A Hearing Test: What to Expect

Who performs the test

• An audiologist is a hearing health professional who tests hearing, interprets results, fits hearing aids and counsels the family. In India, audiologists are trained at the graduate or postgraduate level and are registered with the national rehabilitation council; ask about qualifications.
• An ENT (ear, nose and throat) doctor examines the ears, diagnoses medical causes of hearing loss and arranges treatment or surgery. Many hospitals have both working together.
• Screening in camps, pharmacies or phone apps can flag a possible problem, but is not a full test.

If your parent has sudden hearing loss, pain, discharge, dizziness or one-sided symptoms, see an ENT doctor first and urgently; see signs of hearing loss in parents and how to raise it gently.

Before the appointment

• Book a quiet time and allow about an hour.
• Tell the clinic of any hearing difficulty, ringing, dizziness, ear pain or discharge, and whether your parent has other health conditions or takes medicines.
• Bring a list of medicines and any previous hearing reports.
• Bring glasses, since the clinician may show pictures or written words, and bring any hearing aids already owned.
• Bring a family member who knows what your parent finds difficult, and who can help remember instructions.
• Avoid loud noise for the preceding day or so, and avoid sticking cotton buds or oil into the ears. See ear wax and hearing: safe care.
• Prepare questions: about the results, treatment options, costs and follow-up.

The steps of a typical hearing assessment

### 1. Conversation and history

The clinician asks about the hearing difficulty, when it started, whether it is in one or both ears, ringing, dizziness, ear infections, noise exposure at work or in life, family history, medicines and general health. They may ask about the situations in which your parent struggles most. The family can add details.

### 2. Looking in the ears (otoscopy)

A small lighted instrument checks the ear canal and eardrum. The clinician looks for wax, infection, fluid, perforation or other abnormalities. If wax blocks the view, it may be removed first, by a safe method. The clinician may ask not to continue the test until wax is cleared, because it can distort results. Never attempt removal with cotton buds, hairpins or ear candles; see ear wax and hearing: safe care.

### 3. Pure-tone audiometry

This is the core test. In a quiet, sound-treated booth, the person wears headphones. The clinician plays tones at different pitches, from low to high, and different loudness levels. The person presses a button or raises a hand whenever they hear a tone, however faint. Each ear is tested separately. A second test uses a small vibrating pad on the bone behind the ear, which bypasses the middle ear, to find out whether any loss is due to the outer or middle ear or to the inner ear and nerve.

The results are drawn on a chart called an audiogram. Pitch runs along the top from low to high, and loudness runs down the side. Points lower on the chart mean softer sounds are not heard.

### 4. Speech tests

The person listens to words or sentences at different loudness levels and repeats what they hear. This shows how well they understand speech, which matters more in daily life than hearing beeps. A test in background noise may show real-life difficulty. Some people hear sounds but find speech unclear, which affects hearing aid choice.

### 5. Middle ear tests (tympanometry)

A soft probe is placed at the opening of the ear canal, and air pressure changes briefly. This measures how the eardrum moves and can detect fluid, a stiff or perforated eardrum or eustachian tube problems. It takes seconds and is painless, though the pressure change can feel odd.

### 6. Other tests as needed

• Acoustic reflex tests and otoacoustic emissions to check the inner ear and nerve.
• Balance tests if there is dizziness; see vertigo, BPPV and balance problems.
• Imaging or blood tests, ordered by an ENT doctor for suspected medical causes, such as one-sided loss.

Understanding the results

The audiogram and speech tests are summarised in terms of the degree of hearing loss. The World Health Organization groups hearing loss by the softest sounds heard in the better ear, in decibels hearing level (dB HL): mild, moderate, moderately severe, severe, profound or complete. As a very rough idea:

• Mild (about 20 to 35 dB): difficulty with soft speech or in noise.
• Moderate (about 35 to 50 dB): difficulty with normal speech in groups.
• Moderately severe (about 50 to 65 dB): difficulty with loud speech.
• Severe (about 65 to 80 dB): only very loud speech is heard.
• Profound (above about 80 dB): little or no speech heard without amplification.

The clinician will also describe the type of loss:

• Conductive: a problem in the outer or middle ear, such as wax, fluid or eardrum damage. Often treatable.
• Sensorineural: a problem in the inner ear or hearing nerve, as with age or noise. Usually permanent but helped with hearing aids.
• Mixed: both.

And the shape: most age-related loss slopes down at high pitches, which is why speech seems muffled and consonants are lost.

Ask the audiologist to explain the audiogram with your parent's name on it, in simple terms, and to give a copy.

What happens after the test

Depending on the results, the plan may include:

• No treatment needed, with a plan for a repeat test in a year or two.
• Wax removal or treatment of an infection, by an ENT doctor.
• Medical referral if the loss is sudden, one-sided, asymmetrical, with dizziness, pain or discharge, or has an unusual pattern.
• Review of medicines that can affect hearing, by the doctor.
• Hearing aids, if the loss is enough to cause difficulty; see hearing aids: types, costs and how to choose and hearing aid or personal sound amplifier: what is the difference?.
• Assistive devices such as TV headphones, amplified phones and alerting devices; see TV headphones and streamers for hearing loss and amplified phones and phone settings for hearing loss.
• Communication strategies for family; see talking with someone who is hard of hearing.
• Tinnitus advice, if there is ringing; see ringing in the ears (tinnitus) at home.
• Hearing protection advice.
• Follow-up for monitoring.

You do not have to decide about aids on the day. Ask for time, a written report and a second opinion if desired.

Helping a nervous parent

• Explain that the test is painless and has no wrong answers; it simply tells us what the ears are doing.
• Go together, and sit in the room if allowed.
• Reassure that the test result is not a judgement.
• Encourage honesty: say if you are unsure whether you heard a beep, and tell the clinician about difficulty understanding.
• Link the test to a wider check-up that includes eyes and blood pressure; see a hearing and vision check-up schedule after 60.
• For people with dementia, inform the clinic beforehand so that they can adapt the tests and timing. See caring for a parent with dementia at home.

How often to test

After sixty, many guidelines suggest a hearing check every one to three years, or sooner if there are symptoms, noise exposure, diabetes or medicines affecting hearing. People who use hearing aids should be tested at least yearly or as the audiologist advises. See a hearing and vision check-up schedule after 60.

Limits of online and app tests

Phone apps and online tests can be useful for awareness, but they depend on the phone speaker or headphones and the room's noise, and they do not examine the ear. A normal app result does not exclude a problem, and an abnormal one is not a diagnosis. Use them only as a nudge to see a professional.

Cost and access

Costs vary by city, clinic and tests done. Many government and charitable hospitals offer low-cost or free hearing assessments, and some camps provide screening. Ask about schemes and insurance coverage; see government schemes for senior citizens and health insurance for senior citizens in India.

When to ask a professional

Book a full assessment with an audiologist or ENT doctor whenever you notice signs of hearing loss. Go urgently for sudden loss, dizziness, ear pain, discharge or one-sided symptoms. Ask the doctor about the cause, whether anything is treatable, and which devices suit your parent. Call 112 for sudden hearing loss with weakness, facial droop, speech difficulty, severe dizziness or confusion.