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Standard Diagnostic Hearing Evaluations

A hearing evaluation is a thorough assessment of an individual’s hearing by an audiologist. Because a hearing problem can be triggered by a deficiency in any part of this complex system, we use a number of different tests that provide important information about all aspects of the auditory system. The purpose of the evaluation is to determine the nature and degree of the hearing loss and the best treatment options. A hearing evaluation can be performed on infants, children, and adults. The method of testing used depends on the patient’s age and ability to complete the task.

Tests for Adults

A standard adult evaluation includes the following tests:

  • Tympanometry: Evaluates middle ear function. It determines if the eardrum is moving appropriately and assesses middle ear pressure.
  • Acoustic reflex testing: Assesses whether the stapedius muscle in the middle ear responds normally to sound.
  • Otoacoustic emission: Assesses the function of the outer hair cells, a key indicator in determining hearing function. A probe that contains both a tiny speaker and a tiny microphone is inserted into the ear canal. Quiet tones that pass through the middle ear are sent via the speaker to stimulate the hairs in the cochlea, the part of the ear that produces nerve impulses. The hairs respond by generating their own tiny sounds, which are detected by the microphone.
  • Pure tone testing: Determines the softest sounds a patient is able to hear at different frequencies.
  • Word recognition testing: Measures a patient’s ability to correctly repeat words at a comfortable volume
  • Testing in noise: Speech testing may be done in a quiet or noisy environment. Difficulty understanding speech in an environment with background noise is a common complaint of people with hearing loss. Testing in noise can provide helpful information.

Tests for Children

A hearing evaluation for a child may include the following tests, depending on the child’s age and ability to complete the task.

  • Tympanometry: Evaluates middle ear function. It determines if the eardrum is moving appropriately and assesses middle ear pressure.
  • Acoustic reflex testing: Assesses whether the stapedius muscle in the middle ear responds normally to sound.
  • Otoacoustic emission: Assesses the function of the outer hair cells, a key indicator in determining hearing function. A probe that contains both a tiny speaker and a tiny microphone is inserted into the ear canal. Quiet tones that pass through the middle ear are sent via the speaker to stimulate the hairs in the cochlea, the part of the ear that produces nerve impulses. The hairs respond by generating their own tiny sounds, which are detected by the microphone.
  • Visual reinforcement audiometry: Assesses hearing in infants and toddlers (generally from 6 months to 3 years) who can’t be adequately tested by standard hearing tests. It involves conditioning the child to turn his or her head in response to a sound to train the child to respond to sounds or auditory cues.
  • Conditioned play audiometry: Useful in assessing hearing of children 2–3 years old, it conditions to perform a certain task (i.e. put a block in a bucket) upon hearing a sound.
  • Conventional audiometry: Useful for assessing children 5 years and older, this test stimulates the child to raise a hand or speak a response upon hearing a sound.
  • Word recognition testing: Assesses a child’s ability to correctly point to or repeat words at a comfortable loudness level.

Ototoxic Audiological Monitoring

Certain chemotherapy drugs can damage the ear and auditory system. Such ototoxic drugs can potentially cause hearing loss, tinnitus, and dizziness. The purpose of audiological monitoring is to promote early intervention (i.e. chemotherapy reduction or treatment modification) when possible. 

In cases when a patient’s cancer treatment cannot be altered, UI Health audiologists play an important role in patient counseling and work alongside each patient to provide the appropriate intervention (i.e. hearing aids, cochlear implants, assistive listening systems, etc.). An ototoxic audiological evaluation involves completing a full standard diagnostic evaluation with the addition of high-frequency audiometry and extended otoacoustic emission testing. Each evaluation takes approximately 60 minutes to complete. The audiologists and oncologists at UI Health work together to ensure quality care.

Newborn Hearing Screening Follow-up Testing

Since 1993, the National Institutes of Health (NIH) has recommended that all infants should be screened for hearing impairment, preferably prior to hospital discharge as newborns. Our program has long been at the forefront of such efforts, maintaining a comprehensive screening and follow-up testing program.

If your child did not pass the universal newborn hearing screening in either ear or both ears while in the hospital, additional outpatient testing is required. Often a test called an Auditory Brainstem Response (ABR) will be completed.

What is an ABR?
An ABR test uses a special computer to measure the way the child’s hearing nerve responds to different sounds. Three electrode stickers will be placed on your child’s head and in back of his or her ears and connected to a computer. As sounds are made through the earphones, the electrodes measure how your child’s hearing nerves respond. For this test, your child will have to remain very still and sleep the entire time — an easy achievement for most newborns! The test can last up to 90 minutes. 

How can you prepare for an ABR test?

  • If possible, schedule the ABR during naptime.
  • It may be necessary to sleep-deprive the child so that he or she will sleep for the duration of the test.
  • Do your best to keep your child awake during your travel to the appointment; once you’ve arrived have handy items that will help the child fall asleep, such as a bottle, blanket, or pacifier.
  • Ensure that your child does not fall asleep before you are brought back for your appointment.