An Otolaryngologist, commonly referred to as an ENT, is a medical doctor specializing in conditions affecting the ears, nose, and throat. This physician has extensive training in the medical and surgical management of these interconnected structures. Many people seek out an ENT when they experience changes in their hearing, ringing in the ears, or persistent ear discomfort. The comprehensive evaluation of hearing concerns involves a structured process that combines a medical examination with specialized diagnostic testing. Understanding this process helps patients know what to expect during their appointment.
Clarifying Roles: ENT vs. Audiologist
While the ENT is the physician overseeing the patient’s overall ear health, the full hearing test is typically administered by a licensed Audiologist. An Audiologist is a hearing healthcare professional who holds a Doctor of Audiology (Au.D.) degree and specializes in the non-medical diagnosis and management of hearing and balance disorders. Their primary focus is on measuring the functional ability of the auditory system and determining the degree and type of hearing loss.
In many modern clinics, the Audiologist is an integrated part of the ENT office team, ensuring a coordinated approach to care. This collaboration allows the ENT to concentrate on identifying and treating the underlying medical or surgical causes of hearing loss, such as infections or structural issues. The Audiologist focuses on the technical administration of tests, the detailed interpretation of the results, and non-medical solutions like hearing aid fittings.
The Pre-Test Examination
The initial part of the visit involves a medical assessment by the Otolaryngologist, which precedes the formal hearing testing. This begins with a detailed review of the patient’s medical history, focusing on symptoms like tinnitus, dizziness, ear discharge, or a recent history of head trauma. The physician will inquire about the onset of hearing changes, whether the loss is sudden or gradual, and any occupational noise exposure that could be a factor.
Following the history, the ENT performs an otoscopy, which is a visual examination of the ear canal and eardrum using a lighted instrument. The purpose of this physical check is to identify any simple, correctable causes of hearing loss, such as a large buildup of earwax (cerumen impaction) or signs of an active middle ear infection. The physician is also looking for structural abnormalities, fluid accumulation behind the eardrum, or a perforation in the tympanic membrane.
A simple screening test may also be performed using a tuning fork, such as the Rinne or Weber tests. These bedside tests use bone and air conduction to quickly categorize the hearing loss as either conductive, which involves the outer or middle ear, or sensorineural, which involves the inner ear or auditory nerve. These initial findings guide the Audiologist in selecting the most appropriate diagnostic tests that follow.
Types of Hearing Tests Performed
The formal hearing evaluation is conducted in a sound-treated booth and consists of multiple objective and subjective measurements. The most fundamental test is Pure-Tone Audiometry, which measures the quietest sounds a person can hear at various frequencies, or pitches. During this test, the patient wears headphones and signals when they hear tones presented at different intensities in each ear.
This pure-tone testing includes both air conduction, which assesses the entire auditory pathway, and bone conduction, which bypasses the outer and middle ear to test the inner ear directly. The results are plotted on a graph called an audiogram, which visually maps the hearing thresholds across low, middle, and high pitches. The comparison between air and bone conduction thresholds allows the specialist to determine the specific location of the hearing problem.
Another common procedure is Speech Audiometry, which assesses the ability to hear and understand spoken words. This test determines the Speech Recognition Threshold (SRT), which is the softest level at which a patient can correctly repeat 50% of spoken words. Tympanometry is an objective test that measures the movement of the eardrum in response to slight changes in air pressure. This helps confirm the health of the middle ear, detecting issues like fluid buildup or Eustachian tube dysfunction that can cause conductive hearing loss.
Diagnosis and Treatment Pathways
Once the Audiologist has completed the diagnostic tests, the ENT uses the comprehensive report, including the audiogram and middle ear data, to form a medical diagnosis. The test results allow the physician to classify the hearing loss, which is a necessary step for determining the correct course of action. For conductive hearing loss, treatments often fall directly under the ENT’s medical purview.
This medical management may involve prescribing antibiotics or corticosteroids to treat infections or inflammation. In cases where the loss is caused by structural issues, the ENT may recommend surgical procedures, such as placing ear tubes for chronic middle ear fluid or repairing a perforated eardrum (tympanoplasty).
For sensorineural hearing loss, which is often permanent due to damage to the inner ear hair cells, the ENT’s role shifts to management and referral. After ruling out medically or surgically treatable causes, the ENT will work with the Audiologist to manage the functional hearing loss. This often involves a recommendation for hearing aids, cochlear implants, or other assistive listening devices. The ENT ensures the patient’s ear is healthy enough for these devices, while the Audiologist handles the selection, fitting, and programming of the technology.