Do You Need a Hearing Test?

Spotting the Signs of Hearing Loss

Female doctor examining patient ear with otoscope
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Hearing loss in both children and adults can significantly impair lifestyle. More than 30 million adults in the United States are exposed to levels of noise that are dangerous for your hearing. If your hearing is damaged in adulthood, you may be at risk for missing opportunities for advancement if you do not have your hearing loss treated. Adults with untreated hearing loss tend to make less than adults with normal or corrected hearing.

If you have uncorrected hearing loss, then you are among the 80 out of 100 affected individuals that do nothing about improving their hearing.

Children that have hearing loss that is not treated early are at significant risk for developmental delay. By having your newborn child's hearing tested, not only can you help them maintain their developmental progress, but also save approximately $400,000 in treatment later in life. Screening costs are minimal, with some tests that can be performed for as little as $8.

Untreated hearing loss can negatively impact the following areas of your life:

  • physical health
  • emotional health
  • mental health
  • social skills
  • relationships with peers, family and work colleagues
  • academic and career success

Do I Need a Hearing Test?

For children, regular assessment of hearing loss risk factors should be reviewed by their pediatrician. According to Bright Futures by the American Academy of Pediatrics, you should have your newborn infants hearing tested soon after birth with the otoacoustic emissions (OAE) hearing test and, if necessary, confirmed with the brainstem auditory evoked response (BAER) hearing test within 3 to 5 days up to no later than 2 months.

After your child's infant hearing test, risk factors should be screened at regular health maintenance visits. Risk factors for your child include:

  • parental concern for hearing loss
  • family history of hearing loss
  • intensive care unit stay of greater than 5 days as an infant
  • ototoxic medication exposures (known for potential to cause hearing loss)

If your child has any of these risk factors, hearing tests will be performed more regularly to detect hearing loss as early as possible. Without any of the risk factors above, your child should have their hearing tested with audiometry at the following ages:

  • once at 4, 5, 6, 8 and 10 years of age
  • once between the ages of 11 to 14
  • once between the ages of 15 to 17
  • once between the ages of 18 to 21

If you do not show signs of hearing loss into adulthood, you still need to self monitor, and your physician will still look for signs of hearing loss during your physical exams by taking a thorough health history and by examining your ears. Both older children and adults can consider the following points to help identify if hearing loss should be discussed with your physician:

  • Other people mention that you listen to the TV too loud.
  • You have difficulty following conversations with more than one person talking at the same time.
  • You have trouble hearing with a lot of background noise.
  • You ask others to repeat themselves frequently.
  • You have trouble hearing women and children but not men.
  • Other people seem to be mumbling all the time.
  • You frequently find yourself misunderstanding what other people are saying.

If you feel that any of these statements are true, you should ask your physician to screen you for hearing loss. A primary care physician can perform basic hearing testing. Further evaluation for hearing problems can be referred to either an audiologist or an ENT specialist. The following is a list of common tests that you may have performed in order to evaluate your level of hearing loss.

Hearing Tests: Whispered Voice Test

An effective screening measure in to determine hearing loss in one or both ears. This test can easily be performed by any general practice physician and a great method to determine if you should be referred for further evaluation.

If your physician performs this test, they will stand behind you at an arm's distance. They will occlude one ear at a time and begin rubbing the tragus of your ear (which is the external flap that projects over the opening of your ear) in order to prevent hearing out of the one side. Your physician will then whisper a series of letters and numbers and have you repeat them back before testing the other ear.

Hearing Tests: Weber and Rinne Testing

A simple screening test that your physician can perform in the office is the Weber and Rinne Test. This is a great screening method to help determine if further assessment is necessary. The only equipment necessary for this testing method is a tuning fork. There should not be any pain associated with this test, however you will feel vibrations in your ear during part of the testing.

The Weber test is performed by striking the tuning fork on a solid object in order to start it vibrating. The end of the tuning fork will then be place on the bridge of the forehead, nose, or teeth. If you have normal hearing, the sound will be equally loud in both ears. If it is louder on one side, then your physician will assess for what type of hearing loss you have:

  1. Tuning fork sound is louder in your best hearing ear indicates sensorineural hearing loss.
  2. Tuning fork sound is louder in your worst hearing ear indicates conductive hearing loss.

The Rinne test is also performed by striking the tuning fork on a solid object in order to start it vibrating. However unlike the Weber test, there are two parts to this test. Your doctor will place the end of the tuning fork on your mastoid process, which is behind the lower portion of your ear in order to test your bone conduction of sound. Your physician will then move the tuning fork away away from your body, but close to your ear, in order to test your air conduction. A normal response to this test is that you should hear the sound (air conduction) more than you feel the sound (bone conduction). An abnormal response may signify conductive hearing loss.

Hearing Tests: Tympanometry

Tympanometry is a great screening tool when used with a pneumatic otoscope for fluid in the ear that may be causing conductive hearing loss. The test results in a tympanogram which shows a wave form that your physician can use to determine the likelihood of fluid behind your ear drum. This wave form illustrates to your physician either how well sound can be transmitted through your ear drum or how much it is being impeded. A flattened wave is consistent with otitis media.

Hearing Tests: Otoacoustic Emissions

Otoacoustic Emissions (OAE) testing is the preferred test for infants. Since the results do not require a response from the person, this test can also be useful in developmental delay or other disorders that make following instructions difficult. OAE measures the response of the cochlea to sound and can help assess cochlear dysfunction or conductive hearing loss.

Hearing Tests: Pure-Tone Audiometry (Audiogram)

The audiogram is a common screening method. In order to perform this test, an audiologist will have you sit in a quiet booth. There are two parts of this test in order to test for both air conduction and bone conduction abnormalities. Headphones are used to assess air conduction, while a bone oscillator (a small device that acts like a tuning fork) will be placed behind your ear over your mastoid to assess bone conduction. Each device will used different frequencies in order to determine the lowest threshold (in decibels) where you can hear the sound 50 percent of the time.

After this test is performed, your doctor will use the measurements received from the test to determine what type of hearing loss you are experiencing. When looking at your audiogram, you will see a graph showing a line of X's and O's. The X's represent your left ear results, while the O's represent your hearing from your right ear. The vertical axis of the graph represents the lowest level of loudness (in decibels) for you to hear the sound. The horizontal access represents the pitch that was being tested. This will allow your physician to understand at what frequency you are suffering from hearing loss and how severe your hearing loss is.

Hearing Tests: Speech Audiometry

Speech audiometry is a great test to validate an audiogram, and identify whether or not a hearing aid would be beneficial. It is also useful in identifying where the damage to the hearing has occurred. In the first part of the test, you be checked for the lowest level of volume at which you repeat back a series of two syllable words with 50 percent accuracy. The result, or speech reception threshold (SRT), should be relatively close to the pure-tone audiometry results.

The second part of a speech audiometry exam is the word discrimination score. This test uses a list of 50 phonetically-balanced words at which you will be asked to repeat each word. The list is read at a level of 40 decibels higher than the threshold determined in the first part of your test. This is the segment of the test that can help your physician determine if a hearing aid would be effective for you or not.

This test can be particularly important as 80 out 100 people suffering from hearing loss do not wear a hearing aid, but could benefit from one. As mentioned above, this can affect you academically, socially, and professionally.

Sources:

American Academy of Pediatrics. (2017). Recommendations for Preventive Pediatric Health Care. Accessed on April 25, 2017 from https://www.aap.org/en-us/Documents/periodicity_schedule.pdf

Haddad, J & Keesecker, S. (2016). Nelson Textbook of Pediatrics. 20th ed. Elsevier. 3071-3080.e1

Hearing Loss Association of America. (n.d.). Hearing Loss Facts & Statistics. http://www.hearingloss.org/sites/default/files/docs/HearingLoss_Facts_Statistics.pdf

Kelly, NR. (2017). Screening tests in children and adolescents. Accessed on April 25, 2017 from http://www.uptodate.com (Subscription Required)

Weber, PC. (2017). Evaluation of hearing loss in adults: Evaluation. Accessed on April 25, 2017 from http://www.uptodate.com (Subscription Required)

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