Hearing Care Services

There are a number of different tests we can conduct to check your hearing health. Some of these tests may also indicate other issues with your ears, which may not be visible or apparent but may require further medical examination by an ENT consultant. Ear Health Matters Ltd will always conduct the necessary tests to ensure we have all the information required to provide you with the best advice regarding future management of any conditions identified, including medical referral to your GP or an ear, nose and throat (ENT) consultant where applicable. The more common types of test that are available are listed below, with a brief description of what that test entails and what the possible outcomes may be from taking that test.

Hearing Assessments - Types and Purpose

Online or Hearing Screening Check

What is it? A hearing screening check is a brief hearing test which can indicate if a possible hearing loss exists.   They can be conducted in a quiet space and you can do them online or in person via a computer, iPad/tablet or smartphone, using a set of headphones or earphones.   Supra aural (over the ear) headphones are best for these tests as they will reduce the possibility of any ambient noise affecting the results.

What does it show?  It is important to remember that these tests are only used to indicate whether a hearing loss possibly exists.   If the results from a hearing screening check show that you may have a hearing loss, you should seek further advice and assessment from a qualified hearingcare professional.   Ignoring a hearing loss won't make it go away, and the cause of the loss may need to be dealt with medically such as earwax removal or treating an ear infection.

What is it?   A puretone audiogram is the most common type of hearing assessment conducted.  The test is often conducted in a soundproof booth, but advances in technology have led to the development of audiometers that can be used without a soundproof booth.  One such audiometer is the Interacoustics Affinity Compact which Ear Health Matters Ltd use to conduct accurate tests in a domiciliary setting.   The puretone audiogram is comprised of a series of tests, some or all of which may be required to be performed, depending on the purposes of the investigation of the hearing loss, and the results achieved from each test as it is conducted.   The test involves playing a series of tones at different frequencies into one ear, to determine the quietest level at which the sounds are heard.   The same test is then conducted in the other ear before also being tested through the bone behind the ear, or occasionally via the forehead..

A Standard Puretone Audiogram

figure 1.  A basic audiogram showing puretone thresholds for air and bone conduction using insert earphones.  The result shows a bilateral sensorineural hearing loss most commonly associated with the natural ageing process.

A puretone audiogram could be quite basic, or could be more in depth and contain a lot of information which may indicate the possible reasons for a hearing loss.   It is vital that the hearingcare professional conducts all the necessary tests as set out by the British Society of Audiology  (BSA) to ensure that the advice you receive at the end of the assessment is accurate and appropriate to your needs and future management of any identified conditions.

If an audiogram shows the loss is symmetrical (i.e. there is little or no difference between the results) as shown in figure 1, then no further puretone testing may be necessary.   In some cases the hearingcare professional may also conduct Uncomfortable Loudness Level (ULLs) tests which could help when programming hearing aids for patients with high sensitivity to noise.   Someone may have this type of test for employment reasons when starting a new job (such as a train driver or a pilot), or if they just want a basepoint for future comparison, which could be helpful if you work in noise.

A Masked Puretone Audiogram

A masked audiogram is necessary when the standard audiogram shows there is a difference between the results of the two ears (figures 2 & 3.).  In these cases, the better ear may have heard some of the tones presented to the worst ear.  The hearingcare professional should conduct further tests and complete a masked audiogram.  This is done by playing a different noise (like a rushing noise) into the better ear, whilst also retesting the results of the worst ear.   This should then give the true results for the worst ear.

Under normal circumstances you would expect both ears to develop hearing loss at a similar level, so if the loss is as shown in figures 2 or 3, something specific has caused, or is causing this.  In the case of figure 2, it may be possible to correct the conductive element of the loss in the right ear with some form of medical intervention.   In the case of figure 3 it would be necessary to confirm there wasn't anything identifiable causing the difference between the ears, that may require treatment.

Therefore if your hearing test shows that either ear has a conductive or asymmetrical element within it, that has not been previously investigated by a suitably qualified professional, such as an ENT consultant, the hearingcare professional is obligated to refer you for medical advice before continuing with any treatment. You are not obliged to seek such advice but at Ear Health Matters Ltd we would always encourage you to do so, so that any advice we give you regarding future management of your hearing loss can be accurate and specific to your own personal circumstances..

figure 3.  A masked audiogram showing puretone thresholds for air and bone conduction using insert earphones.   The result shows a bilateral sensorineural hearing loss with asymmetry between the left and right ears.  If not previously investigated by an ENT consultant, this condition would be referrable

figure 2  A masked audiogram showing puretone thresholds for air and bone conduction using insert earphones.  The result shows a conductive mixed hearing loss in the right ear and a sensorineural loss in the left ear.  If not previously investigated by an ENT consultant, this condition would be referrable

figure 5.   A typical audiogram for noise induced hearing loss caused by shooting without protection

figure 4.   A typical audiogram for otosclerosis - a congenital middle ear condition affecting the middle ear bones

The completed audiogram will identify if a hearing loss exists, and if so the extent and type of loss in each ear.   In most cases it is not possible to identify the cause of the hearing loss purely from the audiogram alone, but sometimes there are clues within the audiogram pattern which may indicate certain factors which have influenced, or are influencing your hearing loss.   The patterns shown in figures 4 & 5 show the audiograms that are typical of certain types of hearing loss.

Most hearingcare professionals will conduct a standard puretone audiogram between the frequencies of 125Hz and 8kHz. (figure 1), as these frequencies are those most affected by how we hear speech.    The full range of human hearing frequencies can be as low as 31Hz and as high as 19-20kHz.   In comparison a bottlenose dolphin is estimated to have a hearing range from 150Hz to 150kHz.    

An extended high frequency audiogram (figure 2) tests your hearing at the frequencies beyond those where we hear speech signals.   In the normal ageing process we lose the very highest range of hearing first.  This is due to the fact that high frequency sound waves are short in length and dissipate quicker than low frequency sounds as they travel, so the fine hairs in the inner ear that pick up the higher frequency sounds need to be nearer the entrance of the inner ear.   This means the higher frequency hairs wear out more quickly as they are also exposed to the lower frequency sounds, which are picked up deeper in the inner ear.  This is commonly known as 'the doormat effect'. 

This process can start as early as your mid 20s, and the highest frequency sounds become inaudible to ourselves, but are still audible to younger people.   Possibly the best example of this is the use of sonic mosquito alarms to disperse gangs of teenagers from shopping centres.  The younger people would find the sounds annoying, whilst even slightly older people whose ears no longer pick up those sounds, could go about their shopping without even noticing that the alarms were there.

An Extended High Frequency Puretone Audiogram

figure 1.  A basic audiogram showing puretone thresholds when tested at the lower range of human hearing frequencies.

figure 2.  A basic high frequency audiogram showing puretone thresholds when tested at the higher range of human hearing.

Speech Tests

Sounds in the ear trigger neurons in the brain.  The ear to brain neurons that are triggered by beeps and whistles may still work well even if there is up to 80% damage to them, whereas the ear to brain neurons that are triggered by speech sounds can create issues with only 20% damage to them. There has been an increase, particularly amongst younger people who present with difficulty hearing conversation in background noise, but when the audiologist does a standard puretone audiogram, their hearing appears to be within normal parameters. This is thought to be caused by factors such as over exposure to noise, and is being labelled as 'hidden hearing loss'.  A standard puretone audiogram alone will not identify this problem.

Speech tests are exactly that.   Evidence now shows that untreated hearing loss can lead to a more rapid decline of cognitive function which can then affect how you hear and how you differentiate between different sounds.  With speech tests your hearing is tested using spoken words rather than beeps and tones.   Speech tests should be a vital part of any full hearing assessment, simply because your ability to hear beeps and tones doesn't always equate to your ability to distinguish the very different sounds of speech, especially if there are other competing noises in the environment.

If your cognitive function, when it comes to speech perception is impaired, then hearing aids may be of limited benefit to you.   Doing speech tests as part of your full hearing assessment will ensure that hearing aids are appropriate to your hearing loss, and that you do not need to be referred for specialist medical attention by an ENT consultant or a neurologist, due to impaired  cognitive function.

If you've told a hearingcare professional that you struggle to hear speech, in quiet or in noise, and that same professional hasn't even attempted speech tests with you, you need to ask yourself, have you really been given a full hearing assessment?   On occasion, if the hearing loss is too great,  speech tests may not be possible due to equipment or safety limits.

Tympanometry & Reflex Testing

A tympanogram is a test which tests how your eardrum moves in response to sound pressure waves.  What the test is actually checking is whether your middle ear is being compliant in transferring sounds from the eardrum to the inner ear.  If you have middle ear issues which aren't visible through otoscopy (looking into the ear), then tympanometry can confirm a middle ear pathology.   This can then be confirmed with a fully completed puretone audiogram (including masking if required) as detailed above.

Figure 1: A 'type A' tympanogram showing a normally functioning and compliant middle ear.

Figure 2: A 'type C' tympanogram showing negative middle ear pressure associated with eustachian tube dysfunction or middle ear issues.

Your ears have a natural response to protect your hearing from overly loud sounds, which is called the acoustic reflex.  If sounds reach a level that could become damaging to your hearing, the stapedius muscle is triggered which pulls the stapes bone back from the inner ear, reducing the amount of sound transmitted to the delicate hair cells of the cochlea.  Reflex tests check to see if your natural reflex is triggered, and if so at what volume level. Along with the tensor tympani muscle which also adds tension to the eardrum to reflect sound back into the ear canal, the middle ear muscles help to protect your ears from noise damage, but this protection is limited.    To fully protect your hearing against the dangers of loud noise, you should consider wearing some form of hearing protection.