Hearing Evaluation

What is included in a hearing evaluation?

A hearing evaluation is a noninvasive evaluation that determines the presence or absence of a hearing loss. At a minimum, it should include the patient’s relevant medical history, otoscopy (e.g. a physical examination of the ear canal and ear drum), and basic audiometry that determines if a hearing loss is present. If a hearing loss exists, the evaluation will reveal the type and extent of the loss as well as the impact it has on understanding speech.

At Community Audiology Services hearing evaluations are done in an accessible, sound-treated room in order to reduce any noises that could affect evaluation results.

What are the basic parts of a hearing evaluation?

A thorough hearing or audiologic evaluation includes patient history, otoscopy, and basic audiometry.

History

The past medical and neuro-otologic history is reviewed with emphasis on ear disease, previous ear surgery, tinnitus, noise exposure, pre-existing hearing loss, head trauma, and ototoxic drugs.

Otoscopy

Otoscopy is performed before the audiologic evaluation and examines the outer and middle ear using an instrument called an otoscope. When the ear is impacted with wax, has infection, foreign bodies or fluid, an ear, nose, and throat (ENT) consultation is recommended. Community Audiology Services has a board-certified otolaryngologist and surgeon on site.

Pure tone audiometry

Conventional pure tone audiometry consists of air and bone conduction evaluations. This evaluation determines hearing thresholds in the low, mid, and high frequencies (125 Hz -8000 Hz) that contribute to speech perception. The results are charted on an audiogram. Audiometric interpretation determines the degree and type of hearing loss. Types of hearing loss are conductive, sensorineural, or mixed (a combination of conductive and sensorineural).

Speech audiometry

Speech audiometry quantifies the ability to receive and understand speech. Two evaluation measures are obtained: the speech threshold and the word recognition score. The former indicates the lowest decibel (dB) level that two syllable words are identified correctly 50% of the time. If the speech threshold is greater than 20 dB HL, a significant hearing loss exists. Typically, word recognition is measured using a phonetically-balanced word list. The percent correct (0 – 100%) indicates how well speech is understood when it is sufficiently loud. It also serves as a prognostic indicator for aural rehabilitation. For example, a score of 70-100% requires less long-term intervention than a score of 60% or less.

Immittance audiometry

Immittance audiometry has two parts: tympanometry and stapedial reflex evaluations. Tympanometry is used to determine the mobility of the middle ear system while stapedial reflex evaluation is used to examine how the ear responds to loud sounds. These objective findings - along with pure tone and speech audiometry - will help determine if further evaluations are needed to determine underlying cause(s).

Otoacoustic Emissions (OAE) Testing

Otoacoustic Emissions (OAE) Testing is another objective test that evaluates the integrity of the inner ear. The presence or absence of OAEs indicates the health of the receptor cells in the cochlea. It is used as a screening evaluation to assess hearing in newborns and to monitor cochlear changes in patients taking ototoxic drugs.

Who needs hearing evaluations?

All 50 states have mandated hearing screenings for newborns. These evaluations are painless and are typically performed in the hospital before a baby goes home. However, when an infant is not born in a hospital or fails the hospital screening, they can be seen in the audiologist’s office for a newborn hearing screening evaluation.

Hearing loss becomes more common with age. Approximately 25% of men and women aged 55-65 have some level of hearing loss. This number nearly doubles after age 65. Therefore, as a precautionary measure, it is imperative that hearing is periodically evaluated throughout one’s life. For example, adults starting at age 18 should have their hearing checked every 5 years. At age 45, a hearing evaluation should be done every three years and every two years after age 60.

How does the ear work?

There are three parts to the ear: outer, middle, and inner. The outer ear funnels sound waves to the ear drum. The eardrum connects to three middle ear bones which collectively vibrate in response to sound. This vibration is sent to the inner ear or cochlea. This fluid-filled structure stimulates the inner ear receptor cells that translate these vibrations into electrical signals that transmit frequency-specific information to the brain. The brain decodes the signals resulting in one’s ability to distinguish individual sounds. Any disruption in this auditory pathway can result in hearing loss ranging from mild to profound.

How is hearing loss treated?

Dr. Randolph provides several treatments for hearing loss depending on the cause and severity. Treatment can range from medical intervention to the use of some type of amplification system and includes:

• Removal of wax or foreign body
• Prescriptive intervention
• Surgery
• Amplification devices 

Treating hearing loss provides numerous personal benefits including greater self-confidence, stronger relationships with loved ones, reduced instances of depression, and a dramatically improved quality of life. To learn more about hearing evaluations and hearing loss treatments, call Community Audiology Services or schedule an appointment online today.