Hearing Loss
Pure-Tone Testing

Pure-Tone Testing

Types of Tests:

A pure-tone air conduction hearing test determines the faintest tones a person can hear at selected pitches (frequencies), from low to high. During this test, earphones are worn so that information can be obtained for each ear.

Sometimes, use of earphones for the test is not possible, such as when a child refuses to wear them. In these cases, sounds are presented through speakers inside a sound booth (called sound-field screening). Since sound-field screening does not give ear-specific information, a unilateral hearing loss (hearing loss in only one ear) may be missed.

The person taking the test may be asked to respond to the sounds in a variety of ways, such as by:

  • Raising a finger or hand
  • Pressing a button, pointing to the ear where the sound was received
  • Saying "yes" to indicate that the sound was heard

The results are recorded in an audiogram.

Sometimes, young children are given a more play-like activity to indicate response. The most common techniques involve visual reinforcement audiometry (VRA) and conditioned play audiometry (CPA).

Visual reinforcement audiometry is the method of choice for screening children between 6 months and 2 years of age. The child is trained to look toward a sound source. When the child gives a correct response (e.g., looking to a source of sound when it is presented), the child is "rewarded" through a visual reinforcement. Example rewards include getting to watch a toy that moves or a flashing light.

Conditioned play audiometry can be used as the child matures and is commonly used with toddlers and preschoolers (ages 2–5). The child is trained to perform an activity each time a sound is heard. The activity may involve putting a block in a box, placing pegs in a hole, or putting a ring on a cone.

If there is a blockage, such as wax or fluid, in the outer or middle ears, a method called pure- tone bone conduction testing may be used. With this technique, the blockage is bypassed by sending a tone through a small vibrator placed behind the ear (or on the forehead). The signal reaches the inner ear (or cochlea) directly through gentle vibrations of the skull. This testing can measure response of the inner ear to sound independently of the outer and middle ears. In these cases, this test helps the audiologist determine the type of hearing loss being measured.

How To Tell If Your Child’s Hearing is Normal

How To Tell If Your Child’s Hearing is Normal

About Child’s Hearing

Many children under the age of 18 have some hearing loss including four out of every thousand newborns. Hearing loss can increase the risk of speech and language developmental delays. So, every parent and caregiver should be aware of the signs of hearing loss in his/her child and seek a professional diagnosis.

How the Ear Works

The ear has three main parts: the outer, middle and inner ear – please see the picture for more detail. The outer ear (the part you can see) opens into the ear canal.

The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate.

The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.).

Indicators for hearing loss

During pregnancy

  • Mother had German Measles, a viral infection or the flu
  • Mother drank alcoholic beverages


  • Weighed less than 1.5 kg at birth
  • Has an unusual appearance of the face or ears
  • Was jaundiced (yellow skin) at birth and had an exchange blood transfusion
  • Was in neonatal intensive care unit (NICU) for more than five days
  • Received an antibiotic medication given through a needle in a vein
  • Had meningitis
  • Failed newborn hearing screening test


  • Has one or more individuals with permanent or progressive hearing loss that was present or developed early in life


  • Received an antibiotic medication given through a needle in a vein
  • Had meningitis
  • Has a neurological disorder
  • Had a severe injury with a fracture of the skull with or without bleeding from the ear
  • Has recurring ear infections with fluid in ears for more than three months

Response to the environment – speech and language development

Newborn (Birth to 3 Months)

How to tell if your child’s hearing is normal – some signs there may be a problem with your child’s hearing

  • Does not startle, move, cry or react in any way to unexpected loud noises
  • Does not awaken to loud noises
  • Does not freely imitate sound
  • Cannot be soothed by voice alone
  • Does not turn his/her head in the direction of your voice
  • Does not point to familiar persons or objects when asked
  • Does not babble or babbling has stopped

Infant (3 months to 2 years)

  • Does not accurately turn in the direction of a soft voice on the first call
  • Is not alert to environmental sounds
  • Does not respond on first call
  • Does not respond to sounds or does not locate where sound is coming from
  • Does not begin to imitate and use simple words for familiar people and things around the home
  • Does not sound like or use speech like other children of similar age
  • Does not listen to TV at a normal volume
  • Does not show consistent growth in the understanding and the use of words
  • By 12 months does not understand simple phrases by listening alone, such as “wave bye-bye,” or “clap hands”

Hearing tests: How, when, and why

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be professionally tested.

Tests for newborns and infants under one year

Hearing tests are painless, and they normally take less than half-an-hour.

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a microphone is placed in the baby’s ear. It sends soft clicking sounds, and a computer then records the inner ear’s response to the sounds. In the AABR test the child must wear earphones. Sensors are placed on his/her head to measure brain wave activity in response to the sound.

For infants over six months of age, the diagnostic auditory brainstem response and the visual reinforcement audiometry (VRA) tests are commonly used. The diagnostic auditory brainstem response test is similar to the AABR test, but it provides more information. The VRA test presents a series of sounds through earphones. The child is asked to turn toward the sound, and then he/she is rewarded with an entertaining visual image.

Tests for older children and adults

Children between two and four years old are tested through conditioned play audiometry (CPA). The children are asked to perform a simple play activity, such as placing a ring on a peg, when they hear a sound. Older children and adults may be asked to press a button or raise their hand.

All children should have their hearing tested before they start school. This could reveal mild hearing losses that the parent or child cannot detect. Loss of hearing in one ear may also be determined in this way. Such a loss, although not obvious, may affect speech and language.

Hearing loss can even result from earwax or fluid in the ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

In contrast to temporary hearing loss, some children have nerve deafness, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’s existing hearing.

Please note that this information is not a substitute for an ear examination or a hearing test.

What you should do

If you have checked one or more of these indicators, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

If you did not check any of these factors but you suspect that your child is not hearing normally, contact your local doctor who will arrange for you to see an ear nose throat specialist and have your child’s hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist.

I can hear, but don’t understand. Why

I can hear, but don’t understand. Why

For the majority of individuals with a hearing loss, two things are happening, often at the same time.

First it’s unusual to lose the ability to hear equally across all frequencies (pitches). Typically you lose higher frequencies first. The higher frequencies are where many consonant sounds can be found. In all likelihood what you’re able to hear are a lot of vowel sounds and lower frequency consonant sounds (for example m, b, p) and what you’re not able to hear are the higher pitched consonant sounds (for example s, t, c, f, th, sh). In other words depending on your hearing loss, you’re hearing far less than 100% of every word. The effect of a high frequency loss is that you may be able to decifer what a person is talking about in a complete sentence but that may not always be the case.

Secondly you may face is a less than ideal signal to noise ratio. The signal to noise ratio is essentially the level or volume of what you want to hear compared to the level or volume of what you don’t want to hear. As the noise level increases, the signal to noise ratio becomes poorer and the sounds you were barely able to hear before are becoming much more difficult to hear. The percentage of every word you hear is declining and as it declines so does your ability to figure out or to understand what someone is saying.
Hearing loss comes is many variations.

Unless you’re an audiologist, when you think of hearing loss, severe hearing loss or deafness probably come to mind. But mild, moderate and high frequency hearing losses are actually much more common. With these hearing losses, the only symptom may be subtle difficulty with word understanding, especially in situations where there is competing noise.

Certain voices or words may be sound garbled, as if others are mumbling. At times, you may play the television and radio at louder than normal volume levels, but still some words may not come through clearly. Hearing on the telephone may be difficult sometimes, especially if the person on the other end has an accent. Music may sound distorted at times, even when the overall volume of the music is comfortable, leading to a decreased enjoyment of music.

Other symptoms of hearing loss may include asking people to repeat what they say, perception of people not speaking clearly, difficulty with women’s and children’s voices, and difficulty hearing when the person speaking is at a distance. In general, in situations where there is background noise – such as in restaurants, family gatherings, parties, etc. – hearing (or rather, understanding what is said) is much more difficult for people with hearing loss.

If you have difficulty understanding words, voices or conversations at times when others around you don’t seem to be having difficulty, you may have a hearing loss. In this case, a comprehensive hearing evaluation by a professional is recommended.

Our owner, Robert Hutchcraft, explains why you can hear sound but not understand what is being said. This video talks about how hearing loss starts out.

What Types of Hearing Tests are Available

What Types of Hearing Tests are Available

According to the ASHA (American speech-language-hearing association), There are several types of hearing tests. Here’s a list of the hearing tests we offer.

  • Pure-Tone Testing
  • Speech Testing
  • Tests of the Middle Ear
  • Auditory Brainstem Response (ABR)
  • Otoacoustic Emissions (OAEs)

Pure-Tone Testing

This is the test most people think about when the think “hearing test”. The pure-tone air conduction test determines the faintest tones a person can hear at selected pitches, from low to high. You wear earphones for this test to gain information from each individual ear. During the test you may be asked to raise your hand, or press a button when you hear the tones.

Speech Testing or Live Speech Mapping

With special equipment a hearing professional can actually measure the live speech of your spouse or family member. A microphone is placed between the hearing aid’s speaker and your eardrums to measure exactly how much amplification at every frequency the hearing aid is producing. Speech testing may be done in a quiet or noisy environment. Difficulty understanding speech in background noise is a common complaint of people with hearing loss, and this information is helpful.
A live speech test allows your hearing professional to program your hearing aids with a proportionate amount of amplification to offset your specific hearing loss at each frequency.

Middle Ear Tests

The audiologist may also take measurements that will provide information about how the middle ear is functioning. These measurements include tympanometry, acoustic reflex measures, and static acoustic measures. This type of testing is particularly important in preschool children (ages 3–5), for whom hearing loss is more often associated with middle ear disease.

Auditory Brainstem Response (ABR)

Performed by an Audiologist, the auditory brainstem response (ABR) test gives information about the inner ear (cochlea) and brain pathways for hearing. The test can be used with children or others who have a difficult time with conventional behavioral methods of hearing screening. The ABR is also indicated for a person with signs, symptoms, or complaints suggesting a type of hearing loss in the brain or a brain pathway. This is a specialized test that is not usually required until simpler test have determined a further investigation into a person’s hearing loss.

Otoacoustic Emmissions (OAEs)

Otoacoustic emissions (OAEs) are sounds given off by the inner ear when the cochlea is stimulated by a sound. When sound stimulates the cochlea, the outer hair cells vibrate producing a nearly inaudible vibration. The sound can be measured with a small probe inserted into the ear canal.

People with hearing loss greater than 25–30 decibels (dB) do not produce these very soft sounds. The OAE test is often part of a newborn hearing screening program. However this particular test can also detect blockage in the outer ear canal, as well as the presence of middle ear fluid and damage to the outer hair cells in the cochlea.



Tinnitus ("TIN-a-tus" or "Tin-EYE-tus") refers to "ringing in the ears" when no other sound is present. Tinnitus can sound like hissing, roaring, pulsing, whooshing, chirping, whistling, or clicking.

Tinnitus can occur in one ear or both ears. Below are some commonly asked questions about tinnitus.

Is tinnitus a common problem?

Yes. Almost everyone at one time or another has experienced brief periods of mild ringing or other sounds in the ear. Some people have more annoying and constant types of tinnitus. One third of all adults experience tinnitus at some time in their lives. About 10%–15% of adults have prolonged tinnitus requiring medical evaluation. The exact cause of tinnitus is often not known. One thing is certain: Tinnitus is not imaginary.

Is tinnitus a disease?

No. Just as fever or headache accompanies many different illnesses, tinnitus is a symptom common to many problems. If you have tinnitus, chances are the cause will remain a mystery.

What causes tinnitus?

Conditions that might cause tinnitus include:

  • Hearing loss
  • Ménière's disease
  • Loud noise exposure
  • Migraine headaches
  • Head injury
  • Drugs or medicines that are toxic to hearing
  • Anemia
  • Hypertension
  • Stress
  • Too much wax in the ear
  • Certain types of tumors
  • Too much coffee
  • Smoking cigarettes

Why is my tinnitus worse at night?

During the day, the distractions of activities and the sounds around you make your tinnitus less noticeable. When your surroundings are quiet, your tinnitus can seem louder and more bothersome. Fatigue and stress may also make your tinnitus worse.

How is the cause of tinnitus diagnosed?

Tinnitus is a symptom of a problem. The first thing you should do is to try to find out the underlying cause. You should have a medical examination with special attention given to conditions associated with tinnitus. You should also receive a full hearing evaluation by an audiologist to see if hearing loss may be causing your tinnitus.

Should I see an audiologist?

Your hearing should be tested by an audiologist certified by ASHA to see if hearing loss is present. Since tinnitus can be associated with a number of hearing-related conditions, the hearing (audiologic) evaluation can help provide information about the cause and treatment options for you.

Can tinnitus actually be measured?

Tinnitus cannot be measured directly. The audiologist relies on information you provide in describing your tinnitus. The audiologist will ask you questions such as:

  • Which ear is involved? Right … left … both?
  • Is the ringing constant?
  • Do you notice it more at certain times of the day or night?
  • Can you describe the sound or the ringing?
  • Does the sound have a pitch to it? High pitch … low pitch?
  • How loud does it seem? Does it seem loud or soft?
  • Does the sound change in volume or pitch over time?
  • Do you notice conditions that make the tinnitus worse—such as when drinking caffeinated beverages, when taking particular medicines, or after exposure to noise?
  • Does the tinnitus affect your sleep … your work … your ability to concentrate?
  • How annoying is it? Extremely so or not terribly bothersome?

In discussing your answers to these questions, the audiologist can give you information that will increase your understanding of your tinnitus.

Knowing more about the cause of your tinnitus can be a great relief. When the possible cause of your tinnitus is understood, your stress level (which can make tinnitus worse) is frequently reduced. You can "take charge" by anticipating, preventing, and changing situations that make your tinnitus worse.

How is tinnitus treated?

The most effective treatment for tinnitus is to eliminate the underlying cause. Tinnitus, in some cases, can be a symptom of a treatable medical condition. Unfortunately, in many cases, the cause of tinnitus cannot be identified, or medical or surgical treatment is not an option. In these cases, the tinnitus can still be managed using a variety of other methods. Be sure to discuss with your doctor any medical treatment options before considering tinnitus management.

Tinnitus management can include:

  • Biofeedback
  • Hypnosis
  • Electrical stimulation
  • Relaxation therapy
  • Counseling
  • Habituation therapies
  • Tinnitus maskers
  • Sound machines

Audiologists and otolaryngologists (ear, nose, and throat doctors, or ENTs) routinely collaborate in identifying the cause of tinnitus and providing treatment and management. A treatment that is useful and successful for one person may not be appropriate for another.

Will a hearing aid help my tinnitus?

If you have a hearing loss, there is a good chance that a hearing aid will both relieve your tinnitus and help you hear. Your audiologist can assist with the selection, fitting, and purchase of the most appropriate hearing aids for you. Your audiologist will also help you learn how to get the best use out of your hearing aids.

What is a tinnitus masker?

Tinnitus maskers look like hearing aids and produce sounds that "mask," or cover up, the tinnitus. The masking sound acts as a distracter and is usually more tolerable than the tinnitus.

The characteristics of the tinnitus (pitch, loudness, location, etc.) that you describe for the audiologist determine what kind of masking noise might bring relief. If you have a hearing loss as well as tinnitus, the masker and the hearing aid may operate together as one instrument.

Like all other treatments for tinnitus, maskers are useful for some, but not all people. As with a hearing aid, a careful evaluation by an audiologist will help decide whether a tinnitus masker will help you.

Are there other devices that can help me?

Sound machines that provide a steady background of comforting noise can be useful at night or in a quiet environment. Fish tanks, fans, low-volume music, and indoor waterfalls can also be helpful. Today there are even applications for portable media players (iPod or MP3 players) that offer a variety of masking sounds that may reduce the annoyance of tinnitus.

Should I join a self-help group?

Tinnitus can be stressful because it can be difficult to describe, predict, and manage. Self-help groups are available in many communities for sharing information and coping strategies for living with tinnitus.

Often a self-help group promotes feelings of hope and control. Members of the group share strategies they have found successful in dealing with their tinnitus. It can help to be reassured that you do not have a rare disease or serious brain disorder or are not going deaf. With support, people with tinnitus usually find that they can cope with their tinnitus.