Audiometry Testing: Understanding Hearing Assessment and Decibel Levels
What Is Audiometry Testing?
Audiometry testing is the standard way doctors check how well you hear different sounds. It’s not just a quick beeping test - it’s a detailed measurement of your hearing sensitivity across frequencies, using precise decibel levels to map out what you can and can’t hear. The results are shown on a graph called an audiogram, which tells your audiologist exactly where your hearing is strong and where it’s weak.
This test isn’t for everyone who thinks they’re a little hard of hearing. It’s used when there’s a real concern - like trouble understanding speech in noisy rooms, ringing in the ears, or sudden hearing changes. It’s also required for people working in loud environments, like factories or airports, to track hearing over time.
How Does Pure-Tone Audiometry Work?
The most common type of audiometry is pure-tone testing. You sit in a quiet room wearing headphones, and tones at different pitches (frequencies) play - from low rumbles at 250 Hz to high whistles at 8,000 Hz. You press a button every time you hear a sound, no matter how quiet.
The machine starts with a tone you can easily hear, then slowly lowers the volume in 10-decibel steps until you stop responding. Then it goes back up in 5-decibel steps to find the exact point where you hear it half the time. That’s your threshold. This method, called the modified Hughson-Westlake technique, has been the gold standard since the 1940s and is still used today because it’s accurate and reliable.
Testing usually starts with the ear that seems better. Each ear is tested separately, and the whole process takes about 10 to 15 minutes per ear. The results are plotted on an audiogram: circles for your right ear, X’s for your left, with decibels on the vertical axis and frequencies on the horizontal.
What Do Decibel Levels Mean for Your Hearing?
Decibels (dB) measure sound intensity. On an audiogram, 0 dB HL (hearing level) is the quietest sound a young, healthy person can hear. If you need 25 dB or less to hear a tone, your hearing is considered normal. But if your threshold is 40 dB at 2,000 Hz, that means you need the sound to be twice as loud as someone with normal hearing to notice it.
Hearing loss is classified by these numbers:
- Normal hearing: 0-25 dB
- Mild loss: 26-40 dB - You miss soft speech or consonants like ‘s’ and ‘th’
- Moderate loss: 41-55 dB - You struggle in group conversations
- Mod-severe loss: 56-70 dB - You need hearing aids to follow speech
- Severe loss: 71-90 dB - You hear only loud sounds
- Profound loss: 91+ dB - You may rely on lip-reading or sign language
Many people don’t realize they have mild hearing loss until they’re told. A 45 dB loss at 2,000 Hz - common in age-related hearing loss - makes it hard to hear women’s voices or children’s speech. One patient described it as ‘hearing people talk but not understanding what they’re saying.’
Why Bone Conduction Testing Matters
Just testing with headphones isn’t enough. Bone conduction testing uses a small device placed behind your ear or on your forehead. Instead of sending sound through your ear canal, it vibrates directly through your skull to your inner ear. This bypasses your eardrum and middle ear.
If your air conduction (headphone) results show hearing loss but your bone conduction results are normal, the problem is in your outer or middle ear - like wax buildup, fluid, or a perforated eardrum. That’s called conductive hearing loss.
If both air and bone conduction show the same level of loss, the issue is in your inner ear or auditory nerve - sensorineural hearing loss. This is often caused by aging, noise exposure, or genetics. It’s permanent, but hearing aids or cochlear implants can help.
An air-bone gap of 15 dB or more at any frequency confirms conductive loss. Without bone conduction, you’d never know the difference - and you might get the wrong treatment.
Speech Testing: More Than Just Beeps
Beeps don’t tell you if you can understand speech. That’s why speech audiometry is part of the full test. Two key parts:
- Speech Reception Threshold (SRT): You repeat two-syllable words like ‘baseball’ or ‘hotdog’ at lower and lower volumes. The goal is to find the quietest level where you get half right. Your SRT should match your average pure-tone hearing loss at 500, 1000, and 2000 Hz - within 10 dB. If it doesn’t, something’s off.
- Word Recognition Score (WRS): At a comfortable volume (usually 30-40 dB above your threshold), you repeat a list of single-syllable words. Normal scores are 90-100%. If you score below 70%, even with hearing aids, you’ll still struggle to follow conversations.
Some people have normal audiograms but terrible word recognition. That’s a red flag for conditions like acoustic neuroma or auditory processing disorder. A 62-year-old patient told her audiologist, ‘I hear people, but I can’t make out what they’re saying.’ Her pure-tone test was fine, but her WRS was 58%. That’s why speech testing isn’t optional - it’s essential.
Tympanometry and Other Tests
Not all hearing problems come from the inner ear. Tympanometry checks your eardrum’s movement by changing air pressure in your ear canal. It’s quick - just 3 to 5 seconds per ear - and helps detect fluid behind the eardrum, earwax blockage, or a stiff eardrum.
A flat line on the tympanogram (Type B) means fluid is likely present. In children, this often means ear infections. In adults, it might point to Eustachian tube dysfunction.
For babies, non-responsive patients, or people who can’t press a button, Auditory Brainstem Response (ABR) testing is used. Electrodes on the head record brainwave responses to clicks or tones. It doesn’t need a patient response - it’s objective. It’s the standard for newborn hearing screenings. The CDC recommends all babies be screened before one month old and diagnosed by three months, so treatment can start early.
Who Performs Audiometry Testing?
Audiologists - not doctors or nurses - are the experts who do full diagnostic testing. They have doctoral degrees, state licenses, and specialized training in hearing science. They know how to mask one ear during testing so the other doesn’t pick up the sound, how to calibrate equipment to ANSI standards, and how to interpret complex audiogram patterns.
Screening tests - like those at pharmacies or online - are not the same. They might catch obvious hearing loss but miss subtle patterns. A 2023 study found that tele-audiology tools miss 18% of mild hearing losses below 25 dB, which can still affect communication.
In the U.S., there are about 14,300 licensed audiologists. But access is uneven: urban areas have 2.3 per 100,000 people; rural areas have just 0.7. That’s why many people delay testing - they can’t find someone nearby.
What to Expect During the Test
You won’t feel pain. You might find bone conduction a little odd - the vibration can feel like a buzz, especially if you wear glasses. Some patients say it’s uncomfortable, but not painful.
Bring a list of medications. Some - like certain antibiotics or chemotherapy drugs - can damage hearing. Tell the audiologist about noise exposure, dizziness, or family history of hearing loss. These details help them interpret your results.
Don’t be afraid to ask questions. If you don’t understand your audiogram, ask for a printed copy and a breakdown. One patient on Yelp said, ‘They gave me the chart but didn’t explain what the bone conduction line meant.’ That’s not good care. A good audiologist will show you where your hearing loss is, why it matters, and what your options are.
How Often Should You Get Tested?
If you’re over 50, get tested every two years - even if you think your hearing is fine. Hearing loss is slow, and you adapt without realizing it.
If you’re exposed to loud noise at work or hobbies (construction, concerts, shooting), annual testing is recommended. OSHA requires it for workers in high-noise environments.
If you’ve been diagnosed with hearing loss, follow-up tests every 6 to 12 months help track progression and adjust hearing aids.
For children, the CDC recommends screening at birth, and again if there are risk factors - like recurrent ear infections, family history, or developmental delays.
Common Misconceptions
‘I can hear fine - I just don’t understand people.’ That’s classic high-frequency hearing loss. It’s not about volume - it’s about clarity. You hear the vowels but miss the ‘s,’ ‘t,’ ‘k’ sounds that give words meaning.
‘Hearing aids will fix everything.’ They help, but they don’t restore normal hearing. If your brain has been starved of sound for years, it may take time to relearn how to process speech. That’s why speech testing matters.
‘I’ll know if I’m losing my hearing.’ You won’t. Hearing loss creeps in slowly. Your brain compensates. By the time you notice, you’ve already lost 20-30 dB.
What Happens After the Test?
Your audiologist will explain your results in plain terms. They’ll tell you if you have hearing loss, what type, and how severe. Then they’ll talk about options: hearing aids, assistive devices, or referrals to ENT specialists if there’s a medical cause like a tumor or chronic infection.
They might also suggest hearing protection if you’re still exposed to loud noise. Prevention is just as important as treatment.
Most people who get tested and follow through with hearing aids report better relationships, less stress, and improved quality of life. The Cleveland Clinic found a 92% satisfaction rate among patients who received full diagnostic testing and clear explanations.
Final Thoughts
Audiometry testing isn’t scary. It’s not invasive. It doesn’t hurt. But it’s one of the most important health checks you can take - especially as you age. Hearing loss doesn’t just affect your ears - it affects your brain, your relationships, and your safety.
If you’ve been avoiding this test because you think you’re fine, or because you’re worried about what you might find - don’t. The sooner you know, the more you can do about it. And with today’s technology, even moderate hearing loss can be managed effectively.
Don’t wait until you’re missing half the conversation. Get tested. Know your numbers. Take back your hearing.
What is the normal hearing range in decibels?
Normal hearing is defined as being able to hear sounds at 25 decibels hearing level (dB HL) or lower across the tested frequencies (250 to 8000 Hz). This means you can detect quiet sounds like rustling leaves, a ticking clock, or soft speech without difficulty. Anything above 25 dB indicates some level of hearing loss, even if mild.
Can audiometry detect ear infections?
Audiometry alone doesn’t diagnose ear infections, but it can suggest them. If air conduction shows hearing loss but bone conduction is normal, it points to a problem in the outer or middle ear - like fluid buildup from an infection. Tympanometry, often done alongside audiometry, measures eardrum movement and can confirm middle ear issues with up to 94% accuracy in children.
How accurate is audiometry testing?
When performed correctly by a licensed audiologist using calibrated equipment, pure-tone audiometry is accurate within ±3 dB, meeting ANSI S3.6-2018 standards. Accuracy depends on patient cooperation, proper masking to prevent cross-hearing, and correct testing procedures. In experienced hands, it’s the most reliable behavioral test for hearing sensitivity.
Is audiometry testing painful?
No, audiometry testing is not painful. You’ll hear tones through headphones or feel vibrations from a bone oscillator behind your ear, but there’s no physical discomfort. Some people find the bone conduction vibration unusual or slightly uncomfortable, especially if they wear glasses, but it’s not harmful. The test is entirely non-invasive.
Can I do audiometry testing at home?
Home hearing tests and smartphone apps can give you a rough idea of your hearing, but they’re not diagnostic. They lack proper calibration, controlled environments, and the ability to test bone conduction or speech recognition. The FDA warns that these tools can miss mild hearing loss and are not reliable for medical decisions. For accurate results, see a licensed audiologist.
What if my audiogram shows hearing loss?
Your audiologist will explain the type and degree of loss. If it’s conductive (outer/middle ear), they may refer you to an ENT for treatment like earwax removal or surgery. If it’s sensorineural (inner ear), hearing aids are usually recommended. In some cases, assistive devices or cochlear implants may be options. Early intervention improves outcomes - don’t delay.
How long does an audiometry test take?
A full diagnostic audiometry test, including pure-tone, speech, and tympanometry, usually takes 30 to 45 minutes. Pure-tone testing alone takes 10-15 minutes per ear. Screening tests are faster - around 5 to 10 minutes - but don’t provide the full picture. Plan for at least an hour to allow time for discussion and questions.
Do I need a referral for audiometry testing?
In most cases, no. You can schedule an appointment directly with an audiologist without a doctor’s referral. However, if you’re using insurance, check your plan - some require a referral from your primary care provider for coverage. Medicare and many private insurers cover diagnostic audiometry when medically necessary.