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There are several different types of hearing tests that focus on different aspects of the hearing mechanism and test for hearing loss or impairment. Tests can be divided into two types – screening and diagnostic. As the titles suggest, screening identifies if there is a problem and diagnostic identifies what the problem is. Measuring auditory function can either be done subjectively, where the individual gives behavioural responses to auditory stimuli given by the tester, or objectively, where the individual cooperates while the tester measures physiological responses to auditory stimuli.
The most common subjective measure is pure tone audiometry, testing both air and bone conduction. The results are plotted and an audiogram and give an indication of the hearing ability of each ear. Often, the ear will work better at picking up some frequencies than others. This is likely to be the most common test conducted on an adult at a routine hearing assessment. The individual will be played a series of sounds (high and low frequencies) to see what they can hear, and to determine their hearing thresholds. See our Child Hearing Assessment page for a fuller explanation of Audiometry and audiograms.
There are also specific tests for the middle ear, tests for the inner ear and auditory pathways to pinpoint the source of the hearing loss. It may take a couple of different tests to exactly pinpoint the true cause of a hearing impairment.
Middle ear testing
Tympanometry or acoustic reflex measures are procedures to measure the functioning of the middle ear. Tympamometry measures the feedback from sounds put into the ear, and reflex measurements focus on the movements of the muscles in the middle ear in response to sound.
There are several objective measurements for testing sensorineural hearing loss:
Auditory brainstem response (ABR) measures the response along the auditory pathway by taking measurements from electrodes on the head.
Auditory Steady State Response (ASSR) is relatively new test and is often done in conjunction with ABR test. This test also measures the brains response to sound.
Otoacoustic emissions are a measurement of the low-intensity sound energy that is generated by the cochlear when it responds to sound. This is measured by sending sound into the ear and placing a microphone in the ear canal to measure the cochlear’s response.
Following a consultation and hearing assessment with an Audiologist, the fitting of some form of amplification may be suggested if the audiologist feels it would be beneficial. The Audiologist should reassure the individual by describing the benefits of hearing aids and advising on the range of aids available. It may be a good idea to focus on what the individual wants from an aid e.g. to hear conversations in meetings at work, or to converse with his spouse more easily etc. This can help encourage the individual to try hearing aids, if they can see the potential benefits. These actions may also help reduce the negative social perceptions some people have about wearing a hearing aid.
Following the fitting of the hearing aid the audiologist should provide some orientation sessions. These sessions will focus not just on hearing aid care and trouble shooting, but also adjusting amplification, discussing hearing aid use in different environments, and communication strategies.
Funding for hearing aids
Some health boards may be able to partly or totally fund a hearing aid and devices, depending on the country or area where you live. In other countries you may have to rely on your health insurance, if it covers hearing impairment, or purchase the aid yourself.
The stigma of hearing aids
For some people there is a stigma when it comes to wearing a hearing aid and this has probably been made worse by hearing aid wearers being made fun of in TV and film comedies. However, hearing devices are part of everyday life now for many people. Some people dislike wearing hearing aids because they are cosmetically ugly, but new digital hearing aids are very small and hardly noticeable, fitting right inside the ear. Some new digital hearing aids have also been designed to filter out some background noise and amplify spoken sound frequencies. Some aids also automatically control the volume for you. These are big steps in hearing aid development because in the past the hearing aid would amplify everything, including background noise.
Loop systems can be used in conference halls, churches, office meeting rooms, classrooms etc. Basically, a loop is a cable that is positioned around a room or building and this generates a magnetic field picked up by a hearing aid. The loop facilitates the listener (via their hearing aid) to hear events more clearly in larger, busier environments. The loop will also help eliminate some of the background noise that can be distracting for a hearing aid user.
Other Equipment used for Hearing Impairment
Other equipment is available for hearing impaired people to help with day-to-day living:
- flashing doorbells
- TV subtitles
- text telephones
- flashing alarm clocks
- vibrating alarm clocks
- telephone amplifiers
- flashing / vibrating smoke alarms
Hearing impairment can be very unpleasant and will be a fact of life for many of us. However, with the advent of new technology we can reduce the impact of this impairment and still lead active lives and continue with all the things we really enjoy.
Some adults are now receiving cochlear implants, these aids do not amplify the sound, but send impulses directly to the cochlear and stimulate the auditory nerve which sends the signal to the brain. They work best for adults who have previously had some hearing and then lost it. These are not usually a viable alternative to normal hearing aids for someone who is experiencing presbycusis, but rather they are an option for someone with severe hearing loss. Cochlear Implant wearers need to undergo a complex and expensive operation to have the aid fitted. However, for some adults cochlear implants have made a tremendous difference, allowing the listener to distinguish many different sounds and listen, speak and communicate much more effectively.
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