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The Hearing Examination: A Short Primer

What is the examination like? Short and painless and its in two parts. First you will see the MD and then you will have a hearing test provided by the Audiologist .  Starting with the ENT (shot for Ear Nose and Throat doctor), you will be taken to a private examination room and asked to sit in something that looks like a barber chair while the ENT hovers over you. He or she will take a flashlight and look into your ears, your eyes, and your sinuses. If the ENT finds any blockages, he or she may remove the debris that has been gathering in your ears. Some people have little; others generate more. Removing the wax will take very little time. For a microsecond, a small number of people might feel a pinch, but that will subside instantly. Some doctors may perform specific tests that will also involve your sinuses. There’s nothing to it.

 

Does look a little like a barber's chair.

What about the hearing test?

Ah, the hearing test will be done by the audiologist. In fact, one of the reasons to get your ears cleaned is to have your hearing measured more accurately, without the junk. You will be put in what is essentially a room-size phone booth, which is divided in half. Your half-booth has been isolated from all external sounds. The audiologist will fit you with a headset and then withdraw to the other half-booth, from which he or she will communicate with you through a microphone.

While being tested you are sitting in a soundproof room; the audiologist and you can see each other through the window.

The audiologist will tell you in advance about the sounds you will hear during the exam and let you know what aspect of your hearing is being tested. The whole procedure is likely to take no more than 20 minutes.

The result of the test will be put into an audiogram, which unlike most reports from doctors is very readable—it’s visual. See below:

Normally, an audiogram would contain just two lines rather than four lines. What is shown near the top of the graph (in solid lines) is normal hearing below (in broken lines) is the loss caused by a lifetime of exposure to sound. By the way, the Os indicate the right ear, the Xs the left ear (hearing loss can vary between ears). Now look at the horizontal bar at the top (frequency) and note that the scale ranges from 125 to 8,000 Hz (that is the frequency range) . Most age-related hearing loss occurs between 2,000 and 8,000 Hz. Unfortunately, those are the frequencies of human speech.

Now let’s look at a reference chart:

 

http://auditoryneuroscience.com/acoustics/clinical_audiograms

Here you see the grid predefined. If you go back and look at the first chart, you will see that it indicates a moderate hearing loss. People always look at the worst part of the chart because it represents the sound that you are not hearing. On the vertical scale, the difference between a whisper and normal speech is 30 decibels. In the prior chart, the line dips some 30 decibels in the higher frequencies; the numbers tail off after 2000 Hz (on the horizontal bar). This indicates that sounds above 2000 Hz will be muffled or barely audible because they are down to the whisper level. The role of hearing aids is to raise the volume.

The audiogram below is typical of age-related hearing loss.

http://auditoryneuroscience.com/acoustics/clinical_audiograms

The next step is deciding what to do about your diagnosis, and that depends on what your audiogram shows and on how you feel about your loss. Mine is in the moderate to severe range, and eventually I decided to get hearing aids. You will have to make a decision based on your own needs and on what your loved ones are telling you. If you think you are fine but they are complaining, you will need to assess their message in light of the audiogram and what your doctor says. Not all hearing loss can or should be treated; many physicians believe that hearing aids make sense mostly when hearing loss has progressed to the moderately severe stage and beyond.