Diagnostic Audiologic Evaluation

hearingtest.JPGA Diagnostic Hearing Assessment is the first step towards better hearing health.  We will provide you with a specialized assessment of your entire hearing system- from the outer ear, middle ear, and inner ear, all the way up to the brain.  This includes a case history, otoscopy, immittance audiometry and middle ear analysis, pure tone audiometry, speech audiometry and if needed otoacoustic emissions.

Following the assessment, all results and recommendations will be discussed so that you, your family and your other healthcare providers can make informed decisions about your hearing healthcare. 

It is recommended that you bring a family member with you to the evaluation appointment. Hearing difficulty is a family issue and does affect communication. It helps to have another supportive person at the appointment to help you understand the information and recommendations.

What Tests Will Be Done?

CASE History

The hearing and communication assessment begins with an in-depth questionnaire pertaining to your hearing health, noise history, and medical history.  An accurate case history is essential for accurate diagnosis of any hearing or medical disorder. 


The assessment continues with a thorough inspection of the external/out ear.  We will inpsect the external auditory meatus (ear canal) and tympanic membrane (ear drum) using an otoscope.  We will be looking for any blockages (e.g. cerumen or "ear wax"), as well as any abnormalities of the tympanic membrane (e.g. perforation or "hole" in the ear drum) and ear canal. 

Immittance Audiometry And Middle Ear Analysis

We will then complete an analysis of your middle ear system (i.e. we want to know how much your ear drum and middle ear bones are moving).  Certain hearing losses are due to a very "loose" or "stiff" middle ear systems that affects the way sounds are transmitted to your inner ear.  Immittance audiometry also sometimes includes a test of your stapedial reflex (contraction of the muscle), which helps us determine the status of various nerves in your brain.

Pure-tone Air and Bone Conduction Audiometry

This is the part of a hearing assessment that people tend to remember the most.  Various headpieces will be placed in or behind your ears while you are seated in a sound treated booth.  You will listen to a series of beeping tones at various pitches (or frequencies).  This will help us determine the softest volume you can hear (threshold level) and help us determine how much sound pressure if required at various frequencies to stimulate your auditory cortex so that you "hear".  Pure tone audiometry helps us diagnosis the severity and location of a hearing loss and is one of the primary tests used to calculate prescriptions for hearing aids. 

Speech Audiometry

A speech reception threshold (SRT) test is often used with older children and adults to confirm the results of a pure-tone test. This test determines the lowest level at which the patient can recognize words or speech stimuli. 

Word recognition (WR) testing is also done when age-appropriate to determine how you understand speech in a quiet environment when presented at a comfortable listening level.  

Speech-in-noise testing is also done with many patient who have increased understanding difficulties in noisy environments.  Since we live in a very noisy world, this testing provides us with additional information on how the brain processes what you hear when background noise is present. 

Additional Tests:

Specialized tests exist for infants and young children, as well as children and adults with developmental and cognitive impairments. These more-specialized tests allow the us to test the auditory system when the patient is not able to actively participate in the tests or evaluation. Hearing loss in children can result in difficulties in school, behavioral issues as well as speech and language delays so thorough picture of their hearing ability is very important. 

These tests may include:

  • Otoacoustic emissions (OAE) screening
  • Auditory brainstem response (ABR)
  • Conditioned play audiometry (CPA)
  • Visual reinforcement audiometry (VRA)

Putting it All Together

All these tests are what we call a full comprehensive hearing test battery and functional communication assessment.  No single test on its own gives us the whole picture. No single test on its own gives us the whole picture.  Thinkg about each test as a piece of a puzzle - with just a single piece it is not possible to know what you are looking at.  But with many pieces of the puzzle a picture starts to form.  As we look at all ot these tests together we get a picture of your hearing system.  We can determine what parts are not functioning as well as they should and what parts are working well.  Without a complete picture it is not possibel for us to make an accurate diagnosis or recommend treatment options (e.g.hearing aids, surgery, family physician referral, ENT referral, etc.)

It is for this reason that we recommend you visit Hearing Solutions of North Carolina for a comprehensive diagnostic hearing evaluation. Our providers ensure that you and your loved ones are receiving the highest standard of hearing healthcare available.