2/23/2017 Learnwhattoexpectduringahearingtest

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ContributedbyBrandePlotnick,MS,MBA,managingeditor,HealthyHearing
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Thiscontentwaslastreviewedon:September13th,2016

Doouupectouhaveahearinglo?Howcanoueure?Athoroughhearingtetithefirttepinourjournetoetterhearinghealth.
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Dooususpectouhaveahearingloss?Howcanouesure?Hearinglosscanaffectanoneandoftenprogressessograduall,itcanedifficult
tonoticeuntilouexperiencesmptoms.Hearinglosshasfar-reachingeffectsonourhealth,sogettingaaselinehearingtestandannualfollow-up
testscanhelpoucatchitearl.

Thepurposeofahearingtestistodeterminenotonlifouhaveahearingloss,uthowmildorsevereitis.Athoroughhearingtestcanalsohelp
definethetpeofhearinglossouhave:conductive,sensorineuralormixedandwhetheritwillrespondesttomedicaltreatmentorhearingaids.

Ahearinghealthhitor

Yourhearinghealthcareprofessionalwilltakeahistoryofyourhealthbeforeperforminganexam.

Whenouvisitahearinghealthcareprofessional,theirfirststepwilletogettoknowourpersonalhearinghealthandmedicalhistorandfindout
whatconcernsouhave.Therearemanpotentialcausesofhearingloss,sothehistorhelpsdetermineifoucouldhaveanthinginheritedor
geneticinourfamil.Medicalconditionslikeallergies,headcolds,earinfectionsandevenimpactedearwax(cerumen)canalsocontriutetohearing
loss.Also,thehearinghealthpractitionermightaskifouveexperiencedantraumatotheheadorearstructuresrecentl.Ankindofinjurtothe
cranialareacanresultintemporarorpermanenthearingdamage.

Yourhearinghealthcareprofessionalmaalsoaskaoutourexposuretoloudnoisesorifouworkinaloudenvironment.Noise-inducedhearing
lossisvercommoninoursound-filledworld.

Finall,ourhearinghealthprofessionalmightwanttodiscussthesmptomsouareexperiencingandhowtheareaffectingourdaillife.Thewill
wanttounderstandourlifestleandthetpesofwork,hoiesandsocialsituationsthatareimportanttoou.

Afterourhearinghealthhistoriscomplete,thehearingtestcanegin.

Gettingahearingtet
Hearingtestsarepainlessandnon-invasive.Mostoccurinaquiet,sound-treatedroom(ooth)orenclosuredesignedtokeepoutanothernoises
whichmightaffectourhearingexamscores,suchastheheater,airconditionerorofficeenvironment.Youwilleaskedtowearheadphonesorsoft
earplugswithwiresconnectedtoaninstrumentcalledanaudiometerthatisusedtoconductthetest.

Thesound-proofoothmaalsoeequippedwithspeciall-placedspeakersusedfortestinginfants,smallchildrenorpeoplewhoneedtoetested
whileaidedwithhearingaidsorcochlearimplants.

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Onceintheooth,ourhearingcareprofessionalwillcommunicatewithouandprovideinstructionsthroughourheadphones.Youwilleaskedto
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listentotonesatdifferentpitchesandvolumesandpushauttonorraiseourhandwhenouhearthem.Youwillhavetofocusandlistenintentl
ecauseouneedtorespondevenifthetonesoundsversoftandoucanarelhearit.Thetestmeasurestheversoftestsoundsoucanhearat
eachfrequenctested.Thispartofthetestiscalledpuretoneaudiometr.
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peechaudiometrisanothercomponentofmosthearingtests,anditusesrecordedorlivespeechinsteadofpuretones.Thespeechportionofthe
examevaluatesthesoftestspeechsounds(threshold)oucanhearandunderstand.Youwilltheneaskedtorepeatackwordsthatarepresented
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atalevelwellaovethresholdtoseehowwelloucanunderstandthemaccuratel.omepractitionersusespeechsoundstodetermineourmost
comfortalelisteninglevelandtheupperlimitsofcomfortforlistening.

Ifnecessar,thepractitionermaperformtmpanometrandatestofouracousticreflexes.Forthesetests,asoftplugthatcreatespressure
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changesandgeneratessoundswilleplacedintheear.Thiswilldeterminehowwelloureardrumismovingandwillmeasurethereflexive
responsesofthemiddleearmuscles.
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Whattoexpectduringahearingtet

8:42

Hearingtetforchildren
Didouknow?

Therearetwotpeofnewornhearingcreeningandall50tatemandateatleat
oneapartofthetetingatirth

Newornhearingscreenings
Anewornhearingscreeningismandatedacrossall50states,requiringthatnewornaieshavetheirhearingscreenedeforeleavingthe
hospital.Therearetwotpesofnewornhearingscreenings,otharepainlessandcanedonewhiletheasleeps:

Otoacousticemission(OA)screening:Thistestrecordstinsoundsthattheinnerearmakesinresponsetoclicksorchirpsthataredelivered
throughasmall,flexileplugplacedintheinfant'sear.Thescreeningisdoneoneachearandapassingresultconfirmsthattheinfantsinner
earsarereceivingsounds.
Automatedauditorrainstemresponse(AR):Thistestrecordsactivitoftheauditornerveinresponsetoclicksorchirpsdeliveredthrough
asmall,flexileplugplacedintheinfantsear.Thisscreeningisamorecompletetestoftheauditorsstem,anditrequiressmallelectrodesto
etapedtothea'sscalp.Thescreeningisagaindoneforeachearandapassingresultconfirmsthattheinfantsrainisreceivingsounds.

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2/23/2017 Learnwhattoexpectduringahearingtest
Asignificantnumerofinfantsfailtheirfirsthearingscreeningduetofluidthatmastillepresentintheearcanalrightafterirth.Ifourinfant
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doesn'tpasstheinitialhearingscreening,scheduleafollow-upscreeningwithapediatricaudiologistwithinacoupleofweeks.Themajoritofinfants
willpassthesecondscreeningquiteeasil.Forthosewhodonotpassthesecondnewornscreening,adiagnostichearingtestfromourpediatric
audiologistwillinvestigatefurther.
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Hearingtestingforinfantsandoungchildren
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Pediatricaudiologistscantestinfantsasoungassixmonthsofageehaviorallina

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sound-treatedoothusingatestcalledvisualreinforcementaudiometr(VRA).VRAtakesadvantageofaninfantsreflexiveheadturntowardsound.
Inthistest,aparentwillholdtheirchildontheirlapwhilethesitonachairinthecenterofthesoundooth.Theaudiologistwillplasoundsortalk
throughspeakersthatareorientedtotheleftandrightofthechild.

Whenthechildhearsthesoundandlookstowardit,heorsheisrewardedwithavisualreinforcementtolikeaflashinglightordancingear.The
infantwillusuallstaengagedlongenoughfortheaudiologisttogetagoodindicationofhearingailitforatleasttheetterhearingear.

Thevisuall-appealingtoslosetheirailittoholdthechildsattentiononcethearetoddlers.Aroundtheageoftwo,socialpraisewillworkfor
ehavioraltesting.Apediatricaudiologistwilluseamethodoftestingcalledplaaudiometrfortoddlersandpreschoolchildren.Plaaudiometrisa
hearingtestthatismadeintoagamefortoddlers.Theparentorassistantwillsitonthefloorintheoothwiththechildandtrainthemtorespondto
ansoundtheheardoingacertaintask,likeputtingalockinaucket.

Whenthechildcorrectlrespondstoasound,theparentorassistantsittingwiththemwillcheerwithenthusiasm.Likethevisualreinforcement
descriedaove,thisage-appropriatesocialreinforcementwilltpicallkeepthechildengagedlongenoughfortheaudiologisttogetagood
indicationofhearingailitatleastfortheetterhearingear.Ifthetoddlerwillwearearphones,ear-specificinformationcaneotained.

Onceachildisschool-aged,heorshecanusuallsitstill,remainquietandraiseahandinresponsetospeechandtonestimuliinthesoundooth.At
thispoint,thechildcaneasilwearheadphonesforear-specificmeasurementsandsitstillfortmpanometrandacousticreflextests,asdescried
aoveforadulthearingtests.

Undertandingourhearingtetreult
Testresultsarepresentedonagraphcalledanaudiogramthatdisplasthesoftestsoundsoucanhearatdifferentpitchesorfrequencies.The
verticalaxisofanaudiogramrepresentstheintensitorvolumeofthesounds.Thehorizontalaxisdepictsthefrequencorpitchofthesound.

Yourresultswilleplottedindecielsofhearingthresholdlevel(dHL).Theseunitsareuniquetohearingtestingutareasedonperceptionof
soundpressurelevelsacrossallfrequencies.Foreachtoneouheardduringthetest,therewilleamarkontheaudiogramattheappropriate
deciellevel.achearisplottedseparatelandrepresentedtwodifferentlines.Thelinesmaequitesimilarandfollowthesamepatternorthe
maeverdifferent.

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2/23/2017 Learnwhattoexpectduringahearingtest

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Hearinglossismeasuredindeciels(d)andinthefollowingcategories:

Normalhearing(0to25dHL)
Mildhearingloss(26to40dHL)
Moderatehearingloss(41to70dHL)
everehearingloss(71to90dHL)
Profoundhearingloss(greaterthan91dHL)

Althoughsomepeopletalkaouthearinglossintermsofpercentage,itisnotanappropriateormeaningfulmeasureofhearingloss.Itisver
commontohavemorehearinglossatsomefrequenciesthanforothers,sothepercentageofhearinglosswouldedifferentateachtestfrequenc,
makingitvirtuallmeaninglesswhendescriingtheoverallhearinglossordeterminingacourseoftreatment.Inaclinicalsetting,hearinglossisnot
descriedinpercentages.However,itcaneexpressedinpercentagesforspecificlegalsituations.Inthesecasesdecielsofhearinglossare
convertedusingarecognizedformulatocreatea"percentageofhearingloss"forlegalpurposes.

Onlinehearingtet
Therearegeneralltwotpesofonlinehearingtests:

omeuseaudiosamplestodeterminearangeofhearingloss.
omeaskquestionstodetermineifourehavingenoughtrouletoseeahearinghealthcareprofessional.

Onlinehearingtestsarenomeansareplacementforathoroughdiagnostichearingevaluation,utthecaneagoodplacetostartifouare
hesitantaoutmakinganappointment.Notsurewheretostart?VisittheHealthHearingonlinehearingcheck!

randePlotnick,M,MA,managingeditor,HealthHearing
BrandePlotnickholdsamastersdegreeandMBAfromtheUniversityofLouisville.Hercareerinhearingcarespanssales,marketingandcontent
creationandsheenjoyshelpingpeoplewithhearinglossseekhelpandbetheirownadvocates.ReadmoreaboutBrande.

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