Hearing Tests

Hearing tests identify changes in hearing levels, what kind of changes and how these changes impact speech and hearing. The results of the hearing test is shown on an audiogram.

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

Depending on your insurance/medical care provider, your child may also need to see an ear, nose and throat specialist (ENT). ENTs will evaluate the ear, nose and throat to rule out any illness or other physical causes.

Audiograms

An audiogram is a graph of the result of a hearing test. It shows what sounds can be heard at different pitches or frequencies. Symbols are used on the audiogram to represent what the right ear or left ear hears.

The example audiogram on the right shows degrees of hearing loss. BabyHearing.org has more audiogram examples and explains how sounds are recorded.

Another audiogram you may see is a "speech banana audiogram" (shown below). An area of the audiogram will be colored yellow and it looks like a banana. That area shows were most conversational speech or sounds tend to happen. This helps audiologist and speech and language providers develop a plan to support a child's speech and listening development. A.G. Bell explains the speech banana further.

Common Tests Explained

Browse the three types of hearing tests and one speech recognition test available below.

Pure Tone Testing

Pure tone testing measures if the child can hear a sound or a spoken word. The child will either use headphones or listen to a speaker system. The child has to respond when he/she hears a sound. They can raise a hand, press a button, point to the ear where the sound was received, or say "yes".

There are two types of pure tone testing for younger children to provide a play-like environment.

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

Auditory Brainstem Response (ABR)

Tests of the Middle Ear

Tests of the middle ear measure how well the middle ear is functioning. It mainly looks at the physical structure of the ear. There are three types of middle ear testing:

- 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

Otoacoustic Emissions (OAEs)

Otoacoustic emissions tests measure how the inner ear responds to sounds when the cochlea is stimulated. It 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 The tests uses a small probe in the ear. It is harmless and the child does not need to respond.

This test is used as part of a newborn hearing screening.

Speech Recognition Threshold (SRT)

Frequently Asked Questions

How do I monitor changes in hearing levels?

There are various milestones with no one resource being the same. Checklists, like those below, can be helpful. It is more beneficial if you stay in continuous communication with your child and observe their responses. Pay attention to changes in response time or response accuracy.

Texas Department of State Health Services (DSHS) provides a hearing checklist for parents.

Your Child's Hearing Development Checklist (Silence Isn't Always Golden) - checklist for hearing milestones at specific ages. Available in English, Spanish, and Vietnamese, from National Institute on Deafness and Other Communication Disorders.

How Hearing Changes - checklist for hearing milestones at specific ages from Raising Deaf Kids

Speech and Language Developmental Milestones - from the National Institute on Deafness and Other Communication Disorders.

What is the cost of hearing tests?

My child is deaf and hard of hearing. Do they need a test every year?

My child has some hearing. How do I maximize it?