An audiology test is a series of painless evaluations that measure how well you hear different sounds, how clearly you understand speech, and how well the structures of your ear are functioning. Most full evaluations take 30 to 60 minutes and require no preparation. The results are plotted on a chart called an audiogram, which maps out exactly where your hearing stands across a range of pitches and volumes.
There isn’t just one “hearing test.” A typical audiology appointment includes several distinct tests, each designed to evaluate a different part of the hearing system. Together, they give a complete picture of what’s happening in your ears and where any problems might be.
Pure-Tone Testing: The Core of the Exam
Pure-tone audiometry is the part most people picture when they think of a hearing test. You sit in a soundproof booth wearing headphones, and the audiologist plays a series of beeps at different pitches and volumes. Each time you hear a tone, you press a button or raise your hand.
The test covers pitches from 250 Hz (a low hum, like a bass note) up to 8,000 Hz (a high-pitched whistle). The audiologist works through specific frequencies in a set order: 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz first, then circles back to recheck 1,000 Hz for consistency before testing 500 and 250 Hz. At each pitch, the volume starts at a level you can easily hear, then drops by 10 decibels each time you respond. When you stop hearing the tone, it rises by 5 decibels until you hear it again. Your “threshold” at that frequency is the softest level you can detect at least half the time.
This back-and-forth might feel slow, but it’s precise. The method narrows in on the exact boundary of your hearing at every pitch, giving the audiologist a detailed map rather than a rough estimate.
Air Conduction vs. Bone Conduction
The pure-tone test is actually run twice, using two different methods. Air conduction testing sends sound through headphones the normal way: into your ear canal, through your eardrum and middle ear bones, and into the inner ear. It tests the entire hearing pathway from the outer ear to the brain.
Bone conduction testing skips the outer and middle ear entirely. A small vibrating device is placed on the bone behind your ear, sending sound vibrations directly to the inner ear. This isolates the nerve-based portion of your hearing.
Comparing the two results is what makes the test so useful diagnostically. If both air and bone conduction scores are equally reduced, the problem is in the inner ear or the hearing nerve (sensorineural hearing loss). If bone conduction is normal but air conduction is reduced, something is blocking or disrupting sound in the ear canal, eardrum, or middle ear bones (conductive hearing loss). Some people have a mix of both, and the gap between the two scores tells the audiologist exactly how much of each type is present.
Speech Testing
Hearing beeps in a quiet booth doesn’t tell the whole story. Speech testing measures how well you actually understand language, which is what most people care about in daily life.
The first part is the speech reception threshold. The audiologist plays two-syllable words (like “baseball” or “hotdog”) at decreasing volumes until you can barely repeat them. Your threshold is the softest level at which you correctly identify the words 50% of the time. This number should line up closely with your pure-tone results, serving as a cross-check.
The second part is the word recognition score. Here, single-syllable words are played at a comfortable, conversational volume, and you repeat each one. Your score is the percentage you get right. A score of 80% or higher is considered normal. A low word recognition score, even with relatively mild hearing loss on the audiogram, can signal that the hearing nerve itself isn’t processing speech clearly. This distinction matters because it affects how much benefit you’d get from hearing aids or other interventions.
Middle Ear Testing (Tympanometry)
Tympanometry doesn’t require you to respond at all. A small probe is placed in your ear canal, creating a gentle seal. The device changes the air pressure inside your ear canal while playing a low tone, then measures how much sound your eardrum absorbs versus reflects at each pressure level.
A healthy eardrum moves freely, absorbing the most sound when the pressure on both sides is equal. If your eardrum is stiff (from fluid behind it, for example) or too loose (from a perforation), the pattern looks different. Tympanometry is especially useful for detecting middle ear infections, fluid buildup, or problems with the tiny bones that transmit sound. The whole process takes only a few seconds per ear and feels like a mild pressure change, similar to a gentle altitude shift.
Otoacoustic Emissions (OAE)
This is another test that doesn’t need your active participation. A small probe in the ear canal plays sounds and then listens for faint echoes produced by the inner ear itself. Healthy hair cells in the cochlea (the snail-shaped organ of the inner ear) vibrate in response to sound and produce their own tiny sounds in return. If those emissions are present, the inner ear is working. If they’re absent or weak, the hair cells may be damaged.
OAE testing is a standard part of newborn hearing screenings because it’s quick, completely painless, and doesn’t require the baby to do anything. It’s also used in adults to help pinpoint whether hearing loss originates in the inner ear specifically, separate from nerve or brain-related causes.
How Children Are Tested
Kids too young to press a button or raise their hand need modified approaches. For infants and toddlers with a developmental age of roughly 5 to 24 months, audiologists use visual reinforcement audiometry. The child sits in a booth, and when a sound plays, an animated toy or video lights up as a reward for turning toward the sound. Over time, the audiologist lowers the volume to find the child’s threshold, just like in the adult version.
Children between about 2 and 7 years old typically do conditioned play audiometry. Instead of pressing a button, the child drops a block in a bucket, stacks a ring, or completes some other simple game each time they hear a tone. The playful format keeps young children engaged long enough to get reliable results.
For newborns and infants who can’t participate at all, audiologists rely on OAE testing and a separate brain-based test that measures electrical signals along the hearing nerve in response to sound, no participation required.
Reading Your Audiogram
After testing, your results are plotted on an audiogram: a graph with pitch (frequency) along the top and volume (decibels) down the side. Each ear gets its own set of markings. The lower your thresholds fall on the chart, the louder a sound needs to be before you hear it.
The American Speech-Language-Hearing Association classifies hearing loss by degree based on your thresholds:
- Normal: -10 to 15 dB
- Slight: 16 to 25 dB
- Mild: 26 to 40 dB
- Moderate: 41 to 55 dB
- Moderately severe: 56 to 70 dB
- Severe: 71 to 90 dB
- Profound: 91 dB and above
Your audiologist will also look at the shape of your hearing loss. Some people lose only high-pitched sounds (common with aging or noise exposure), while others have a flat loss across all pitches. The pattern helps identify the cause and guides treatment decisions. A person with mild loss at high frequencies, for instance, might struggle with consonant sounds like “s,” “f,” and “th” while hearing vowels just fine, making speech sound muffled rather than quiet.
How Often to Get Tested
Current guidelines recommend hearing screening for adults starting at age 50, or earlier if you’ve noticed changes. A simple starting point is the question: “Do you feel you have hearing loss?” If the answer is yes, that alone warrants a full evaluation. For ongoing monitoring, screening every one to three years is a reasonable interval. People with known risk factors, like regular noise exposure, a family history of hearing loss, or certain medications that can affect hearing, may benefit from more frequent testing.
Hearing loss often develops gradually enough that you don’t notice it yourself. Many people first learn about it when a family member points out the TV volume or when they realize they’ve been reading lips in conversation without thinking about it. Baseline testing gives you a reference point, so future changes are easier to catch early.