Hearing tests

 

Diagnostic Hearing Test perth

Hearing Test Perth

We offer 4 different Type of hearing tests in Perth. You can come and visit us at one of our Perth hearing clinics for either a free hearing test (screening) or a diagnostic hearing test for which we charge $120. A report is sent to your doctor as required.

 

You can also have a hearing test at home. Take our quick online hearing test or contact us to order the at Home Hearing Test Kit. We express mail you the equipment and upon receiving it we can remote in and guide you through the hearing test procedure.

 

What is a diagnostic hearing test?

A full diagnostic hearing test consists of a battery or group of tests where the combination of results gives sufficient information to help diagnose your ear health and nature of your hearing loss.  It also shows your ability to understand speech in quiet and in competing noise. It can show whether hearing aid amplification will be of any benefit at all.

 

Composition of a diagnostic hearing test

 

COSI Goal Setting

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 next best steps.

 

 

Medical & Ear Health History

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.

 

Otoscopic Examination of the Outer Ear

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.

 

 

 

 

 

 

 

 

 

 

 

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

Tympanometry – Middle Ear Testing

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.

 


Hearing Test: Pure Tone Audiometry

 

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 clinic’s 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.

 

Why we test more frequencies:

Most companies openly limit the thresholds they test to just 9 frequencies that range from 250Hz to 8000Hz. At Harmony Hearing we understand that speech has higher frequency harmonics above 8000Hz that can provide additional cues for separating speech from competing noise and to help localise where sounds are coming from.

We also understand that the most common type of hearing loss, age related hearing loss usually starts in the higher frequencies and gradually moves to lower frequency ranges.

Some quality hearing aids now have a wider bandwidth up to 10,000Hz and even 12,000Hz which enables better access to these higher frequency speech cues.

These are some of the reasons we believe it’s important to test into these higher frequency ranges. We also test at more frequency intervals than most as it gives us more of an accurate Audiogram. Then when if it comes to programming your hearing aids we have more thresholds to work with to more to accurately shape the amplification across the frequency range to you hearing levels. We routinely include in our test range from low to high: 250Hz, 500Hz, 750Hz, 1000Hz, 1500Hz, 2000Hz, 3000Hz, 4000Hz, 6000Hz, 8000Hz, 9000Hz and 10,000 Hz.

 

 

 

 

 

 

 

 

 

 

 

 

 

 The above audiogram shows the ranges of normal hearing and the respective levels of hearing loss. Also shown is the relative pitch and volume across the frequency range. You can see the shaded area where these sounds are located is shaped a bit like a banana. It is given the name the Speech Banana. This person has a severe to profound bilateral hearing loss and wouldn’t be able to hear any speech sounds at average conversational levels. The above example only shows air conduction thresholds to 8000Hz.

Understanding Speech

For people living with hearing loss understanding speech especially when there’s competing noise is the holy grail. Speech sounds vary markedly in their frequency and intensity. Some of the low frequency speech sounds include ‘m’ and ‘u’ whilst others are very high in frequency such as ‘s’ and ‘t’.  It’s true that many of the speech sounds produced by an adult male are of lower frequency then those produced by a female or chid.

In a study by Boothroyd and Medwetsky (1992) they found that the average ‘s’ sound produced by a male adult is approximately 4300 Hz and 7200 Hz for female adults. For some females where there’s a neighbouring vowel sound such as an ‘ee’ the frequency of the ‘s’ sound was found to be as high as 8900Hz. This illustrates the importance of hearing those higher frequencies.

 

 

Bone Conduction Thresholds:

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.

Speech Discrimination Hearing Tests

 

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.

 

Feel Educated About Your Hearing & Ear Health

We believe it’s only fair and ethical to give you the full picture about your hearing health and rehabilitation options. Our educational approach of sharing the hearing test results in a clear and understandable way forms part of this process.

Being independent of the hearing aid manufacturers empowers us to provide you with an unbiased view of your rehabilitation options.

Price of our diagnostic hearing test

We schedule a 90minute appointment for a diagnostic hearing test to provide adequate time to be thorough. It gives us enough time to discuss and demonstrate hearing aid options if they are indicated. If you are self-funded we charge $120 for this full diagnostic hearing test and hope you can see that it is excellent value. It should be considered a baseline for a hearing rehabilitation program. The industry average price of a hearing test is around $140 and for Pensioner hearing tests and veterans the Office of Hearing Services will pay $145.48 for delivering this service.

Hearing Aids Demonstrations 

Part of this thorough hearing test can be to discuss hearing aid options and demonstrate in the clinic how they can sound and feel. We show you the styles they come in, discuss your preferences and consider your cosmetic concerns. We can then program and configure them to your hearing levels and put them on for an initial impression as to how they can sound and feel in the clinic. Most people are pleasantly surprised at the immediate improvement they notice in terms of improved clarity of speech and reduced listening effort.

Reporting to Your Doctor (As required)

If your test results indicate that there is some underlying ear or health condition that should be investigated we will forward the test results and a written report letter describing the results and indicating why further investigation is likely required. This is done in a timely manner within 3 days of the completing the testing This may often be a necessary first step that should be cleared before hearing aids are fitted. Although sometimes this can occur as a parallel process. 

Why is a diagnostic hearing test so important?

Audiology is considered a para-medical field where we are required to work in alliance with your other health care providers. We follow best practice protocol in all our hearing tests.

 

If there are any red flags that appear as a result of completing your battery of hearing tests our Audiologists will advise you as to whether referral to your G.P. is recommended and whether your G.P. is likely to refer you to see an Ear Nose and Throat Specialist (ENT or Otolaryngologist).

There can be numerous reasons the test results may require further investigation. For example; An unexplained sensori-neural asymmetrical hearing loss can be due to an acoustic neuroma (a slow growing tumour) on the Auditory nerve. Or there may be a fungal infection in the external ear canal. If such conditions are not picked up and referred on for appropriate treatment there can be a whole host of longer term consequences to your ear health, hearing and overall health.

 

Following best practice protocol

Any good Audiologist that follows best practice protocol will know what indicators warrant further investigation. For example, an unexplained sensori-neural asymmetry of 10dB HL at two adjacent frequencies or 15dB at one frequency is enough to trigger the need for Specialist investigation. Especially in the presence of other symptoms such as tinnitus or vertigo.

 

Over the last 15 years of practice I’ve referred numerous clients for medical investigation on the basis of an unexplained asymmetry and at least three had MRI scans that found acoustic neuromas present. I recall correspondence from Professor Atlas a renowned E.N.T Specialist in Perth informing me that my referral had helped them detect a very small acoustic neuroma in a gentleman that they would be monitoring moving forward.

 

Unfortunately, the hearing health care industry is relatively unregulated and has become corporatized and competitively sales driven. The focus has shifted from health to the provision of products as the solution. At Harmony Hearing we maintain a health first approach.