What Is a Hearing Evaluation?

What can a hearing evaluation tell you?

A complete evaluation may help answer several questions:

Is hearing within the expected range?

Is hearing loss present in one or both ears?

Which pitches are affected?

What is the degree of hearing loss?

Is the loss conductive, sensorineural or mixed?

Are the ears similar or significantly different?

How well is speech understood in quiet?

Is speech especially difficult in background noise?

Is middle-ear function normal?

Is medical referral appropriate?

Would hearing aids, assistive technology or monitoring help?

No single test answers every question. The audiologist interprets the complete pattern rather than relying on one number.

Hearing evaluation versus hearing screening

A **hearing screening** is a brief pass-or-refer check. It is designed to identify people who may need further testing. A screening does not usually determine the complete type, degree or cause of a hearing problem.

A **diagnostic hearing evaluation** is more detailed. It uses several tests to measure hearing, compare the ears and examine possible sites of difficulty. The results support individualized recommendations.

| Hearing screening | Hearing evaluation |
|---|---|
| Brief check | Detailed test battery |
| Pass or refer result | Ear-specific measurements and interpretation |
| Identifies possible risk | Helps identify type, degree and configuration |
| Limited recommendations | Individual follow-up plan |
| Does not diagnose a cause | May show when medical assessment is needed |

If a person does not pass a screening, the next step is generally a comprehensive evaluation—not repeated self-testing until a passing result appears.

Who should consider a hearing evaluation?

An evaluation may be appropriate when a person:

Frequently asks others to repeat themselves

Feels that people mumble

Has difficulty following conversation in noise

Turns up television, phone or media volume

Notices that one ear hears differently from the other

Has tinnitus, ear pressure or sound sensitivity

Experiences dizziness or balance symptoms

Has a history of loud-noise exposure

Takes or has taken medication that may affect hearing

Has recurring ear infections or middle-ear problems

Is considering hearing aids

Already uses hearing technology and needs monitoring

Has family members who notice communication changes

Has a child with speech, language, learning or response concerns

Testing may also establish a baseline before noise exposure, medication treatment or another situation in which hearing needs to be monitored.

When not to wait for a routine appointment

Seek urgent medical care for:

A sudden drop in hearing over hours or days

Sudden one-sided hearing change

Hearing loss after a head injury, blast or extremely loud sound

Hearing change with severe dizziness or neurological symptoms

Facial weakness or numbness

Severe ear pain, bleeding or drainage

Rapidly worsening hearing

Call emergency services for possible stroke symptoms. Sudden hearing change should not be treated as routine ear congestion until medically evaluated.

Who performs a hearing evaluation?

An audiologist is a hearing and balance professional trained to evaluate hearing, identify the type and degree of hearing loss, assess communication needs and recommend rehabilitation or technology.

An ear, nose and throat physician—also called an otolaryngologist or ENT—diagnoses and treats medical and surgical conditions of the ear. An audiologist may refer to an ENT when test results or symptoms suggest a medical concern.

Some settings use a team that may also include primary-care clinicians, pediatric specialists, speech-language pathologists, educators, hearing-aid specialists or implant professionals.

What happens before testing?

Case history

The appointment usually begins with questions about:

The main hearing or communication concern

When the change began

Whether it was sudden, gradual or fluctuating

Which ear seems affected

Tinnitus, dizziness, pain, pressure or drainage

Ear infections, surgery or injury

Noise exposure

Medications and medical conditions

Family history of hearing loss

Previous hearing tests or devices

Listening needs at home, work, school and socially

Accurate history helps the audiologist select the right tests and recognize warning signs.

Communication-needs discussion

Hearing test results are most useful when connected to real life. The audiologist may ask which situations are most difficult and what improvement would matter most.

Examples include hearing a partner at home, following meetings, understanding grandchildren, using a phone, hearing in a place of worship or detecting safety signals.

Tests that may be included

Not every person needs every test. The following are common parts of an evaluation.

Otoscopy

The audiologist looks into the ear canal with a lighted instrument called an otoscope. This can reveal earwax blockage, irritation, drainage, an object in the canal or visible eardrum concerns.

Otoscopy does not test hearing and cannot show every middle- or inner-ear condition. It helps determine whether testing can proceed safely and whether medical attention may be needed.

Pure-tone air-conduction testing

The person wears earphones and responds whenever a tone is heard, even when it is very soft. The audiologist changes the pitch and loudness to find the softest reliable response at each tested frequency.

These thresholds are plotted on an audiogram. Air-conduction results show the total hearing response through the outer, middle and inner ear.

Bone-conduction testing

A small vibrating device is placed behind the ear or on the forehead. It sends sound to the inner ear by vibrating the skull, bypassing much of the outer and middle ear.

Comparing air- and bone-conduction thresholds helps determine whether the pattern is conductive, sensorineural or mixed.

Speech testing

Speech testing may measure:

The softest level at which speech is detected or recognized

How accurately words are repeated at a comfortable level

How well speech is understood in background noise

Tone thresholds and speech understanding measure different abilities. Two people with similar audiograms may have very different word-recognition results.

Tympanometry

Tympanometry uses gentle air-pressure changes in the ear canal to measure eardrum movement and middle-ear mechanics. It may help identify patterns associated with fluid, pressure problems, eardrum perforation or restricted movement.

The person does not need to respond to sounds during this test. A brief pressure sensation is common, but the test should not be painful.

Acoustic reflex testing

This test measures an involuntary middle-ear muscle response to sound. It can add information about parts of the auditory pathway and help interpret other findings.

It is not required in every evaluation.

Otoacoustic emissions

Otoacoustic emissions, or OAEs, measure faint sounds produced by healthy outer hair cells in the cochlea. A small probe presents sound and records the response.

OAEs do not provide a complete hearing threshold test. They are interpreted with other results and may be absent because of inner-ear damage, middle-ear problems or test conditions.

Auditory brainstem response

Auditory brainstem response, or ABR, uses small electrodes to measure the auditory system’s electrical response to sound. It may be used for infants, people who cannot complete standard behavioral testing or when an auditory-pathway concern is being investigated.

ABR is noninvasive. Sleep or sedation may be needed in some circumstances, especially when a long recording must remain free from movement. The care team explains any preparation or risk.

Hearing-aid or implant testing

Someone who already uses hearing aids may have device checks, real-ear measurements or aided speech testing. People being considered for a cochlear implant receive specialized testing that evaluates performance with appropriately fitted hearing aids.

What is an audiogram?

An audiogram is the chart used to record hearing thresholds.

The horizontal axis shows frequency, or pitch, from low to high.

The vertical axis shows hearing level in dB HL, from softer levels near the top to louder levels lower on the chart.

Different symbols represent the right ear, left ear, air conduction and bone conduction.

The audiogram can show degree, configuration, symmetry and possible type of hearing loss. It does not, by itself, identify the exact medical cause or fully predict communication ability.

Ask the audiologist to explain the chart in plain language and connect it to specific listening situations.

Types of hearing loss the evaluation may identify

Conductive hearing loss

Conductive loss occurs when sound transmission through the outer or middle ear is reduced. Possible causes include earwax blockage, middle-ear fluid, eardrum problems or conditions affecting the middle-ear bones.

Some conductive causes may improve with medical or surgical treatment.

Sensorineural hearing loss

Sensorineural loss involves the inner ear or auditory nerve. It may be associated with aging, noise exposure, genetic factors, illness, injury or medications.

Sensorineural loss is usually permanent, but hearing aids, implants, assistive technology and communication strategies may help.

Mixed hearing loss

Mixed loss combines conductive and sensorineural components. Treatment may address the conductive condition while also managing the remaining inner-ear loss.

Does a hearing evaluation hurt?

Most hearing tests are painless. Earphones, a bone-conduction vibrator and small ear-canal probes may feel unfamiliar. Tympanometry can create a temporary pressure sensation similar to an altitude change.

Tell the audiologist immediately if anything causes pain. Active infection, recent surgery, severe tenderness or another ear condition may require a modified test plan or medical referral.

How long does a hearing evaluation take?

Appointment length varies. A straightforward adult evaluation may take roughly 30 to 60 minutes, while pediatric, balance, implant or complex diagnostic testing may take longer.

Allow time for discussion of results and next steps. When scheduling, ask the clinic which services are included and how long to plan for the visit.

How to prepare

Before the appointment:

Write down the main hearing concerns and when they began.

List ear symptoms such as tinnitus, dizziness, pain or drainage.

Bring relevant medical, medication and noise-exposure information.

Bring previous audiograms if they are available.

Bring current hearing aids, chargers and accessories.

Ask a family member or communication partner to attend if helpful.

Request an interpreter, captioning or accessibility accommodation in advance.

Confirm insurance, referral and payment requirements with the clinic.

Do not insert cotton swabs or tools to clean the ears before testing. If earwax is blocking the canal, the clinician will advise on safe management.

What happens after testing?

The audiologist should explain:

Whether hearing loss is present

The results for each ear

The degree, type and configuration

Speech-understanding findings

Whether results match the reported difficulties

Whether medical referral is recommended

Which treatment or support options may be appropriate

When hearing should be checked again

Possible next steps include monitoring, ENT evaluation, medical treatment, prescription hearing aids, assistive listening technology, communication strategies, rehabilitation or specialized implant assessment.

You should receive or be able to request a copy of the audiogram and report.

What if the results are normal but hearing still feels difficult?

A standard audiogram measures detection of tones in a controlled setting. Real-world listening also involves speech processing, background noise, attention, memory, language and room acoustics.

If symptoms remain, explain the exact situations that are difficult. The audiologist may consider speech-in-noise testing, additional auditory testing, device evaluation or referral to another clinician. Normal pure-tone thresholds do not mean the communication concern should be dismissed.

Can an online hearing test replace an evaluation?

No. An online test can be a useful screening tool, but it cannot examine the ear, measure bone conduction or middle-ear function, or reliably identify the type and cause of hearing loss.

Results may also be affected by background noise, headphone fit and uncalibrated device output.

Do not use online screening for sudden hearing change, head trauma, severe dizziness, neurological symptoms, pain, bleeding or drainage. Seek professional care.

Hearing evaluations for babies and children

Babies and young children can be evaluated even when they cannot raise a hand or repeat words. Audiologists use age-appropriate behavioral and objective methods, including OAE and ABR testing.

For infants, national early-hearing programs emphasize timely screening, diagnostic evaluation after a non-passing screen and early access to intervention when hearing loss is confirmed.

Children with speech-language concerns, inconsistent responses, recurring ear infections, school difficulty or caregiver concern should receive appropriate hearing assessment. A brief school screening is not the same as a diagnostic pediatric evaluation.

How often should hearing be evaluated?

There is no single schedule for everyone. Follow-up depends on age, symptoms, hearing results, noise exposure, medication risk, medical conditions and device use.

Return sooner than planned for sudden or rapid change, new one-sided symptoms, worsening tinnitus, dizziness, pain or drainage. People using hearing aids or implants usually need periodic hearing and device follow-up.

Questions to ask at the appointment

What did each test measure?

Is hearing loss present in one or both ears?

Which frequencies are affected?

Is the loss conductive, sensorineural or mixed?

How well do I understand speech in quiet and noise?

Do I need an ENT or another medical evaluation?

Would hearing aids or assistive technology help my main concerns?

What can I do immediately to improve communication?

May I have a copy of my audiogram and report?

When should my hearing be checked again?

The bottom line

A hearing evaluation is a personalized group of tests—not merely a pass-or-fail check. It measures hearing sensitivity, speech understanding and other parts of auditory function while considering symptoms and everyday communication needs.

The results can identify hearing loss, guide medical referral and support decisions about monitoring, hearing technology and rehabilitation. Sudden hearing change requires immediate medical attention rather than a routine or online test.

Use the **Audiology.md provider directory** or **Request Hearing Help** to connect with local hearing care near you.