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Hearing Tests

Test Overview

A hearing (audiometric) test is part of an exam that tests how well a person is able to hear. It is done by measuring how well sound can reach the brain.

The sounds we hear start as vibrations in the air around us. The vibrations make sound waves, which vibrate at a certain speed (frequency) and have a certain height (amplitude). The vibration speed of a sound wave determines how high or low a sound is (pitch). The height of the sound wave determines how loud the sound is (volume).

Hearing happens when these sound waves travel through the ear and are turned into nerve impulses. These nerve impulses are sent to the brain, which "hears" them.

  • Sound waves enter the ear through the ear canal (external ear). Then they strike the eardrum (tympanic membrane). The eardrum is what separates the ear canal from the middle ear.
  • The sound waves make the eardrum vibrate. The vibrations move to the bones of the middle ear. This boosts the sound and sends it to the inner ear.
  • The inner ear is a fluid-filled, curved space that is sometimes called the labyrinth. It contains the cochlea, the main sensory organ of hearing. Sound vibrations cause the fluid in the inner ear to move. This bends tiny hair cells (cilia) in the cochlea. The movement of the hair cells creates nerve impulses. These nerve impulses then travel along the cochlear nerve to the brain and are heard as sound.

Hearing tests help find what kind of hearing loss you have. The tests measure how well you can hear sounds that reach the inner ear through the ear canal. They also measure sounds that are spread through the skull.

Some hearing tests ask you to respond to a series of tones or words. But there are some hearing tests that do not require a response.

Why It Is Done

Hearing tests may be done:

  • To check, or screen, babies and young children for hearing problems that might affect their ability to learn, speak, or understand language. All babies born in Alberta are eligible for hearing screening.
  • To screen or test children and teens for hearing loss. Hearing loss in children and teens can start or get worse at any time. In children, normal hearing is important for proper language development. Some speech, behaviour, and learning problems in children can be related to problems with hearing.
  • To test for possible hearing loss in anyone who has noticed an ongoing hearing problem in one or both ears or has had a hard time understanding words in conversation.
  • To screen for hearing problems in older adults. Hearing loss in older adults is often mistaken for a reduced mental ability. (For example, a person may seem to not listen or respond to conversation.)
  • To screen for hearing loss in people who are exposed to loud noises or who take certain antibiotics, such as gentamicin.
  • To find out the type and amount of hearing loss (conductive, sensorineural, or both). In conductive hearing loss, the movement of sound (conduction) is blocked or does not pass into the inner ear. In sensorineural hearing loss, sound reaches the inner ear, but a problem in the nerves of the ear or, in rare cases, the brain itself prevents proper hearing.

How It Is Done


Before starting a hearing test, the audiologist will look in the ear with a special flashlight called an otoscope. The audiologist is looking to see if there is wax in the ear canal and they are checking the condition of the eardrum.

If they find excessive wax, they may recommend removing the wax before the hearing test. If they see a hole in the eardrum or fluid behind the eardrum, the audiologist may recommend a follow-up visit with your doctor.

Pure tone audiometry

A machine called an audiometer plays a series of tones through headphones. The tones change in pitch and loudness. Your audiologist will reduce the loudness of a tone until you can no longer hear it. Then the tone will get louder until you can hear it again. If you can hear the tone, you signal by raising your hand or pressing a button.

The headphones will then be removed. A special vibrating device will be placed on the bone behind your ear. Again, you will signal each time you hear a tone.

Audiometry is done differently for young children. Instead of raising their hand or pressing a button, children may play listening games, like putting a peg in a pegboard or dropping a block in a bucket. Learn more about hearing tests for children.

Speech reception and word recognition tests

In these tests, you hear a series of simple words spoken with different degrees of loudness. You are asked to repeat the words. Your audiologist measures the level at which you can no longer hear the words well enough to repeat them.

Young children may be asked to point to body parts (for example, “Show me your nose”) or point to pictures on a picture card (for example, “Show me the playground”) instead of repeating words to determine the softest level at which they can hear a sound.

Middle ear test (tympanometry)

In this test, your audiologist will place a soft plastic tip into your ear to measure how your middle ear (eardrum) works. You may hear some sounds. You need to sit quietly for these measurements.

Auditory brain stem response (ABR) testing

In this test, electrodes are placed on your scalp and on each earlobe. Sounds are then sent through earphones. The electrodes monitor your brain's response to the sounds and record the response on a graph.

How long the test takes

  • The tests usually take about 1 hour.
  • ABR testing may take 1 to 3 hours depending on the reason for the test and the age of the person being tested.

How It Feels

During the hearing test you will sit in a quiet sound treated room. This test usually doesn't cause any pain or discomfort.


Hearing test results


  • You are able to hear whispered speech correctly.
  • You can hear tones at equal loudness in both ears.
  • You are able to repeat 90% to 95% of the words in a word recognition test.
  • The measurement of the middle ear shows the eardrum to move the way it should.
  • The values recorded on the graph for auditory brain stem response testing show that the nerves in the ear and the brain that help with hearing are working as they should.


  • You hear the tone more loudly in one ear than in the other ear.
  • You can only hear certain sounds at high decibel levels.
  • You can hear sounds, but you can't understand words clearly.
  • The values recorded on the graph for auditory brain stem response testing show that the nerves in the brain that help with hearing are not working as they should.

Sound is described in terms of frequency and intensity. Your hearing threshold is how loud the sound of a certain frequency must be for you to hear it.

  • Whether a sound is low or high is measured in vibrations per second, or hertz (Hz). This is called frequency, or pitch. The human ear can normally hear frequencies from a very low rumble of 16 Hz to a high-pitched whine of 20,000 Hz. Most speech sounds occur in the range of 250 to 8,000 Hz.
  • Intensity, or loudness, is measured in decibels (dB). The normal range (threshold or lower limit) of hearing is 0 dB to 20 dB.

The following table relates how loud a sound must be for a person to hear it (hearing thresholds) to the degree of hearing loss for adults. Your audiologist will review the test results with you, answer your questions, and give recommendations based on the test results.

Hearing loss table

Hearing threshold in decibels (dB)

Degree of hearing loss

Ability to hear speech

0–20 dB


No significant trouble hearing.

21–40 dB


Trouble with faint or distant speech.
Trouble hearing speech in noisy environments.

41–55 dB


Trouble with conversational speech in both quiet and noisy environments.

56–70 dB

Moderate to severe

Trouble with conversational speech in both quiet and noisy environments.
Trouble taking part in group conversation.

71–90 dB


Extreme difficulty hearing speech and taking part in a conversation in both quiet and noisy environments.

91+ dB


Will not hear conversational speech in quiet or noisy environments without the use of hearing technology.



  1. Joint Committee on Infant Hearing (2019). Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. Journal of Early Hearing Detection and Intervention, 4(2), 1–44. DOI: 10.15142/fptk-b748. Accessed January24, 2023.
  2. Centers for Disease Control and Prevention (2022). Screening and diagnosis of hearing loss. Centers for Disease Control and Prevention.,than%203%20months%20of%20age. Accessed January 24, 2023.


Adaptation Date: 2/26/2024

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

Adapted with permission from copyrighted materials from Healthwise, Incorporated (Healthwise). This information does not replace the advice of a doctor. Healthwise disclaims any warranty and is not responsible or liable for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.