What is pure-tone audiometry?

Pure-tone audiometry is a behavioral hearing test that measures the softest sounds you can hear at different frequencies (pitches). It's called "pure-tone" because the test uses pure sine wave tones — single-frequency sounds — rather than speech or complex sounds. The results are plotted on an audiogram, a graph that shows your hearing thresholds across the frequency range.

Pure-tone audiometry is the foundation of any comprehensive hearing evaluation. It tells the audiologist how much hearing loss you have, at which frequencies, and in which ear — information that guides diagnosis and treatment decisions.

What happens during the test

Before the test

The audiologist will review your medical history, ask about your hearing concerns, and examine your ear canals with an otoscope to check for earwax or other obstructions that could affect the test results.

Air conduction testing

You'll sit in a sound-treated booth (a small, quiet room designed to block external noise) and wear headphones or insert earphones. The audiologist will play a series of pure tones through the headphones — one ear at a time — at different frequencies and volumes. Your task is simple: press a button (or raise your hand) every time you hear a tone, no matter how faint.

The audiologist uses a method called "ascending-descending" to find your threshold at each frequency — the softest level at which you can reliably detect the tone. This is repeated at frequencies from 250 Hz to 8,000 Hz in each ear.

Bone conduction testing

After air conduction testing, the audiologist may perform bone conduction testing using a small vibrator placed behind your ear (on the mastoid bone). This bypasses the outer and middle ear and stimulates the inner ear directly. Comparing air and bone conduction thresholds helps determine whether hearing loss is sensorineural (inner ear), conductive (outer/middle ear), or mixed.

How long does it take?

Pure-tone audiometry typically takes 20–30 minutes. A complete audiological evaluation — which may include pure-tone audiometry, speech audiometry, tympanometry, and a case history review — typically takes 60–90 minutes.

Is the test uncomfortable?

Pure-tone audiometry is completely painless and non-invasive. The only discomfort some people experience is from wearing insert earphones (small foam tips inserted into the ear canal), which can feel slightly uncomfortable but cause no harm.

Some people find the test mentally tiring — concentrating on detecting very faint sounds requires sustained attention. This is normal and not a cause for concern.

What the audiologist is looking for

The audiologist is measuring your hearing thresholds — the softest sounds you can reliably detect at each frequency. These thresholds are plotted on the audiogram and used to:

• Determine the degree of hearing loss (normal, mild, moderate, severe, profound)
• Identify the configuration of hearing loss (which frequencies are affected)
• Distinguish between sensorineural and conductive hearing loss
• Determine whether hearing aids are appropriate and what settings they should use
• Monitor changes in hearing over time

After the test: reviewing your results

After the test, the audiologist will review your audiogram with you, explain what the results mean, and discuss next steps. If hearing aids are recommended, the audiologist will explain the options appropriate for your degree and configuration of hearing loss.

Ask for a copy of your audiogram — you're entitled to it, and it's useful to have for comparison at future appointments or if you seek a second opinion.