Hearing Testing

Lesson
3
(Week 5)
Lesson Outcomes
At the end of this lesson, you will be able to:
1) Differentiate methods of hearing testing.

2) Explain the importance of knowing the threshold of hearing.
DISCOVER
What is the importance of knowing your hearing threshold?
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DISSECT
Hearing testing is a means of evaluating an individual’s overall hearing
function. Hearing tests help detect hearing loss, identify how severe it is, and
determine what is causing it. They measure the ability of sound to reach the
brain. Sounds are actually vibrations of different frequencies and intensities in
the air around us; air in the ear canals and bones in the ears and skull help
these vibrations travel from the ear to the brain. By measuring the ability to hear
sounds that reach the inner ear through the ear canal (air-conducted sounds)
and sounds transmitted through bones (bones-conducted sounds), hearing tests
can also help determine the kind of hearing loss.
Most hearing tests require a response to a series of tones or words. These
tests include:
Whispered speech testing, which is a simple screening test that
assesses your ability to hear whispered speech across a short
distance.
Pure tone audiometry, which measures your ability to hear sounds
that reach the inner ear through the ear canal (air conduction). By
using vibrations, this test can also measure hearing through bone
(bone conduction).
Tuning fork testing, which assesses how well sound moves through
the ear.
Speech reception and word recognition testing, which measure your
ability to hear and understand speech.
Hearing tests that do not require a response (often used to screen

newborns for hearing problems) include:
❖ Otoacoustic emissions (OAE) testing, which measures the inner
ear’s respond to sound.
❖ Brainstem auditory evoked responses (BAER), which evaluates the
function of nerve pathways in the brain that are required for
hearing.
❖ Electrocochleography (ECOG) is a variant of BAER where an
electrode is placed on or in the ear drum to increase the size of wave
1 of the BAER.
❖ Tympanometry is a measure of the stiffness of the eardrum and thus
evaluates middle ear function. This test can be helpful in detecting
fluid in the middle ear, negative middle ear pressure, disruption of
the ossicles, tympanic membrane perforation, and otosclerosis.
The pure tone audiometry and tympanometry are briefly described below:
Pure Tone Audiometry

Saying that two sounds having equal intensity is not the same thing as
saying that they have equal loudness. Since the human hearing sensitivity varies
with frequency, it is useful to plot equal loudness curve which show that
variation for the average human ear (Fig. 1). If 100 Hz is chosen as a standard
frequency, then each equal loudness curve can be referred to the decibel level at
1000 Hz. This is the basis for the measurement of loudness in phons. If a given
sound is perceived to be as loud as a 60 dB sound at 1000 Hz, then it is said to
have a loudness of 60 phons.
Fig. 1 Equal loudness curves
Threshold of Hearing
Sound level measurements in decibels are generally referenced to a
standard threshold of hearing at 1000 Hz for the human ear which can be stated
in terms of sound intensity:
I0 = 10-12watts/m2
Sound intensity is defined as the sound power per unit area. The most
common approach to sound intensity measurement is to use the decibel scale.
The sound intensity I may be expressed in decibels above the standard threshold
of hearing I0. The expression is
I (dB) = 10 log10
The logarithm involved is just the power of 10 of the sound intensities

expressed as a multiple of the threshold of hearing intensity.
Example: if I = 10 000 times the threshold
The factor of 10 multiplying the logarithm makes it decibels instead of

Bels, and is included about 1 decibel is just the noticeable difference in sound
intensity for the normal ear. This value has a wide acceptance as a nominal
standard threshold and corresponds to zero decibel.
The standard threshold of hearing can be stated in terms of pressure and
the sound intensity in decibels can be expressed in terms of the sound pressure:
The pressure P here is to be understood as the amplitude of the pressure
wave. The power carried by a travelling wave is proportional to the square of the
amplitude. The factor of 20 comes from the fact that the logarithm of the square
of a quantity is equal to 2 times the logarithm of the quantity.
The actual average threshold of hearing at 1000 Hz is more like 2.5 x 10 -
12 watts/cm2 or about 4 decibels, but zero decibels is convenient reference. The
threshold of hearing varies with frequency, as illustrated by the measured

hearing curves (Fig. 1). The nominal dynamic range of human hearing is from
the standard threshold of hearing to the threshold of pain. A nominal figure for
the threshold of pain is 130 decibels, but that which may be considered painful
for one may be welcomed as entertainment by others. Generally, younger
persons are more tolerant of loud sounds than older persons because their
protective mechanisms are more effective.
The testing of hearing is most often carried out by establishing the
threshold of hearing, the softest sound which can be perceived in a controlled
environment. It is typical to do this testing with pure tones by providing
calibrated tones to a person via earphones, allowing that person to increase the
level until it can just be heard. Various strategies are used, but pure tone
audiometry with tones starting at about 125 Hz and increasing by octaves, half-
octaves, or third-octaves to about 8 000 Hz is typical. The results of such tests
are summarized in audiograms. Audiograms compare hearing to the normal
threshold of hearing, which varies with frequency as illustrated by the hearing
curves. The audiogram is normalized to the hearing curve so that a straight
horizontal line at 0 represents normal hearing. It is impossible to have scores
less than 0, which indicate better than average hearing.
Tympanometry
The tympanometer measures the compliance (sometimes called
“admittance”) of the tympanic membrane (eardrum) while different pressures are
being applied to the external ear canal. A probe is inserted into the ear canal and
emits a sound signal under different pressure conditions.
The compliance of the tympanic membrane is measured in cubic
centimeters, and the pressure in the ear canal is measured in decapascals
(daPa). The probe has different sized “plugs” that provide a seal at the entrance
to the external ear canal. The tip of the probe has a pressure transducer that
changes the pressure in the external ear canal from negative, through
atmospheric pressure, to positive pressure. While the pressure is changing, a
sound transmitter sends a sound wave to the tympanic membrane. The wave
that is reflected from the tympanic membrane is then picked up by a microphone
in the probe. The tympanometer measures the energy of the sound signal
reflected by the tympanic membrane at these different pressures.
Fig. 2 Scheme of tympanometry
If the middle ear space is filled with fluid, most of the sound is reflected
back to the probe from the stiff tympanic membrane and a flat tympanogram
tracing result (low compliance). If the middle ear space is filled with air, and the
osscicles are intact, energy is absorbed by the tympanic membrane, ossicles, and
inner ear structures. The tracing will show a “normal” peak with normal
compliance. If there is disruption of the ossicles, or if a portion of the tympanic
membrane is flaccid, a large amount of energy will be absorbed into the tympanic
membrane and the tracing will display an abnormal peak (high compliance).
Similarly, if there is a perforation of the tympanic membrane, the tympanometer
will measure an unusually large canal volume, because the space of the middle
ear and mastoid air cells will be included in the volume calculation.
DEEPEN
NAME: Score:
Course, Yr, Section:
Answer the questions briefly but correctly.

1) What is a decibel?
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2) What is a phon?
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3) Describe the Weber-Fechner law?

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4) What is the function of the outer ear?

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5) What are the functions of the middle ear?

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6) What is the function of the inner ear?

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Lesson

1) Differentiate methods of hearing testing.

Hearing tests that do not require a response (often used to screen

Pure Tone Audiometry

The logarithm involved is just the power of 10 of the sound intensities

The factor of 10 multiplying the logarithm makes it decibels instead of

threshold of hearing varies with frequency, as illustrated by the measured

Answer the questions briefly but correctly.

3) Describe the Weber-Fechner law?

4) What is the function of the outer ear?

5) What are the functions of the middle ear?

6) What is the function of the inner ear?

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