Hearing Health Series: Part Two

What To Expect During Your Hearing Evaluation

Are you ready to reconnect with your life? More specifically, are you ready to re-enter the social aspects which allow you to connect with your friends and family? 

We’ve identified how hearing loss can impact your overall quality of life in Hearing Health Part One. If you missed it, take a moment and catch up — it’s chock-full of information that’ll get you thinking. 

And now that you’ve had a chance to reflect and self-assess your current hearing health condition, you’re back and at the very least curious. I’m glad. And I’m excited that you’re allowing me to be a part of this journey with you.  

Hopefully, by now, you’ve found an audiologist in your area. Maybe your loved one or friend who was perhaps a bit too happy and quick to confirm your hearing isn’t what it used to be, even had an excellent recommendation or helped you find one. 

Regardless, there is no better time than the present to begin your journey to better hearing health.

Helen Keller, the first deaf-blind person to earn a bachelor’s degree among being an acclaimed author, political and social activist, made a profound and oh-so accurate statement[1]: 

Wondering where to begin? Why not start with a free hearing consultation.

You might be wondering, “What’s the point? Why not just schedule a hearing evaluation and get it over with?” 

Well, the point is twofold.

1. You’ll get a good sense if you’ve found the right audiologist for you — it’s okay to be selective; they’re an essential part of your health care team.

2. Knowledge is power. You should never feel like someone’s selling you something you don’t need, including hearing aids. It’s a big purchase, why not be confident they’re what you need and that you’re getting the RIGHT hearing aids?

When you schedule a free hearing consultation with us at Audiology Northwest, it includes a pure-tone or air conduction testing. 

Pure-tone testing is all you get when you see an offer for Free Hearing Tests. Free hearing tests are very seldom complete diagnostic evaluations like you’ll get when you schedule a hearing exam with an audiologist. 

I highly recommend you DO NOT BUY HEARING AIDS when your provider only has this limited data. Not only are you rolling the dice as to whether you’ll end up with the right hearing aids for your hearing loss, but what’s worse is you might miss finding out about a medical condition that needs attention. 

Air Conduction or Pure-Tone Testing

Air conduction or pure-tone testing is the basic test where you put on headphones and raise your hand when you hear the ‘beep.’ In other words, how loud you can hear at different pitch levels or frequencies. It merely tells us your general ability to hear. 

Sounds good, right? Unfortunately, not. Here are the two main issues and why audiologists don’t consider it a diagnostic evaluation in and of itself:

1. It tells us about the sensitivity of your ears, your ‘degree’ of hearing, but nothing about how your brain interprets what it hears. 

2. It includes all the parts of your ear anatomy up to the hearing center in the brain. Small system, yes, but awesomely intricate. There is no way to differentiate ‘where’ the problem is until we run the full series of tests. 

   • For example, we will only find issues causing hearing loss such as fluid in the middle ear, collapsed ear canal cartilage, or scarred eardrum when comparing air conduction to bone conduction thresholds.

So, unless we can identify the cause, all this test confirms is your current level of hearing loss, and whether it will be worthwhile to pursue further testing. That’s why it is part of a consult and why it’s free — and why you need to see an audiologist! 

Now here’s what you get when you schedule a full diagnostic hearing exam.

But first, a note about Audiology Northwest’s in-home audiology experience.

There’s nothing we can’t do at an in-home appointment that a brick and mortar audiology clinic can when diagnosing the specifics of hearing loss.

Plus, being in your environment allows us to get a better and more accurate assessment of your hearing needs.

In fact, your test results from in-home testing will be just as accurate and often better than the results you’d have when in a clinic setting.

For more information about the Audiology NW difference check out the Your Experience page.

Now to discuss the additional tests that make-up comprehensive hearing examination.

The following tests give us crucial information about your specific hearing health, which is 100% necessary when prescribing hearing aids.

Bone Conduction Testing 

In this second test, we’re testing how you hear at the nerve level. To do this, we use something like a tuning fork. It’s a bone conductor headset that sits on the skull behind the ear and gently vibrates the bone, setting sound waves in motion inside the inner ear or cochlea.  

With this test, we bypass the ‘mechanical’ parts of the outer and middle ear anatomy — the sound forms as a result of the bone vibration at different frequencies rather than acoustic sound waves. Fast vibrations would be a higher frequency; slow vibrations would be a lower frequency of sounds. Here’s what this test tells your audiologist:

• This simple test tells us so much, but the one doing the test needs to know how to interpret it in conjunction with your history and the rest of the test series.  It can tell us What type of hearing loss you have and provides more insight into what it stems from. Such as noise? Age? Related to other medical conditions or medications?  Damage to or deterioration of the ossicles and their joints?  Fluid or infection in the middle ear?  Damage to the eardrum?  This is not an exhaustive list.

• We know your hearing loss is nerve-related if the results for both the air and bone conduction tests are the same. 90% of all hearing loss cases are sensorineural, or nerve-related[2]. Learn more about sensorineural hearing loss in my post titled, Could the Secret to Aging with Grace Be Through Quality Hearing?.

• When the air conduction test results are worse than the bone conduction test results, we call that the air-bone gap. This gap tells us there’s something medical or physical going on, and further testing or examination is needed to determine the underlying cause.

Speech Audiometry Testing

This test is similar to pure-tone testing using the headset but with speech instead of tones. We’re looking for two specific things:

1. Speech Reception or Recognition Threshold: What’s the softest spoken word you can hear and repeat and does this coincide with the average hearing ability we determined through pure-tone testing...if not, we need to find out why.  Something is not adding up. 

2. Word Recognition Scores: This test scores how many phonetically balanced (PB) words you recognize correctly out of a list of up to 50 single-syllable words, and tells us the following[3]:

   1. How many of the speech sounds you’re understanding.  For instance, with nerve, or ‘the most typical’ type of hearing loss, the first sounds you stop hearing are the high pitched soft sounds like ‘t’ and ‘s.’

   2. It helps us determine the type and cause of your hearing loss and how to counsel you on what to expect using amplification.

   3. Speech-in-Noise Testing determines how background noise impacts your ability to hear, directly affecting which type of hearing aids you need. 

      • Basic hearing aids won’t do much for you in a noisy environment — other than cause your frustration. So, we’ll be selecting a hearing aid that offers better noise-canceling features.

But we don’t stop there. There’s an extensive list of everything an audiologist will do to get the full picture of your hearing health and what treatment and counseling you’ll need to learn to successfully live with a hearing impairment and be successful with hearing aids.

Here’s a thorough overview of what your audiologist can do.

And for ‘fun’ — and to reiterate the significance of choosing an audiologist — I compared our services to what you can expect if you choose a hearing instrument dispenser as your provider

*Please note there is A TON of information in this chart. So please don’t hesitate to ask for further clarification or details in the comments section. Otherwise, stay tuned as future posts will undoubtedly explain these different pieces of information.*

This scope of practice comparison is defined by the minimum standards of practice for Hearing Instrument Fitting and Dispensing by WACs > Title 246 > Chapter 246-828 > Section 246-828-100[4]  and for Audiology by WACs > Title 246 > Chapter 246-828 > Section 246-828-095[5].

What happens after your hearing assessment?

Your audiologist might refer you to a different medical specialist or clinic.

I always ask my patients four questions as part of my evaluation:

1. Have you experienced a sudden or noticeable change in your hearing?

2. Do you have tinnitus, or ringing in your ear(s)? If so, what does it sound like? How often does it occur? Is it in both ears or just one? And where does it seem like it's coming from?

3. Do you experience dizziness? If so, what does it feel like? How often are you dizzy? Have you ever fallen?

4. Do your ears feel plugged up, or do you have pain in your ears?

They are the most informative or most important questions as the answers can lead to further investigation and a referral to a specialist and or clinic setting specializing in treating certain conditions. For instance: 

If it’s a medical condition, you’ll need an ENT otolaryngologist.  

Also, some objective measures and specialized equipment are needed to assess the central auditory system and management for balance disorders.  For these things, we need a more controlled environment or larger space for the equipment, which requires an office or clinic setting. 

But it could even be a medication you’re taking has a nasty side effect that’s affecting your hearing. In that case, you would need to go back to your prescribing physician and discuss adjusting your dose or the medication.

It is of the utmost importance that your hearing care provider completes a comprehensive exam to make sure no underlying medical issues are causing or compounding your hearing loss. 

Only once an identified medical condition has been treated can your audiologist get an accurate diagnosis of your hearing loss. 

But if you’re medically sound, your audiologist will continue with prescribing the perfect set of hearing aids for your hearing needs.

And that’s where we’ll pick up in Healthy Hearing Series Part Three…

But let’s face it, I can’t leave you hanging for two weeks, so here’s a sneak peek!

In part three, we’ll discuss how your audiologist will work with you to determine which type of hearing aids to prescribe based on your hearing loss, lifestyle, and preferences. For example:

• How severe or profound is your hearing loss?

• What is your living environment like?

• What is your social life like? Do you spend time in large crowds like at church or the casino?

• What technology do you need and want to use? TV? Cell Phone? Video Conference Apps?

• Are you a musician? Love listening to music?

• What style of hearing aid do you prefer? Is discreteness a priority? 

Once we’ve taken everything into consideration, I like to program a trial pair of hearing aids for you to use.

If you can’t wait to hear more, call me or schedule your free consultation now and we can get you on your journey to better hearing and better living right away!

1. Helen Keller Biography

2. Sensorineural hearing loss (SNHL) causes

3. Hearing Loss - Beyond Early Childhood

4. WAC 246-828-100:

5. WAC 246-828-095: