Audiometry is a set of tests that measure how well you can hear. These tests evaluate everything from the faintest sounds your ears can detect to how clearly you understand speech in conversation. Audiometry is the primary tool audiologists and ENT specialists use to diagnose hearing loss, determine its type and severity, and figure out which part of the hearing system is affected.
What Audiometry Actually Measures
Your hearing involves a chain of events: sound waves enter the ear canal, vibrate the eardrum, pass through tiny bones in the middle ear, reach the fluid-filled inner ear, and finally travel as electrical signals along nerves to the brain. A problem at any point in that chain changes what you hear. Audiometry tests different links in this chain separately, which is what makes it so useful diagnostically. The results tell your provider not just that you have hearing loss, but where in the system the problem is happening.
Pure Tone Testing
Pure tone audiometry is the core of most hearing evaluations and probably what you picture when you think of a hearing test. You sit in a quiet booth, wear headphones or earbuds, and listen for 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 eight standard frequencies ranging from 125 Hz (a deep hum) up to 8,000 Hz (a high-pitched whistle), mapping out the quietest sound you can detect at each pitch.
There are two versions of this test, and the difference between them is what makes the diagnosis possible:
- Air conduction testing sends sound through headphones the normal way: into the ear canal, through the eardrum and middle ear bones, into the inner ear, and along the auditory nerve to the brain. This tests the entire hearing pathway.
- Bone conduction testing places a small vibrating device on the bone behind your ear, sending sound directly to the inner ear and bypassing the ear canal and middle ear entirely.
If your hearing is reduced on air conduction but normal on bone conduction, the problem is in the outer or middle ear. This is called conductive hearing loss, and it’s often treatable with medication or surgery. If both air and bone conduction show the same loss, the issue is in the inner ear or auditory nerve, which is sensorineural hearing loss. Some people have a mix of both.
How to Read an Audiogram
Your results are plotted on a graph called an audiogram. The horizontal axis shows frequency (pitch) from low to high, left to right. The vertical axis shows volume in decibels, with soft sounds at the top and loud sounds at the bottom. Each ear gets its own symbols: an “O” for the right ear and an “X” for the left. Bone conduction results use angle brackets, with “<” for the right ear and “>” for the left.
The pattern on the audiogram tells a story. A flat line near the top means normal hearing across all pitches. A curve that dips in the high frequencies is the classic shape of age-related or noise-induced hearing loss. A dip only at certain frequencies can point to specific causes, like noise damage that often shows up around 4,000 Hz.
Hearing Loss Severity
Hearing thresholds are classified by how loud a sound needs to be before you can hear it:
- Normal hearing: up to about 20 dB
- Mild loss: 20 to 34 dB (difficulty hearing soft speech or whispers)
- Moderate loss: 35 to 49 dB (trouble following normal conversation)
- Severe loss: 65 to 79 dB (only loud speech or sounds are audible)
- Profound loss: 80 dB and above (most sounds are inaudible without amplification)
Speech Audiometry
Pure tones tell you how sensitive your ears are, but they don’t tell you how well you actually understand language. That’s what speech audiometry is for, and it matters because two people with the same pure tone results can have very different experiences in real conversations.
The speech recognition threshold (SRT) finds the softest level at which you can correctly identify simple two-syllable words about half the time. This gives a baseline that should roughly match your pure tone results. If it doesn’t, that discrepancy itself is a diagnostic clue.
The word recognition score (WRS) tests clarity rather than volume. You’ll hear a list of single-syllable words played at a comfortable, conversational level, and you repeat each one back. Your score is the percentage you get right. A score of 80% or higher is considered normal. A low word recognition score, even with hearing aids turning up the volume, suggests the inner ear or auditory nerve is distorting the signal rather than simply making it quieter. This distinction matters because it affects which treatments or devices will actually help you.
Tympanometry and Middle Ear Testing
Tympanometry isn’t a hearing test in the traditional sense. It measures how well your eardrum moves. A small probe is placed in your ear canal, which changes the air pressure slightly while playing a low tone. You don’t have to respond to anything; the instrument does all the work. It takes only a few seconds per ear.
The result is a graph called a tympanogram, and its shape is classified into types:
- Type A: A nice peak in the center, meaning the eardrum moves normally.
- Type B: A flat line with little to no movement. This typically indicates fluid behind the eardrum or significant scarring.
- Type C: A peak that’s shifted, showing negative pressure in the middle ear. This often means the ear isn’t ventilating properly, possibly due to a developing fluid buildup or problems with the eustachian tube.
Tympanometry is especially useful for children with frequent ear infections, since fluid in the middle ear can cause temporary hearing loss that affects speech development.
Newborn and Infant Hearing Tests
Babies can’t raise their hand when they hear a beep, so audiometry for newborns relies on the body’s automatic responses to sound. Two tests are commonly used, often as part of universal newborn screening programs.
Otoacoustic emissions (OAE) testing works on a remarkable fact of biology: healthy inner ears don’t just receive sound, they produce it. Tiny cells in the inner ear vibrate in response to sound and emit faint echoes back out through the ear canal. A small microphone placed in the baby’s ear picks up these echoes. If they’re present, the inner ear is functioning. If they’re absent, further testing is needed. The whole process happens while the baby sleeps.
Auditory brainstem response (ABR) testing goes a step further. Small sensors are placed on the baby’s forehead, cheek, and neck, and soft clicking sounds are played through earphones. The sensors record the electrical activity generated as the sound travels from the inner ear through the auditory nerve and into the brainstem. This test can identify problems not just in the inner ear but along the nerve pathway, catching issues that OAE testing might miss.
Both tests are painless and typically performed in the first few days of life. ABR can also be used for older children or adults who can’t reliably participate in standard audiometry.
What the Test Is Like
A full audiometric evaluation, including pure tone testing, speech testing, and tympanometry, typically takes 30 to 60 minutes. No special preparation is needed. You’ll be seated in a sound-treated booth designed to block out background noise so the results are accurate. The booth may feel small, but the door doesn’t lock and you’ll be in communication with the audiologist throughout.
For the pure tone portion, you’ll wear headphones or insert earphones and signal each time you hear a tone, even if it’s extremely faint. The key is to respond to the quietest sounds you can perceive, not to wait until you’re sure. For speech testing, you’ll repeat words or sentences played through the headphones. Nothing is painful or invasive, and you’ll typically review your audiogram with the audiologist immediately after.
If hearing loss is found, the type, degree, and pattern on the audiogram guide what comes next. Conductive losses often have medical or surgical options. Sensorineural losses are usually managed with hearing aids or, in severe cases, cochlear implants. The audiogram also serves as a baseline, so repeat testing over months or years can track whether your hearing is stable or changing.