ENT specialist
Pure-tone audiometry (hearing test)
Pure-tone audiometry measures how well you hear with a simple, painless test. It takes 5 to 10 minutes, is done in a booth and needs no special preparation.
What is pure-tone audiometry?
Pure-tone audiometry is the standard hearing test. You listen through headphones to sounds of different pitch and volume, and let us know each time you hear one. It is carried out by a hearing specialist (audioprosthetist) in a soundproof booth, so that no outside noise affects the result.
The quietest sound you can just hear at each pitch is called your hearing threshold. That is what the test measures.
What is it for?
It is the basic test to find out whether you hear normally, how much hearing you have lost and what type of loss it is. We request it when you have:
- Trouble hearing, a feeling of blocked ears or difficulty understanding others.
- Tinnitus (ringing or buzzing).
- Dizziness or vertigo that may be related to the inner ear, as in Ménière’s disease.
- Sudden hearing loss in one ear.
- Regular exposure to loud noise or a history of ear infections.
- Follow-up of a known hearing loss.
It helps us tell apart three situations:
- Conductive loss: the problem is in the outer or middle ear (for example, earwax or fluid behind the eardrum).
- Sensorineural loss: the problem is in the inner ear or the hearing nerve.
- Mixed loss: a combination of both.
It is often completed with Tympanometry, which assesses the eardrum and middle ear.
How should I prepare?
You do not need any special preparation. A few tips:
- You do not need to fast.
- Try to avoid very loud noise (concerts, clubs, machinery) in the hours before.
- Tell us if you have a cold, pain or a blocked-ear feeling. If there is a plug of earwax, it is sometimes best to remove it first.
- If you wear hearing aids, bring them and tell us. If you have tinnitus, let the technician know.
- Take off large earrings and, if they bother you, your glasses.
What happens during the test?
- You sit in the booth. The technician stays outside but can see and hear you throughout.
- You put on headphones.
- You hear soft beeps, from low to high pitch and getting quieter, first in one ear. Each time you hear one, even if it is very faint, press a button or raise your hand.
- If needed, bone conduction is also tested. A small vibrator is placed behind your ear and sends sound through the bone, bypassing the middle ear. This tells us whether the problem is in the middle ear or the inner ear. Sometimes a soft noise is played in the other ear so that it does not “help” during the test.
- The test is repeated in the other ear.
It takes 5 to 10 minutes, depending on which techniques are needed.
Does it hurt? Are there any risks?
It does not hurt and there are no risks. The sounds start very quietly and the volume is controlled. The most you may feel is tiredness from concentrating. If you have tinnitus, listening to beeps can be bothersome: tell the technician.
Results
The result is drawn on a chart called an audiogram:
- Across the chart are the pitches, from low to high.
- Down the chart is the volume in decibels (dB) you need to hear the sound: the lower the mark, the worse you hear that pitch.
- A red circle shows the right ear and a blue cross the left ear.
As a guide, the World Health Organization grades hearing in adults like this:
| Average threshold | Considered |
|---|---|
| Below 20 dB | Normal hearing |
| 20 to 34 dB | Mild hearing loss |
| 35 to 49 dB | Moderate hearing loss |
| 50 to 64 dB | Moderately severe hearing loss |
| 65 to 79 dB | Severe hearing loss |
| 80 dB or more | Profound hearing loss or deafness |
A single number is not enough. We explain the result in the consultation, together with the examination and, if needed, other tests.
When to seek advice
Contact us as soon as possible if you lose hearing suddenly in one ear, even partially. This is urgent: the sooner we assess it, the more treatment options there are. Do not wait for it to pass.
Call 112 (in Spain) or your local emergency number if, along with the hearing loss, you have weakness in your face, difficulty speaking or severe vertigo with other neurological symptoms.
Frequently asked questions
How long does a hearing test take? 5 to 10 minutes. It depends on whether bone conduction also needs to be measured.
Does it hurt? No. You only have to listen and let us know when you hear a sound.
Does it also measure whether I understand words? No. Pure-tone audiometry measures how well you hear simple sounds. The test that measures how well you understand words is called speech audiometry and is not part of this test.
Is it the same as tympanometry? No. Audiometry measures how well you hear; Tympanometry assesses how the eardrum and middle ear are working. They complement each other.
Can children have it? Yes, once they can cooperate enough.
Can I go alone and drive afterwards? Yes. There are no after-effects.
Why do you also test through the bone? To find out which part of the ear is affected. If you hear worse through the air but well through the bone, the problem is usually in the outer or middle ear.
References
- Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019;161(1_suppl):S1-S45.
- Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41.
- British Society of Audiology. Recommended procedure: Pure-tone air-conduction and bone-conduction threshold audiometry with and without masking. 2018.
- World Health Organization. World report on hearing. Geneva: WHO; 2021.
For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.