Hearing Test

Hearing loss is a problem encountered in every age group today. Men are more frequently affected by this issue compared to women. In addition to congenital causes, various factors such as exposure to loud sounds, advanced age, medication use, and even intracranial tumors can lead to hearing loss. The audiometry test is a frequently used method to determine the severity of this condition. With this test, an individual’s hearing capacity can be measured in detail, enabling accurate diagnosis and treatment planning.

Doctor Audiologist Emel Uğur

Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. During her 15-year tenure at Istanbul Training and Research Hospital, she primarily worked on Pediatric Audiology (Hearing Loss in Infants and Children), Otological Diseases (Ear Diseases and Hearing Health), and Vestibular System Disorders (Vertigo and Imbalance). In 2015, she joined the Acıbadem Healthcare Group.

About Me

What is an Audiometry Test?

An audiometry test is a procedure used to determine how the ear perceives sounds through air and bone conduction, and it measures the hearing level. During this test, the ability of the individual to hear is assessed based on the frequencies and intensities of the sound waves.

Accurately measuring hearing capacity has a significant impact on quality of life. Good hearing facilitates daily communication and enhances social interactions. The hearing test plays a critical role in the early diagnosis of hearing problems. Hearing loss can develop in particular under the following circumstances:

• Congenital hearing loss caused by genetic factors,
• Ear infections and issues with a perforated eardrum,
• Prolonged exposure to loud sounds,
• Inner ear diseases,
• All conditions related to hearing loss or impairment.

Why is an Audiometry Test Performed?

An audiometry test is a medical procedure performed to identify potential disorders in an individual’s hearing level. This test is particularly important for individuals experiencing or suspecting hearing difficulties. It is crucial that individuals have been examined by an ENT specialist and have undergone an otoscopic examination before taking the test to ensure reliable results.

Reasons for undergoing an audiometry test include:

• Consistently hearing sounds muffled,
• Difficulty understanding speech,
• Receiving comments that they speak too loudly,
• Struggling to hear conversations in noisy environments,
• Feeling the need to constantly turn up the volume on the television or radio.

By determining the presence and degree of hearing loss with this test, various treatment options ranging from auditory amplification to surgical interventions can be tailored to the individual. Additionally, the hearing test plays a critical role in the early diagnosis of hearing loss. Early diagnosis can prevent the progression of hearing loss and significantly improve quality of life.

What Causes Hearing Loss?

Hearing loss can occur in all age groups due to various factors. Some of these include:

• Diseases such as meningitis,
• Trauma to the head,
• Tumor or polyp formation in the ear,
• Frequent ear infections,
• Pathologies related to the eardrum,
• Prolonged exposure to loud sounds,
• Use of certain chemotherapy drugs or antibiotics,
• Hearing problems that run in the family,
• Advanced age,

These factors can lead to a reduction in an individual’s hearing capacity over time, which can be determined through an audiometry test.

How is the Pure Tone Audiometry Test Performed?

Pure tone audiometry is one of the most commonly used methods among hearing tests. This test aims to determine an individual’s hearing sensitivity and thresholds. Hearing ability is evaluated specifically at frequencies critical for communication, and each ear is examined separately during the test.

The test is conducted in specially sound-isolated cabins. It is essential that the patient is completely isolated from external sounds to ensure the most accurate results. Specially calibrated acoustic stimuli are presented to the patient through calibrated headphones. The purpose of these tests is to determine the degree and type of hearing loss.

The test results play a critical role in accurately diagnosing hearing loss. The results are evaluated by a clinician and appropriate treatment methods are determined. The test duration varies based on the individual’s hearing level, type, degree, and configuration of hearing loss, and various techniques specific to the patient’s hearing may be used.

What is Speech Audiometry?

Speech audiometry is an important method used in hearing tests. The primary goal of this test is to evaluate how the patient perceives and hears human speech. Various thresholds have been determined for a detailed analysis of hearing capacity. The test procedure is arranged to measure how accurately the patient can repeat words at specific sound intensities. Four main thresholds are used in speech audiometry:

• Speech Reception Threshold (SRT): The sound intensity at which patients correctly hear 50% of the words presented.
• Speech Discrimination Score (SDS): A threshold that measures how accurately a patient can repeat words at a specific sound level, in addition to the hearing threshold, for a more detailed evaluation of speech perception.
• Most Comfortable Listening Level (MCL): The sound level at which the patient can listen comfortably and communicate effectively.
• Uncomfortable Loudness Level (UCL): The point at which the sound becomes uncomfortably loud for the patient.

Speech audiometry is always used in conjunction with pure tone audiometry. Based on the responses given by the patient, the hearing level, the most comfortable sound level, the level at which the sound becomes uncomfortable, and higher-level processing abilities such as speech reception and discrimination are all evaluated in a single session.

How is a Hearing Test Performed in Infants?

In our country, all newborns are evaluated under a hearing screening program. The first test administered in this evaluation is the Screening ABR (T-ABR) test. The protocol of the program outlines the risk factors and the referral chain. The methods used for further evaluation in infants who require additional testing according to the referral chain vary. The methods used to assess hearing in infants include:

• Auditory Brainstem Response (Clinical ABR)
• Otoacoustic Emission Test (OAE)
• Immittance Measurements

These tests evaluate the infant’s hearing ability at an early stage. In cases where necessary, behavioral observation audiometry is also added to the test battery. While ABR, OAE, and immittance measurements are performed during sleep, behavioral observation audiometry requires the child to be awake, as it is based on the child’s response to auditory stimuli.

What Do the Hearing Test Results Mean?

The results of a hearing test provide a detailed analysis of an individual’s hearing capacity. These results determine various levels of hearing, helping the individual become aware of the challenges they might face in daily life. In adults, a hearing level of around 20 dB is generally considered normal. The measurements define different levels of hearing loss:

• Mild hearing loss: 21-40 dB
• Moderate hearing loss: 41-55 dB
• Moderately severe hearing loss: 56-70 dB
• Severe hearing loss: 71-90 dB
• Profound hearing loss: 91-100 dB

This classification helps to better understand the impact of hearing loss on daily life. For example, an individual with moderate hearing loss may have difficulty understanding speech when there is background noise.

What is Tympanometry?

Tympanometry is one of the objective measurement methods used to evaluate the functionality of the middle ear and the tympanic membrane. During the test, air pressure is applied to the external auditory canal, and the way the tympanic membrane responds to these pressure changes is observed. The resulting movements are recorded and analyzed by a special device. Tympanometry

• Provides valuable information about the health of the middle ear structures.
• Can be applied to all age groups, including infants.

What are Acoustic Reflex Tests?

Acoustic reflex tests are an important method used to evaluate the integrity of the auditory pathways. The stapedius muscle in the middle ear responds to sound waves with a reflex, and this response is called the acoustic reflex. This test helps identify the causes and location of hearing loss. It provides information about the auditory pathways up to the brainstem. This test is especially useful for understanding the functionality of the brainstem. The test results must be evaluated together with other findings. Thus:

• The patient’s hearing condition is more clearly understood.
• It is used to determine whether the hearing loss is cochlear or retrocochlear.
• The origin of the problems caused by hearing loss can be identified.

What is the BERA/ABR Test?

The BERA or ABR test holds a special place among hearing evaluations. Therefore, it must be administered by experienced clinical audiologists. It is especially used to analyze auditory functions in children and in patients who do not respond to standard tests. The test checks the health of the neural pathways from the ear to the brainstem. During this procedure, auditory stimuli are delivered through the ear, and the electrical responses in the brain are measured. Any damage in the neural pathways that transmit sound to the brain can be detected with this test. Any issue in this complex system, from the inner ear to the auditory regions in the brain, can be identified with the ABR test.

It should never be used alone. When performing an ABR, it is essential to also perform

• Acoustic Immittance (Tympanometry/Acoustic Reflex)
• Otoacoustic Emissions
• ABR Test

These tests must be performed as well.

How is the Clinical ABR Test Performed?

The clinical ABR test is a method used to evaluate auditory functions. It is suitable for adults with hearing problems as well as newborns and children at risk. The test is conducted by an audiologist and is painless. At the beginning of the test, the skin in the head region and around the ears is cleaned. Then, electrodes are placed in these areas:

• Skin cleaning
• Electrode placement

Once the electrodes are connected to the computer, they become active. Special acoustic stimuli are delivered through headphones, and the resulting electrical (neural) activity is recorded by the computer. The administration of the test is objective, while the evaluation is subjective. Therefore, it should be performed by experienced clinicians.

Because the patient must remain still during the test, it is preferably performed while the patient is asleep.

For infants under six months and children up to two years old, if there is no contraindication, the test is performed naturally during sleep without sedation. If necessary, sedation may be applied. Sedation does not alter or affect the test results. The audiologist may advise the baby to fast for a while before the test to facilitate sleep during the test. The data collected during the test are transferred to a computer and recorded. The clinician analyzes the test after completion.

What Treatments are Available Based on the Test Results?

The treatment of hearing loss is determined by a detailed analysis of the test results. Factors such as the degree and underlying cause of the hearing loss are critical in choosing the appropriate treatment. Depending on the difficulties caused by hearing loss, various treatment methods are implemented, ranging from auditory amplification options to surgical interventions. For example, technological solutions such as hearing aids and cochlear implants are frequently used to manage hearing loss. These devices aim to reduce the difficulties that patients face in their social and professional lives.

Factors to consider when choosing treatment methods include:

• Degree of Hearing Loss
• Underlying Cause of Auditory Loss
• Age
• Ability to Adapt to the Treatment Method
• Family’s Perspective on Hearing Loss

Hearing aids are available in different models depending on the degree of hearing loss. These devices aim to maximize the patient’s current hearing capacity. A cochlear implant is recommended for more advanced hearing losses. The implant is a device that directly stimulates the auditory nerve and provides an effective hearing experience.

Frequently Asked Questions

Can a hearing test be performed at home?

Yes and No! New-generation digital applications that make it possible to perform hearing tests at home, at work, in restaurants, on the subway, everywhere, are now available. These tests are generally conducted via online platforms or mobile applications. However, these tests never provide definitive results and do not have medical validity. Therefore, if there is a suspicion of hearing loss, professional services from audiology clinics must be sought.

What is the normal hearing level in dB?

A normal adult’s hearing level is generally considered to be in the range of 0-20 dB. This level is sufficient to comfortably perceive environmental sounds. Thus, a hearing capacity of 20 dB is ideal for hearing everyday sounds. For example, an individual with this level can easily distinguish speech, nature sounds, and ambient noise. Therefore, a person with a normal hearing level does not experience any difficulties in daily communication and interactions.

How much do hearing tests cost?

The cost of hearing tests varies depending on several factors. In audiological procedures, prices may differ based on the test methods used, who administers the test, the equipment used, and the location.

Costs in city centers are generally higher compared to rural areas.

In facilities where doctor-audiologists and specialist audiologists work, test fees may be higher compared to those performed by audiometry technicians. This is not only related to professional responsibilities but also to expertise and experience.

Additionally, the type of test, the quality of the equipment used, and the use of advanced technology contribute to higher costs. Moreover, consultations, follow-up appointments, and other evaluations may add to the total cost.

Does SGK cover hearing tests?

SGK can cover hearing tests under certain conditions. Hearing tests performed in state and university hospitals are generally covered by SGK. However, it is necessary to check whether hearing tests performed in private hospitals are included in SGK coverage.

The hearing tests and health board reports required for the purchase of a hearing aid may be included in SGK coverage. Payment conditions vary according to the individual’s age and employment status.

Which department should be visited for a hearing test?

The department to directly apply for a hearing test is the Ear, Nose, and Throat (ENT) department. An ENT specialist can perform audiological evaluations after assessing the patient’s condition. The ENT examination is essential for the accuracy and feasibility of the tests. In this process, the initial evaluation by an ENT specialist is fundamental. Therefore, in cases of hearing complaints, one should first consult the ENT department.