Types of hearing tests

A comprehensive evaluation typically includes several tests, each measuring a different aspect of your hearing:

Pure-tone audiometry

The core of any hearing evaluation. You sit in a soundproof booth wearing headphones and press a button (or raise your hand) each time you hear a tone. Tones are played at different frequencies (pitches) — typically 250 Hz to 8,000 Hz — and at different volumes. The softest sound you can detect at each frequency is your hearing threshold.

The results are plotted on an audiogram — a graph showing hearing threshold (in decibels) on the vertical axis and frequency (in Hz) on the horizontal axis. Your audiogram is the most important document in your hearing health record.

Bone conduction testing

A small vibrator is placed behind your ear (on the mastoid bone) or on your forehead. It sends vibrations directly to the inner ear, bypassing the outer and middle ear. Comparing bone conduction thresholds to air conduction (headphone) thresholds tells the audiologist whether hearing loss is sensorineural, conductive, or mixed.

Speech audiometry

Two components:

• Speech reception threshold (SRT): The softest level at which you can correctly repeat two-syllable words 50% of the time
• Word recognition score (WRS): How accurately you can repeat single-syllable words presented at a comfortable listening level — expressed as a percentage

Word recognition scores are important for predicting hearing aid benefit. A score below 50% suggests that amplification alone may not be sufficient.

Tympanometry

A probe is placed in the ear canal and changes air pressure while measuring eardrum movement. This assesses middle ear function — detecting fluid, eardrum perforations, Eustachian tube dysfunction, and ossicular chain problems. It is quick, painless, and does not require any response from you.

Otoacoustic emissions (OAE)

A small probe plays sounds into the ear and measures the faint sounds the cochlea produces in response (otoacoustic emissions). Healthy hair cells produce these emissions; damaged ones do not. OAE testing is particularly useful for newborn hearing screening and for assessing cochlear function independently of the auditory nerve.

Auditory brainstem response (ABR)

Electrodes placed on the scalp measure the brain's electrical response to sounds. ABR testing is used when standard audiometry is not possible (infants, people who cannot respond reliably), to assess auditory nerve function, or to screen for acoustic neuroma.

How to read an audiogram

An audiogram plots frequency (Hz) on the horizontal axis — low pitches on the left, high pitches on the right — and hearing level (dB) on the vertical axis, with quieter sounds at the top and louder sounds at the bottom.

Your thresholds are marked with symbols: typically "O" for the right ear and "X" for the left ear. The lower your thresholds on the graph (further down the page), the more hearing loss you have.

Degree of hearing loss by threshold:

• Normal: 0–25 dB
• Mild: 26–40 dB
• Moderate: 41–55 dB
• Moderately severe: 56–70 dB
• Severe: 71–90 dB
• Profound: 91+ dB

The shape of the audiogram also matters. A "sloping" audiogram — normal in the low frequencies, worse in the high frequencies — is the classic pattern of age-related and noise-induced hearing loss. A "flat" audiogram suggests similar loss across all frequencies.

Online hearing tests

Many websites and apps offer free online hearing screenings. These can be a useful first step to identify whether you might have hearing loss, but they are not a substitute for a professional audiogram. Online tests cannot:

• Accurately measure your hearing thresholds (uncalibrated headphones, variable room acoustics)
• Distinguish between sensorineural and conductive hearing loss
• Assess speech understanding
• Identify medical causes of hearing loss

If an online screening suggests hearing loss, schedule a professional evaluation.

What happens after the test

Your audiologist will review your results with you immediately and explain what they mean. Depending on your results, next steps may include:

• Monitoring (if hearing is normal or borderline)
• Medical referral to an ENT (if a medical cause is suspected)
• Hearing aid evaluation and fitting
• Further diagnostic testing (MRI, ABR)
• Audiological rehabilitation