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Testing and Evaluation

Comprehensive Hearing Evaluation
An evaluation with an audiologist will most likely begin with a case history which will involve a series of medical questions pertaining to your ears and related medical conditions. After questions are complete, a visual inspection of the ear’s canals called otoscopy will be done.

The following tests will then be performed based on individual need. All tests assist the audiologist in determining if there is hearing loss present, the type of the hearing loss, the severity of the loss, possible causes, and the best treatments or management possibilities:

• Tympanometry puts air pressure in the ear canal causing the ear drum to move back and forth to assess the mobility of the eardrum and middle ear.  The results of tympanometry can indicate reduced mobility, exaggerated mobility, or a hole in the eardrum.  The graphs produced from this test are called tympanograms.

• Acoustic Reflex iis measured by presenting a loud tone to the ear causing a tiny muscle in the ear to contract.  The presence or absence of the reflex and the level it is recorded give information regarding the integrity of the auditory and facial nerves.

• Audiometry (Speech and Pure-Tones) uses pure-tones and speech to determine the softest sound an individual can hear.  Tones and speech are presented through headphones and the individual is asked to respond, either verbally, with a hand raise, or the push of a button whenever the sound is heard.  The results are recorded on a graph called an audiogram.

• Visual Reinforcement Audiometry (VRA) & Conditioned Play Audiometry
  VRA and Conditioned Play are available assessments for children who cannot intentionally indicate what they hear.  VRA is generally used for children ages six months to two years.  Tones or speech are presented to the child and their physical responses are used to determine the softest they can hear.  Physical responses, such as head turns toward the sound, are reinforced using pleasing visual displays of toys or lights.  Conditioned Play is commonly used for ages two through five.  Instead of the child responding to the sounds via hand raises or button pushing, the child is trained to respond in a more interactive way.  For example, putting blocks in a bucket, placing rings on a peg, or stacking connective blocks.

• Auditory Brainstem Response (ABR) uses electrodes placed on the head to measure neural activity in response to sound.  This test is utilized to determine cochlear and neural function for children who cannot give reliable responses using VRA or conditioned play and for adults with hearing loss of certain pathologies.  This test does not require participation and can be done while the patient is asleep or sedated.  ABR is one assessment used as a screening tool in newborn hearing screening programs.

• Otoacoustic Emissions (OAE) are soft echoes produced by the outer hair cells in the inner ear when they are stimulated by sound.  A small probe is inserted in the ear canal which produces sound and measures the tiny echo responses.  These responses will be present in a normal hearing ear and absent if there is greater than a 25-30 decibel hearing loss.  Much like ABR, no patient participation is necessary, so OAEs are commonly used for a screening tool in newborn hearing screening programs.

About Hearing Loss

Hearing loss is a decrease in hearing sensitivity. It may result from trauma, injury, exposure to high levels of noise, ear infections or as part of the aging process. Affecting people of all ages and backgrounds, it is an associated condition for many disorders, disabilities, or illnesses. Hearing loss can be described by the type of hearing loss, the degree of hearing loss, and the configuration of the hearing loss.

Types of Hearing Loss

Despite a variety of causes, hearing loss generally falls into one of three categories, depending on which section of the ear is affected.

• CONDUCTIVE hearing loss occurs when there is a breakdown of sound transference in the outer or middle ear. Excess wax, a hole in the eardrum, or an ear infection can cause conductive hearing loss. This type of loss can often be treated medically or surgically if caught in time. If medical treatment cannot completely resolve the hearing loss, hearing aids may be indicated. The prognosis of successful hearing aid use is typically very good with conductive hearing loss.

• SENSORINEURAL hearing loss occurs when the inner ear and/or the nerve of hearing (auditory nerve) do not properly send the sound information to the brain. Aging, exposure to loud sounds, head injuries, and certain medications are some of the causes of this type of loss. Sensorineural hearing loss is usually permanent. This is the most common type of hearing loss for individuals using hearing aids. The prognosis of successful hearing aid use is dependent on the degree of hearing loss.

• MIXED hearing loss, as the name implies, is a combination of conductive and sensorineural hearing loss.

Hearing loss in Adults

Hearing loss is often viewed as a problem only for the elderly. While it is a common symptom of aging, hearing loss can have an effect on anyone at any age.  According to the National Institute of Deafness and Other Communication Disorders, hearing impairment is present in 18% of American adults ages 45 – 64, 30% of adults ages 65 – 74, and 47% of adults 75 years old and older. Any amount of hearing loss can have a severe impact on one’s ability to understand and any degradation to communication can greatly impact quality of life.

Despite the impact on life, only 1 in 5 people who could benefit from hearing aids actually wears one.  If other impairing or disabling conditions are present, careful monitoring of hearing becomes even more important to maintain the ability to communicate for the health and well-being of the whole person. 

Hearing loss in Children

Hearing loss can also impact the lives of children. According to the Centers for Disease Control and Prevention, 3 in 1000 babies are born with hearing loss each year. Children are also susceptible to temporary hearing loss due to fluid in the middle ear. Any child with hearing loss has the possibility to develop speech delays whether the hearing loss is temporary, present at birth, or developed later. Hearing loss in children may not be obvious based on behavioral responses. The American Speech-Language-Hearing Association outlines some age-related milestones for hearing and language development. If your child is not meeting milestones, discuss them with your child’s pediatrician and consider a referral for an audiological evaluation. If hearing loss is present, there are many early hearing detection and intervention programs like the Sound Beginnings program in Kansas. An audiologist can help direct you towards the appropriate program.

WARNING SIGNS THAT YOUR CHILD MAY HAVE HEARING LOSS:

• Delayed speech and language development

• Using "what" and "huh" frequently

• Sitting close to the television when the volume is adequate for others

• Not being startled by intense sounds

• Does not awaken to loud noises

More than three million American children have a hearing loss. An estimated 1.3 million of these children are under the three years of age. Parents and grandparents are usually the first to discover hearing loss because they spend the most time with the child. Hearing loss may be temporary, caused by ear wax or middle ear infection, or may be permanent. Temporary losses may be corrected by medication or minor surgery. Those with permanent hearing loss may be fit with hearing aids at three months of age or earlier.

If you are worried about your child's hearing, please contact an audiologist to schedule a complete hearing evaluation as soon as possible.

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