Hearing Testing

Aka: Hearing Testing, Hearing Test, Hearing Exam

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II. Indication

  1. Hearing Loss Screening or Diagnosis
    1. Sensorineural Hearing Loss
    2. Conductive Hearing Loss

III. History

  1. See Hearing Loss
  2. See Hearing Handicap Inventory for the Elderly
  3. Self Assessment of Communication
    1. https://slhs.arizona.edu/sites/default/files/Self-Assessment%20of%20Communication%20form.pdf

IV. Exam

  1. See Audiogram
  2. See Hearing Handicap Inventory for the Elderly
  3. See Hearing Loss
  4. Ear exam (perform before Audiogram)
    1. Confirm a patent external auditory canal
    2. Confirm an intact Tympanic Membrane
  5. Speech Recognition
    1. See Hearing Impairment Severity Scale
    2. Speech Reception Threshold (SRT)
      1. Decibel level at which 50% of words understood
    3. Speech Recognition Score (SRS)
      1. Percentage words understood at 40 db over SRT
  6. Whispered Voice Testing
    1. Typically limited to DOT Physical
    2. Patient occludes opposite ear
    3. Examiner whispers questions or commands
    4. Patient answers or follows commands
    5. Avoid testing with finger snapping or ticking watch
      1. Not accurate for Hearing Testing

V. Diagnostics: Self-Screening Hearing Testing

  1. HearWho
    1. https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/hearwho
  2. Mimi Hearing Test
    1. https://mimi.health/hearing-test
  3. HearTest
    1. https://www.hearxgroup.com/heartest/
  4. HearScreen
    1. https://www.theaudiologyproject.com/hearscreenusa
  5. Other Resources and associated evidence
    1. uHear
      1. Lack of accuracy outside a sound proof booth
      2. Bunnag (2022) Laryngoscope Investig Otolaryngol 8(1):253-261 +PMID: 36846435 [PubMed]
    2. Digits in Noise Test
      1. Smits (2013) J Acoust Soc Am 133(3):1693-706 +PMID: 23464039 [PubMed]

VI. Diagnostics: Office Based Testing

  1. General
    1. Audiometry devices are recommended for calibration each year (ANSI)
  2. Non-Audiology Screening Audiogram
    1. Pure tone audiometer screening
    2. Audioscope (Welch-Allyn)
      1. https://www.hillrom.com/en/products/audioscope-3-screening-audiometer/
    3. Shoebox Audiometry
      1. https://www.shoebox.md/
  3. Audiology Comprehensive Hearing evaluation
    1. See Audiometry

VII. Management

  1. See Hearing Loss
  2. See Hearing Aid
  3. Audiology referral
    1. Covered by Medicare without referral once yearly (patient self-referral is allowed)
    2. Hearing Aid management, however, does require a referral

VIII. References

  1. Sehgal (2024) Am Fam Physician 109(4): 316-23 [PubMed]

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