We often start the conversation quite generally by asking you about your concerns with your hearing or communication ability, even involving significant others to share their observations.  We like to learn about your unique lifestyle, communication needs and preferences.

During this process we document your communication goals. We call these COSI Goals which stands for Client Oriented Scale of Improvement. We do this so that if we take any course of action we can look back at your COSI goals to gauge the levels of improvement and evaluate the next best steps.

Then we ask a you more medical focused questions including your familial history with hearing loss, degree of noise exposure over the years, whether you are experiencing tinnitus or vertigo. If you have had any medicines that could have affected your hearing.

We also like to find out about your general health which can help us if hearing aids are indicated. For example, if you have arthritis or dexterity problems this could affect your ability to manage hearing aids with very small batteries and perhaps a rechargeable hearing aid would be more suitable.

A healthy looking ear canal and ear drum (Tympanic membrane)

It takes a trained eye to look around and into an ear and determine if there are any abnormalities of concern.

We look for obstructions such as wax or debris.

We look at the appearance of your ear drums (Tympanic membranes).

This gives us an understanding of your outer to middle ear health.

Using a Tympanometer we measure your middle ear mobility and pressure. This helps indicate how mechanically efficiently your ear drum and middle ear system is at conveying sound vibration through to your inner ear. It also shows us the pressure at which your middle ear system is most compliant or moving the sound through most efficiently.

We obtain a graph for each ear called a tympanogram. Interpretation of this graph compliments the other Audiological information to help determine whether there’s any abnormal functioning of the middle ear systems, which can indicate middle ear pathologies and contribute to hearing loss.

The air conduction component of Audiometry refers to obtaining your hearing thresholds across the frequency range for tones presented either through headphone, insert ear phones or in a sound field via calibrated speakers.

Your hearing threshold for a particular frequency refers to the minimum volume measured in decibels hearing level (dB HL) required for you to hear a pure tone at that particular frequency or pitch. Your thresholds across the frequency range are plotted on a graph called an Audiogram.

The common attribute of air conduction testing is that the presented tones travel down your ear canal and through the middle ear system to be heard. In our hearing clinics we usually perform this using calibrated headphones in a sound proof booth.

If we perform a remote hearing test we can provide an automated audiometer with the calibrated headphones for use in a quiet room. A third way we conduct hearing tests is using hearing aids themselves to produce test tones. We record your responses to these test tones on a a slightly different type of graph called a Sensogram.

When we test your bone conduction thresholds we place a headband with a vibratory device just behind your ear on the mastoid bone. The presented tones travel directly through your skull to your inner ear. The sound essentially bypasses your ear canal and middle ear system.  This enables us to plot the thresholds that your inner ear or cochlea is picking up the sound. We may have to mask your opposite ear with a masking noise to gain the true thresholds of each inner ear. Because this represents your inner ear or nerve related sensitivity sounds we term any hearing loss associated with the inner ear a sensori-neural hearing loss.

The above illustration shows how sound presented via air conduction audiometry and bone conduction audiometry travel to the inner ear. The dashed lines show that sound from bone conduction can readily travel across the skull to either ear.

By comparing your bone conduction thresholds with your air conduction thresholds, we can see what proportion of your hearing loss is inner ear nerve related (sensori-neural) and what proportion is conductive i.e. sound just not moving through your outer and middle ear system as efficiently as it could. Often a hearing loss can be a combination of conductive and sensori-neural which we term a mixed hearing loss.

Bone conduction testing has a more limited range of test accuracy and is tested from 250Hz to 4000Hz. In the above Audiogram this person has normal bone conduction hearing thresholds bilaterally. This Shown by the brackets [ – right and ] – left. Their inner ear or sensori-neural hearing sensitivity is normal. However, their air conduction thresholds show moderate to mild hearing loss bilaterally. Their hearing loss is purely conductive. So, we would say this person has a mild to moderate conductive hearing loss bilaterally.

A speech discrimination hearing test is an essential ingredient of a diagnostic hearing test battery. We routinely include these tests to determine your speech discrimination ability in both quiet and different levels of competing background noise.

This helps indicate the level of benefit you are likely to attain from hearing aids. We’ll usually perform these types of hearing tests unaided and then aided and compare your speech discrimination scores to see how much improvement in speech understanding or discrimination you have when correctly aided. Effective speech discrimination testing is rarely part of a free hearing test.