What Is Audiometry Testing?
Audiometry testing is the standard way doctors measure how well you hear different sounds. It’s not just a quick check-it’s a detailed process that maps your hearing ability across frequencies, from low rumbles to high-pitched tones. The results are shown on a graph called an audiogram, which tells you exactly what sounds you can and can’t hear clearly.
This isn’t about whether you can hear someone talking across the room. It’s about finding the quietest sound you can detect at each pitch, measured in decibels (dB). If you can’t hear a 25 dB tone at 1000 Hz, that’s a sign of hearing loss. Normal hearing means you can hear sounds at 25 dB or lower across all tested frequencies. Anything above that? That’s where the real work begins.
How Does Pure-Tone Audiometry Work?
The most common type of audiometry is pure-tone testing. You sit in a soundproof booth, wear headphones, and press a button every time you hear a tone. The tones start loud and get softer, until you can’t hear them anymore. Then they get louder again to confirm the exact point where you barely catch it. That’s your threshold.
Testing goes in a set order: usually 1000 Hz first, then 500, 2000, 4000, 8000, 250, and back to 500 Hz. Each frequency is tested separately in both ears. The technique used is called the modified Hughson-Westlake method-named after the audiologists who created it in 1944. It’s still the gold standard today, trusted by clinics from Bristol to Boston.
Here’s how it works step by step:
- The audiologist plays a tone you can easily hear (say, 40 dB).
- They drop the volume by 10 dB. If you don’t hear it, they go back up 5 dB at a time until you do.
- That point where you hear it half the time? That’s your threshold.
This method reduces guesswork. It’s precise. And it’s why audiometry is so reliable for diagnosing hearing loss.
Air vs. Bone Conduction: Finding the Source of Hearing Loss
Just knowing you have trouble hearing isn’t enough. You need to know why. That’s where air and bone conduction tests come in.
Air conduction uses headphones. Sound travels through your ear canal, eardrum, and middle ear bones to reach the inner ear. If something’s wrong in any of those parts-like wax buildup, fluid behind the eardrum, or a broken bone-you’ll hear less clearly.
Bone conduction skips all that. A small vibrator is placed behind your ear, on the mastoid bone. It sends sound vibrations straight to the inner ear, bypassing the outer and middle ear entirely. If your bone conduction thresholds are normal but your air conduction ones are worse, you’ve got a conductive hearing loss. That means the problem is in the ear canal or middle ear.
If both air and bone conduction are poor, it’s sensorineural hearing loss. That’s damage to the inner ear or auditory nerve. This is the most common type, especially with age or noise exposure.
An air-bone gap of 15 dB or more at any frequency confirms a conductive issue. That’s a key number audiologists look for.
Speech Testing: Can You Understand Words?
Some people hear tones fine but still struggle in conversations. That’s where speech audiometry steps in.
There are two parts: Speech Reception Threshold (SRT) and Word Recognition Score (WRS).
SRT finds the softest level at which you can repeat 50% of two-syllable words like "baseball" or "hotdog." Your SRT should match your average pure-tone threshold at 500, 1000, and 2000 Hz-within 10 dB. If it’s way off, something’s wrong.
Word Recognition Score tests how well you understand speech at a comfortable volume, usually 25-40 dB above your threshold. You’ll hear lists of single-syllable words like "cat," "ship," or "pen." A normal score is 90% or higher. If you only get 60%, even with hearing aids, you’ll still miss words in noisy rooms.
This is critical. Two people might have the same audiogram but very different real-world hearing. One hears the sounds but can’t make sense of the words. That’s often a sign of damage to the auditory nerve or brain processing.
Tympanometry and ABR: What Else Do They Test?
Audiometry doesn’t stop at tones and words. Tympanometry checks your middle ear health. A small probe goes in your ear, changes the air pressure, and measures how your eardrum moves. A flat reading (Type B) means fluid is trapped behind the eardrum-common in kids with ear infections. A normal curve (Type A) means everything’s moving freely.
For babies, non-responsive patients, or people who can’t press buttons, there’s Auditory Brainstem Response (ABR). Electrodes on your head record how your brainstem reacts to clicking sounds. It’s objective. No response needed. It’s how newborns get screened before they leave the hospital.
ABR can estimate hearing thresholds without you saying a word. It’s used for infants, people with developmental delays, or when there’s suspicion of a tumor on the hearing nerve. But it’s not for routine checks-it needs special equipment and trained staff.
What Do the Numbers Mean? Hearing Loss Categories
Decibels aren’t just numbers-they’re life-changing labels.
- Normal hearing: 0-25 dB HL
- Mild loss: 26-40 dB HL-you miss soft speech, especially in noise
- Moderate loss: 41-55 dB HL-you struggle in group conversations
- Moderately severe loss: 56-70 dB HL-you need hearing aids to follow daily talk
- Severe loss: 71-90 dB HL-you hear loud sounds but not speech
- Profound loss: 91+ dB HL-you may rely on lip reading or sign language
These levels aren’t guesses. They’re based on decades of research and standardized by the American Speech-Language-Hearing Association (ASHA) and the World Health Organization.
For example, a 45 dB loss at 2000 Hz-common in age-related hearing loss-means you miss consonants like "s," "th," and "f." That’s why people say, "I hear you, but I can’t understand you."
Who Needs Audiometry Testing?
You don’t have to wait until you’re struggling to get tested. The CDC recommends newborns be screened before leaving the hospital. Kids with frequent ear infections, adults over 50, and anyone exposed to loud noise at work or leisure should get checked every 1-3 years.
Occupational hearing loss is a big reason. OSHA requires annual audiograms for workers in noisy environments-construction, factories, music venues. If your hearing drops more than 10 dB in a year, your employer must take action.
And don’t forget: hearing loss isn’t just about volume. It’s linked to depression, social isolation, and even dementia. Catching it early changes outcomes.
What to Expect During the Test
Most tests take 20-30 minutes. You’ll sit quietly, respond to tones, repeat words, and maybe have a probe in your ear. No pain. No needles. Just quiet focus.
Some people find bone conduction uncomfortable, especially if they wear glasses. The vibrator on the mastoid bone can feel strange. But it’s brief.
For kids, audiologists use play-based methods. A child might drop a toy into a bucket every time they hear a sound. It turns testing into a game. Parents often say their kids loved it.
Make sure you’re well-rested. Fatigue affects your responses. And if you’ve got earwax buildup, ask for a cleaning first-it can throw off results.
Why Accuracy Matters
Audiometers must be calibrated yearly to stay accurate within ±3 dB. If they’re off, you might get a false diagnosis. That’s why clinics follow ANSI S3.6-2018 standards.
Masking is another key detail. If one ear is much better than the other, the good ear might hear the tone meant for the bad ear. To prevent that, noise is played in the good ear to block it out. If masking isn’t done right, results are wrong. About 12% of tests have errors because of this.
That’s why you need a licensed audiologist-not a technician, not a kiosk. They know how to spot these mistakes.
What Happens After the Test?
Your audiogram isn’t just a report-it’s a roadmap. If you have a conductive loss, you might need an ENT specialist for wax removal or surgery. Sensorineural loss? Hearing aids or cochlear implants are options.
But many people leave without understanding their results. One patient said, "I got my audiogram but no one explained what the bone conduction lines meant." That’s unacceptable.
Good audiologists sit down with you. They point to the graph. They say, "You’re missing these sounds. Here’s why. Here’s what we can do."
Future of Audiometry
Tele-audiology is growing. You can now do some tests at home with FDA-approved apps and mobile booths. But don’t confuse screening with diagnosis. Remote tests can miss subtle losses below 25 dB.
AI is starting to help too. New software can analyze audiograms and flag patterns of conductive loss with 87% accuracy. But it’s still a tool-not a replacement for the human ear and expertise.
As the population ages, demand will rise. One in four people over 65 has hearing loss. That’s 25 million Americans alone. Accurate testing isn’t optional anymore-it’s essential.
Solomon Ahonsi
February 3, 2026 AT 04:43