A Primer on Hearing Loss and Hearing Tests

Young or old, don’t take your sense of hearing for granted

Do you think you have hearing loss? Hearing loss often happens gradually and can affect just about anyone. It can be quite difficult to notice until symptoms appear. It can affect your quality of life and has adverse effects on your overall health. It’s essential to get a baseline hearing test and follow-up tests to identify and manage it early.

Why do you need a hearing test?

You need a hearing test to determine if you have hearing loss. A hearing test will also tell you how mild or severe your hearing loss is. It can identify the type of hearing loss you have (sensorineural, conductive, or mixed).

What are the main types of hearing loss?

Conductive hearing loss. This type of hearing loss usually occurs among infants and children, but it can also happen at any age. It’s caused by a physical problem most commonly a blockage of sound transmission in the ears. The most common causes of conductive hearing loss are fluid in the ears and middle ear infections. Conductive hearing loss is often treatable and temporary.
Sensorineural hearing loss. The causes of sensorineural hearing loss include problems with the auditory nerve, structure of the ear, or both. It’s more often than not permanent and can manifest at birth or later in life. Examples of specific causes of sensorineural hearing loss include ageing, injury, excessive noise, meningitis, diabetes, stroke, Meniere’s disease, acoustic tumours, hypertension, heredity, and medications that damage your hearing (ototoxic drugs).
Mixed hearing loss. This type combines features of sensorineural and conductive hearing loss.

How do you know you need a hearing test?

You crank up the volume on your earphones, smartphones, TV, speakers, etc. You’ll also notice this when family members or friends complain about how loud you turn up the volume.
There’s ringing or roaring in your ears. That ringing or roaring is neither a phone nor a lion in your ear. It’s a symptom called tinnitus. Another symptom you need to watch out for is vertigo. It’s the sensation that you or your surrounding environment is spinning.
You have difficulty understanding high-pitched sounds like children’s voices. You may also keep on asking people to repeat what they have said. In a crowded environment, you may have a problem following conversations and identifying sources of noise.

What to Expect During a Hearing Test

The hearing test itself is usually done by your primary health care provider or general practitioner. It can also be administered by an audiologist or an otorhinolaryngologist (ears, nose, and throat doctor). An audiologist is an expert who specialises in diagnosing and treating hearing loss.
You don’t need to do anything special to prepare for your hearing test. There are also no risks involved. The tests are non-invasive. Just show up and bring your ears, especially the affected one (just kidding). Seriously, just show up on your appointed date and time.
There are numerous types of hearing tests. The majority of them check for your response to words or tones relayed at different volumes, pitches, noise environments or a combination of any of these. They are referred to as sound tests. The following are some common examples:
1. Audiometry or pure-tone test – this test identifies the quietest sounds you can perceive.
2. Middle ear muscle reflex (MEMR) or acoustic reflex measures
3. Speech and word recognition tests – this test demonstrates how well you understand and hear speech, especially in loud places.
4. Tympanometry test – your eardrums are the stars of this type of test. Problems like infection, fluid, earwax blockage, or a perforated eardrum are confirmed using this test.
5. Tuning fork tests – a tuning fork is used to determine if one or both ears have hearing loss. It can also differentiate between sensorineural and conductive hearing loss.

And the Results?

Results of the previously mentioned tests can show if you’re experiencing hearing loss. The type of hearing loss, whether conductive, sensorineural or mixed, will also be determined. If it’s sensorineural, the results will include additional data about the severity of your hearing loss.

The intensity of sound (how loud, volume) is measured in a unit called decibels (dB). A normal conversation averages around 60 dB. The normal hearing value or hearing threshold is around 0 dB. A sound has to be above 0 dB so you can hear it. A hearing loss of up to 20 dB below 0 dB (hearing threshold) is still classified as normal hearing.
The treatment for sensorineural hearing loss will depend on its cause and on how serious it is.
Hearing screening should be a regular part of your annual physical exam because hearing loss usually occurs gradually. This can make it difficult for you to notice. If your hearing hasn’t been screened, schedule an appointment now or ask your primary health care provider about it.

Newborn Hearing Screening

It’s mandatory for newborn babies to have their hearing screened before they’re discharged from the hospital. The nice thing about newborn hearing tests for screening is that both of them can be done while your baby is sleeping. Both are also painless.
- Otoacoustic emission screening – this test confirms if the newborn’s inner ears are detecting sounds.
- Automated auditory brainstem response – this test confirms if the newborn’s brain is processing and receiving sounds.
Most of the time, the majority of babies don’t pass their first hearing screening. Don’t worry. This is because there may still be some amount of fluid present in their ear canals (from birth). Schedule a follow-up visit. Most babies will pass the second hearing screening.
Some babies have congenital hearing loss, which means they’re born with it. The cause of this type of hearing loss is very hard to identify. Sometimes, the cause may be genetic, and the baby may have inherited it from a parent (who may or may not have hearing loss).

Hearing Tests for Infants and Children

Visual reinforcement audiometry – this test is especially suited for babies as young as six months.
Play audiometry – this hearing test is basically a game for toddlers and young children.

How do you know if your child has hearing loss?

Has problems understanding what people are saying.
You get no response when you call his or her name.
You get a totally different answer when you ask a particular question.
Your child watches your lips intently as you speak. Some children are expert lip readers and escape detection even from the most observant parents.
Cranks up the volume on electronic devices.
May have language and speech delays.
May complain of ear pain and ringing in the ears.

Treatment for hearing loss in children will depend on the underlying cause and can include:

Hearing aids. There are numerous hearing aid models to choose from. You don’t have to worry about your child misplacing them.
Cochlear implants. Children who can’t benefit from hearing aids can have cochlear implants. These are surgically implanted hearing devices that stimulate the auditory nerve with electrical stimuli.
Bone-anchored hearing system. This system is more suited for children with malformed ears.
Speech therapy. Together with cochlear implants or hearing aids, speech therapy allows your child to catch up on speech delay when his or her hearing loss affects speech.
Assistive listening devices are great for classroom settings. The teacher has a special microphone that transmits voice directly to your child’s cochlear implant or hearing aid. Assistive listening devices are manufactured by the same companies that produce hearing aids.

Take your child to your primary health care provider who will refer you to a paediatric audiologist to administer hearing tests. If the problem is in the middle ear (infection, earwax blockage), your child will be referred to a paediatric otorhinolaryngologist (ear, nose, and throat doctor for kids). Follow-ups are scheduled based on the underlying cause and response to treatment. Identifying hearing loss early in the process can enable you and your child to do some essential preparations in the future both at home and at school. Treatment options will also be planned effectively.

Age-Related Hearing Loss or Presbycusis

Presbycusis is the gradual hearing loss in both ears as we grow older. It’s estimated that around one-third of 100 adults over the age of 65 years develop hearing loss. Causes include inner ear problems (most common cause), ageing, diabetes, cardiovascular problems, smoking, infections, etc. Staying away from loud noises can help prevent this type of irreversible hearing loss.

Your sense of hearing is vital to how you understand the people and the world around you. If you suspect that you may have hearing loss or you exhibit one or some of its signs, consult your doctor and ask about hearing tests. We have other articles on the ear you may want to read: (Please attach the links to the article topics below. Thank you.)