permanent loss, hearing aids might be advised.
Similarly, if your results indicate your middle ear isn’t working as well as it should be or other pathologies are suspected, you may be recommended to see an Ear, Nose and Throat (ENT) specialist to determine how you can be helped.
A report of your results is written to your GP so you can discuss any medical questions with them if required. You will also receive a copy of your audiogram charts that display the results of your tests. They can be a bit tricky to understand, so we’ve written a guide to help you decipher the outcome of your assessment.
For more information about free hearing assessments, diagnostic hearing tests, pure tone testing and hearing aids, or to schedule an appointment with a local Attune Hearing clinic, book online or give us a call.