Diagnosis of Hearing loss

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The ENT specialist will record the patient’s medical history, examine their ears using an otoscope or microscope (removing any wax, if necessary) and perform a hearing test.

The hearing test includes subjective and objective tests which provide data as to whether or not the patient has impaired hearing; if there is hearing loss, it also indicates what type, to what degree and the type of treatment required.

Tests used to diagnose Hearing loss

Subjective tests

These tests depend on the patient’s collaboration and the examiner’s expertise. They are used more than others because of the amount and quality of the information they provide.

Tuning fork hearing tests

Acoumetry. A set of tests and instruments used to examine hearing without the need for any electronic equipment. They are usually conducted with tuning forks. The most used tests are:

  • Rinne test. This consists of comparing the patient’s perception of sound transmitted by air or bone conduction. On one hand, a tuning fork is vibrated and placed firmly on the patient’s mastoid bone (bone conduction). On the other hand, the ends of the tuning fork are then placed in the entrance of the external ear canal (air conduction). A comparison of the results from both conduction routes can identify the location of the lesion causing the hearing loss.
  • Weber test. The Weber test is a quick hearing test used to detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). It is carried out by placing a tuning fork in front of the patient who must then state on which side they hear the sound.
Person wearing headphones for hearing test

Audiometry. Audiometry refers to hearing examination systems that use electronic devices. The instrument used in these tests is called an audiometer. It is basically a device that can emit the sounds required to study a person’s hearing.

  • Pure tone audiometry. This test is used to measure the patient’s auditory acuity and locate the lesion. The patient’s hearing threshold (the volume at which they start hearing sounds) is detected at different frequencies (deep, intermediate and high-pitched tones), by means of both air (transmitting sounds along the external ear canal using earphones) and bone conduction (transmitting sounds through the mastoid using a bone vibrator). Each of these thresholds is recorded with a series of internationally recognised signs, giving rise to a graphic record called an audiogram.
  • Speech audiometry. Speech audiometry uses lists of two syllable words instead of pure tones to assess the quality of the patient’s residual hearing.

Objective tests

Person with electrodes on the head and a monitor showing brain activity

These tests do not require the patient’s collaboration, so they can be carried out on babies:

  • Otoacoustic emissions
  • Impedancemetry
  • Brainstem auditory evoked potentials
  • Auditory steady-state evoked potentials

Substantiated information by:

Ignacio Berdejo Gago
Miguel Caballero Borrego

Published: 18 May 2018
Updated: 18 May 2018

The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.


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