If you have noticed hearing changes and suspect you may need hearing aids, we recommend a thorough hearing evaluation in order for you to receive the appropriate treatment plan. Each state has slightly different criteria that a hearing test needs to meet in order for you to be fitted with a hearing aid. Some state rules/laws are more restrictive and require more diagnostic procedures, whereas other states require less. Regardless of what your state requires, there are some best practices that you, as a consumer, should be looking for.


Discussing medical history with your hearing professional

Prior to beginning a hearing test (audiometric evaluation), your hearing healthcare professional should be going through your medical history. In the clinic, we often hear, “I am here for a hearing aid – why is this relevant?” Our response goes something like this: “Your hearing can be affected by a lot of different factors and it is our job to identify the type, configuration, and severity of your hearing loss. Once we identify these things, we then help to develop a treatment plan. These treatment plans may or may not include hearing aids.”


Since different types of hearing loss can be treated in different ways, it is important to have a thorough evaluation of your hearing and any relevant medical history. Yes, your medical history is important. Here are a few medical conditions you should disclose to your hearing health care professional as they can all have some effect on your hearing: history of ear infections and/or ear surgery, high blood pressure, diabetes, cancer, heart disease, kidney disease, history of measles or mumps, history of general anesthetics, arthritis, smoking / tobacco use, alcohol consumption, and recreational drug use. This is by no means a comprehensive list of medical topics you should discuss with your hearing health care professional. However, it is a good start.


Hearing test procedures

Now that you have discussed your medical history, we can begin the actual hearing testing. We recommend the following procedures:


  1. Otoscopy or video otoscopy – This test involves the hearing healthcare professional using an otoscopy or video otoscope to look in your ear to see if the ear drum (tympanic membrane) is visible and intact. This test also reveals whether or not the ear canal is occluded with ear wax (cerumen). If you are undergoing a hearing test and your hearing healthcare professional has not looked in your ear, RUN! If they have looked in the ear and everything appears to be healthy, you are ready for the next test. Please note: if your ears are impacted with wax, either a hearing healthcare professional can safely remove it, or they can refer you to a doctor who can assist. DON’T do a hearing test with impacted ear wax as it will not be accurate.


  1. Tympanometry and acoustic reflexes – These two tests are not required prior to hearing aid fitting in many areas, but we believe they are an important part of a complete hearing evaluation. Tympanometry shows the middle ear resting pressure and how well the ear drum moves. Acoustic reflexes show the health of the lower brainstem feedback loop when loud sounds are presented. These two tests provide the hearing healthcare professional with a lot of information regarding the overall physical health of the auditory system.


  1. Audiometric testing – Now that your hearing healthcare provider has looked in your ear and confirmed that the ear canal is clear, and done tympanometric measures with acoustic reflexes showing normal middle ear function, you will undergo the hearing test you are expecting – push the button or raise your hand when you hear the beeps. This test should be done in a sound booth and it is important you signal your hearing healthcare provider even if the beep is VERY soft. Note: if you suffer from tinnitus, the hearing healthcare provider can use a pulsed tone to eliminate confusion with the ringing that is characteristic of tinnitus.


This pure tone hearing test should be done through headphones as well as through a bone vibrator. This helps to insure that air conduction (headphones) and bone conduction (bone vibrator) have similar test results. These two parts of the hearing test help to determine if medical or surgical intervention may be able to improve hearing abilities.


  1. Speech testing – After pure tone audiometric testing is completed, speech testing should be done. This comes in many different shapes and sizes. However, the most common is Speech Reception Thresholds (SRT) where you are asked to repeat the word (i.e. baseball) no matter how soft. The second most common method is word recognition. These two tests help provide the hearing healthcare provider with good information regarding hearing and understanding abilities.


A complete hearing evaluation has several parts and each part is designed to evaluate the health and performance of a part of the auditory system. A complete hearing evaluation will allow Hearing Aid Advisor and your hearing healthcare professional to make sound recommendations that will help you enjoy the treatment process and leave you with the best outcome possible.