Hearing Evaluation

  • The American Speech-Language-Hearing Association (ASHA) explains that a hearing evaluation is typically more than just one test and is likely to include several, if not all of the following:

    • case history
    • physical exam
    • tests of middle ear function
    • pure-tone audiometry
    • speech audiometry


    An audiogram is a graph of the result of a hearing test.  The softest sound the child hears at each frequency is charted on the graph.  Information may be plotted separately for the right or left ear if the child was wearing headphones or together if a sound field speaker was used.

    Raising Deaf Kids section on audiograms gives information on:

    • what an audiogram is
    • how to read an audiogram
    • sample audiograms for different types of hearing loss
    • how the audiologist will do the hearing tests
    • what the audiogram tells you

    See information about audiograms from the American Speech-Language-Hearing Association (ASHA).

    Sample Audiogram with Speech Banana and Familiar Sounds pdf icon


    Checklists can be a great tool to monitor a child's hearing, speech, and language development. Below is a list of checklist options to track and compare your child's development in comparison with standard development in these areas.

    Hearing Loss:

    • Help Me Hear the Sounds of Texas pdf icon - checklist of behaviors at specific ages related to hearing provided by the Audiology Services Department at the Texas Department of State Health Services (DSHS)
    • Hearing Checklist pdf icon - questions parents on hearing milestones at specific ages and provides families with a form to document results of doctors visits related to their child's hearing - available in English and Spanish, provided by Texas Department of State Health Services (DSHS)
    • Your Child's Hearing Development Checklist (Silence Isn't Always Golden) - checklist for hearing milestones at specific ages, terms doctors might use, and a place for taking notes - available in English, Spanish, and Vietnamese, from National Institute on Deafness and Other Communication Disorders
    • Signs of Hearing Loss - checklist for hearing milestones at specific ages from Raising Deaf Kids

    Language and Communication:

    • The "Student Language and Communication Profile Summary," pdf icon developed by The Laurent Clerc National Deaf Education Center is a tool for determining a student's present level of performance related to communication and can be included on a student's IEP. The profile summary can include:
      • Unaided and Aided Hearing Level Results
      • ASL Skills Checklist
      • ASL Development Checklist
      • Spoken English Development Checklist
      • Receptive and Expressive Communication Continuums
    • Speech and Language Developmental Milestones - from the National Institute on Deafness and Other Communication Disorders. Includes information on:
      • how speech and language develop
      • milestones for speech and language development
      • hearing checklist for babies

    Common Tests Explained

    Tests commonly used include:

    an Infant being tested woth Otoacoustic Emissions (OAEs).Pure Tone Testing

    • used when the child can signal when he/she hears a sound, usually by raising a hand, pressing a button and pointing to the ear where the sound was received, or saying "yes" to indicate that the sound was heard.  
    • Young children may need a more play-like activity to indicate response.
      • Visual Reinforcement Audiometry (VRA) (age 6 months to 2 years) - child is trained to look toward a sound source
      • Conditioned Play Audiometry (CPA) (age 2-4 years) - child is trained to perform an activity each time a sound is heard

    Tests of the Middle Ear 

    • measure how well the middle ear is functioning.
      • Tympanometry - assists in the detection of fluid in the middle ear, perforation of the eardrum, or wax blocking the ear canal
      • Acoustic Reflex - measures information about the possible location of the hearing problem
      • Static Acoustic Impedance - measures the physical volume of air in the ear canal

    Auditory Brainstem Response (ABR)

    • gives information about the inner ear (cochlea) and brain pathways for hearing
    • performed by pasting electrodes on the head and recording brain wave activity in response to sound
    • person being tested rests quietly or sleeps while the test is performed
    • no response necessary

    Otoacoustic Emissions (OAEs)


    • measures response sounds given off by the inner ear when the cochlea is stimulated by a sound
    • uses a small probe in the ear
    • often part of a newborn hearing screening program
    • detects 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
    • no response necessary

    Speech Recognition Threshold (SRT)

    • records the faintest speech that can be heard half the time
    • records word recognition or the ability to correctly repeat back words at a comfortable loudness level

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