A Complete Hearing Test

When you are experiencing hearing loss, it is important to have a complete hearing test administered by an audiologist, licensed hearing aid fitter, or physician. Hearing tests can help determine the best hearing aid for one’s needs and establish a realistic expectation of the results one can achieve when using an aid. Find out more about the steps that comprise a hearing test, including tympanometry, SRT, MCL, UCL, and bone conduction.

If you are experiencing hearing loss, before you have a hearing test administered, it is important that you first visit your physician or an ENT to find out if there is a medical cause. The doctor will be able to assess your situation and may be able to treat your underlying issues, such as an ear infection, a blockage, or even a hole in your eardrum. Once all of your medical issues have been resolved and your doctor determines that you could potentially benefit from a hearing aid, he or she will then likely recommend that you have a complete round of hearing tests administered.

Hearing tests can be performed by an audiologist or a licensed hearing aid fitter, as well as by a physician. Your doctor may be able to give you a referral, and your insurance will likely cover the cost of your hearing test, although you should speak with your carrier to get confirmation. In addition, certain hearing aid vendors may also make the hearing test available free of charge. However, free hearing tests may come along with high sales pressure to buy your hearing aid from that particular vendor, so enter into that situation with caution. If you ever feel any sales pressure, you have the right to leave.

The Beginning of Your Visit

When you go to the audiologist or fitter’s office for your hearing test, you will first have a discussion with the test administrator about your medical history as well as your history of hearing loss in general. You may be asked questions about noise exposure, medications you are taking, any ear surgeries you may have had, any diseases of the ear that you have or had, and hereditary factors. It may be helpful to bring notes with you to make sure that you cover everything comprehensively before the hearing test begins.

Upon completion of this discussion, you will be put through a series of seven different hearing tests to gauge different aspects of hearing loss. Different audiologists and fitters may do the following hearing tests in a slightly different order, but the sequence below outlines what is most common. It is extremely important that you have all of these tests done to create the most complete picture of your hearing - and all of these hearing tests can be performed in a single office visit.

The First Step - Tympanometry

The first step in your hearing test is tympanometry. Tympanometry tests the movement of the eardrum. During this painless test, you need to do nothing but relax and let the readings be taken. The hearing test administrator will begin by placing the tip of a handheld tool into your ear. This tool will change the air pressure inside your ear and will also produce a clear tone. It will then measure how your eardrum responds to the pressure change and to the sound. This test will help to set a baseline for the rest of the hearing tests by letting the administrator know if any specific medical issues, such as an ear infection or a blockage of your Eustachian tube, should to be taken into consideration.

The Next Step - Hearing Tests that Require Headphones

Next, you will be placed in a soundproof room and given headphones through which the administrator will speak to you or play sounds. You will then be given a series of hearing tests through these headphones, including a pure-tone test, a speech reception threshold test (SRT), a most comfortable listening level test (MCL), an uncomfortable loudness level test (UCL), and a word recognition test, also commonly known as a speech discrimination test.

First, you will be given a pure-tone hearing test, which can help to determine the type, degree, and configuration of your hearing loss. Pure-tone thresholds (PTTs) determine the softest level at which you can hear the tone at least 50 percent of the time. For this hearing test, you will be asked to indicate each time you hear a tone in the headphones by either raising your hand or pressing a button.

The SRT test will be administered next. During this hearing test, you will be asked to repeat several two-syllable words while the intensity is decreased in order to find the lowest level at which you are able to repeat half of the words. Then, the MCL test will be performed to determine the loudness at which you prefer to hear by having you identify the level at which it is easy and comfortable to hear sounds. The UCL test (also called the upper level of comfortable loudness) will then do the opposite and will find the loudest level that you would ever wish to listen to - with anything louder being painful. During this portion of the hearing test, the volume in the headphones will slowly be raised, and you will be asked to indicate when the voice you hear has reached this upper level. These three hearing tests can give great insight into your level of hearing loss.

You will then be given the word recognition/speech discrimination test, in which you will listen to a set of single syllable, phonetically balanced words at a comfortable hearing level. You will then be asked to repeat these words back to the administrator one at a time. The results of this portion of the hearing test are critical to helping you establish a realistic expectation of what a hearing aid can do for you.

The Last Step - Bone Conduction

Finally, you will remove the headphones for the last of the hearing tests - the bone conduction test. A small oscillator (which looks like a small disc) will be placed on the bone behind your ear, and it will painlessly stimulate the bones of your skull, which, in turn, stimulate your inner ear. You will again be asked to indicate when you hear a tone as the sound level is raised and lowered to find a level at which you can hear the sound at least half the time. This hearing test is used to find out whether or not your hearing loss is affected by issues relating to your inner ear.

The Results of Your Hearing Test

Once your hearing tests are complete, the results should be available immediately, and the administrator should discuss them with you and put them into the context of your every day life. The hearing tests will be able to determine if your hearing loss is conductive (relating to the outer and/or middle ear), sensory neural (relating to the inner ear hair cells and nerves), or a combination of the two. The hearing test results will also tell you whether your hearing loss is mild, moderate, severe or profound. And your speech discrimination results will give you a practical look at what level of speech understanding you will be able to achieve with a hearing aid, because even with the best hearing aid you cannot achieve a level of understanding that is better than your discrimination score.

If the administrator is also a hearing aid dispenser, he or she may then make recommendations as to what type of hearing aid would work best for you, and may even suggest two or three different models. Remember - you are under no obligation to purchase your hearing aid from the administrator of your hearing test. Because of HIPAA regulations, you are entitled to a copy of the results of your hearing tests without making a purchase. Remind the administrator of this if any issues arise, and make sure that your copy of your results also includes the date of the exam and the administrator’s name.

Armed with the results of your hearing tests, you can then move forward toward making the purchase of a quality hearing aid that meets your needs. Take your time, ask a lot of questions, and shop around for the best product at the best price. The hearing test administrator may be the person you return to when making your purchase, and he or she may not. The most important thing is to make sure that when you finally buy your hearing aid, the dispenser is taking the results of your hearing tests into consideration and is helping you to make a purchase that will help improve your hearing for years to come.

About the Author

Henry Smith is the founder of America Hears, a leading manufacturer and distributor of hearing aids online for over 26 years. The company recently rolled out its new FreedomAD product line, which utilizes the latest generation of ADRO hearing aid technology. Henry started the company in 1979, following a 15-year career at the Pennsylvania School of the Deaf, including his work as an Acoustic Technician. Henry is a pioneer in the use of computers and the Internet to allow customers to have a hands-on approach to the tuning and adjusting of their digital hearing aids. He strives to be customer-centric in all aspects of his work.

Guest article writer  today he knows about a world I am long removed from the club scene and loud music of  entertainment venues. the article has some whiskers but it speaks truth today as it did when Bill clinton still lived in the white house.

 Alexander Chancellor: Most people seem to feel uneasy without noise, tending to equate quiet with loneliness or boredom.

My having gone to a Beatles concert in Bournemouth in 1964 could be the reason why I now wear hearing aids. I still recall the experience with horror. Much as I liked - and still like - the Beatles’ music, nobody could have enjoyed it at this live performance, which took the form of a decibel contest between a screaming mob of fans and a vast loudspeaker system on stage.

I imagine that all Beatles concerts were like that, and that nobody would ever have discovered how good they were if their music had not been recorded in studio conditions for listening to at home.

Yet youth’s addiction to noise for noise’s sake has continued unabated for half a century, and now we learn from the Royal National Institute for Deaf People that 90% of young people suffer damage to their hearing after spending a night out at a club or gig.

The answer, it says, would be for them to wear earplugs; but only 3% of them do so, because most fear that earplugs would block out the music or make them look uncool.

On the one hand, the charity is hoping to persuade them that music doesn’t have to be deafening to be audible - a difficult task, given that sheer volume of noise seems to be at least as necessary to their enjoyment as the music itself.

On the other hand, it wants to make earplugs fashionable by commissioning university students to design ones that look "exciting" rather than "medical"; and with this it could have more success, for glittery earplugs might even catch on as a form of bling.

I have to admit that when I was prescribed hearing aids a couple of years ago, I too was worried about their "medical" appearance. But the specialist pointed out that, since almost every young person now had some kind of electronic device in his or her ear, there was almost no stigma attached to them any more.

This is quite true and makes me think that another way of making earplugs acceptable to the young might be to have wires protruding from them as if they were iPod headphones.

According to the World Health Organization, excessive noise is the main avoidable cause of permanent hearing loss, yet most people seem to feel uncomfortable without it, tending to equate quiet with loneliness or boredom.

As for my hearing aids, they have turned out to be something of a mixed blessing; they make me hear better in conversation, but they make loud noise even more unbearable.

When I was a teenager and already smoking heavily, I would take comfort from the example of Giuseppe di Stefano, the great Italian opera singer who died this week. For di Stefano’s glorious tenor voice - one of the finest of the 20th century - did not appear to be in any way impaired by his addiction to the weed.

Even in the 1950s, when people didn’t yet realize quite how bad cigarettes were for the health, it was thought most inadvisable for a singer to smoke. Yet di Stefano, puffing away, was then at the height of his powers, and so impressed Sir Rudolf Bing, the famous general manager of New York’s Metropolitan Opera, that he wrote of his singing voice: "I shall never as long as I live forget the beauty of that sound."

Di Stefano later freely admitted to having "smoked a lot" and indulged in various other kinds of dissipation, but he always insisted that it wasn’t his disreputable lifestyle but his "severe allergies" that had prematurely ended his career.

Few people believed him, but he did at least survive to the age of 86, and then died only as a delayed consequence of grave head injuries suffered during an attack by burglars four years before (or so his widow has said).

Bing claimed that di Stefano could have been as great a tenor as Caruso if he had been more responsible in his personal conduct, but it must be admitted that, under the circumstances, he did remarkably well.

People who attack the media for withholding the "good news" and instead depressing them with health scares and tales of human depravity should spend more time reading celebrity magazines. For example, the current edition of OK! reveals that David and Victoria Beckham, belying their reputations, lead lives of exemplary domesticity.

"There are so many celebrities going out doing whatever they’re doing and falling out of nightclubs," says Victoria. "But David and I are quite boring. If people really knew the truth about us, they wouldn’t care."

Her "perfect night", she says, "is to stay in with David and watch movies with the kids". His great passion is cooking, and both of them are so happy in each other’s company that they desire almost nothing else.

Even when they are apart, as they are sadly forced to be from time to time, they speak "around 10 times a day, and at least one of those times is an hour long", Victoria says. And her conversations with David are much more meaningful than is popularly imagined. "A lot of people think he is a bit dim, but when you get to know him, he is actually quite deep," she says.

Well, all that is really good to know and warms the cockles of the heart. How shameful of the media to have kept it from us for so long, when all that time they should have been parading the Beckhams as the splendid role models that they now turn out to be!

This week Alexander read Barack Obama’s family memoir, Dreams from My Father, first published in 1995 before he entered politics: "It far surpasses in honesty and interest any modern autobiography of an established politician." He’s also been glued to the presidential election coverage: "I’m dreading more years of worry about what Bill Clinton may be up to in the White House. "

© Guardian News & Media 2008
Published: 3/6/2008

There are a vast number of microscopic sensory hair cells in the the Organ of Corti these hair are very fragile indeed and are easily damaged. In addition to these delicate hairs there are three tiny bones that vibrate and act as amplifiers, these amplifiers do a remarkable job when they are not under assault by excessive noise.
 
When the movement of the tiny bones in the middle ear vibrate the oval window of the cochlea, there are waves that are then created in the fluid surrounding the cochlea. These sound waves bend the basilar membrane in place corresponding to specific frequencies.

The hair cells in those places then brush against the overlying  membrane causing the generation an pulse. It is this pulse which gets sent to the brain. The brain interprets those electrical pulses as sound. 

When the tiny hairs and nerve endings become damaged as a result of exposure to excessive noise, high frequency hearing loss  often results. So the obvious first line of defense limit the noise.

We have touched on excessive exposure to high levels of noise especially over a period of time. I think you might be surprised at how easily your life will get you into a hearing damaging circumstance. Fortunately much of this exposure to excessive noise will cause problems that fade in time once the source of the noise is removed. Below are some  examples of potentially dangerous any day if not everyday exposures to the kind of noise we are talking about. I got these from a simple poll of my own family which includes a couple of high school and a college student. These exposures were experienced in just the last ten days. After you read the exposures that a poll of my own family from just the last month of their lives revealed I hope you will remember to avoid such risks and they will too.

1. high school rally for the basketball team
2. the game itself
3. a party at a friend’s house
4. attendance at a muscle car exhibition
5. several rides on the NYC subway system

 I am sure that if you sit with your family you could come up with a list of your own in no time.

Add to this that many have exposures like these added to a work environment that is excessively noisy and you have a lot of chances for damage to people’s auditory systems. If you are suffering anew from ringing on the ears from noise induced tinnitus do what you can to give the delicate instruments in your hearing system a rest from the assault.

In the event that this is the type of thing you may be experiencing your condition from I thought it might it would be helpful to let you have some information regarding cochlea damage resulting mostly from exposure to excessive or persistent noise.

I hope this  gives you some insight into what actually happens when cochlea damage occurs as a result of exposure to noise.

This type of hearing  loss will be either temporary or permanent depending on a wide variety of factors. See a physician if you think that you may have been impacted negatively by a noise.

There is a vast number of microscopic sensory hair cells in the the Organ of Corti these hair are very fragile indeed and are easily damaged. In addition to these delicate hairs there are three tiny bones that vibrate and act as amplifiers, these amplifiers do a remarkable job when they are not under assault by excessive noise.
 
When the movement of the tiny bones in the middle ear vibrate the oval window of the cochlea, there are waves that are then created in the fluid surrounding the cochlea. These sound waves bend the basilar membrane in place corresponding to specific frequencies.

The hair cells in those places then brush against the overlying  membrane causing the generation an pulse. It is this pulse which gets sent to the brain. The brain interprets those electrical pulses as sound. 

When the tiny hairs and nerve endings become damaged as a result of exposure to excessive noise, high frequency hearing loss and tinnitus often results. So the obvious first line of defense limit the noise.