Audiometry Test (Hearing Test): Purpose, Procedure, Audiogram and Limits

Key takeaways

• Audiometry measures hearing thresholds by frequency; it does not by itself explain why hearing has changed.
• A pure-tone audiogram plus tympanometry and speech testing together give a far more useful picture than pure tones alone.
• A normal audiogram does not exclude auditory processing difficulty, hidden hearing loss, tinnitus or a vestibular disorder.
• Sudden one-sided hearing loss is an emergency-tier symptom and should be assessed the same day, not at a routine appointment.
• Results vary depending on individual clinical circumstances and must be interpreted by the audiologist and ENT surgeon who requested the test.

At a glance

Also known as

• Hearing test
• PTA, pure tone audiometry
• Audiogram test
• Kaan ki jaanch / hearing check-up (commonly used in Indian clinics)
• Free-field or behavioural hearing assessment (in young children)

What an audiometry test is

Audiometry is a behavioural hearing test: the audiologist presents calibrated sounds and records the softest level at which the person reliably responds. Levels are recorded in decibels hearing level (dB HL) at frequencies typically from 250 Hz to 8000 Hz.

Audiometry is a family of tests rather than one test:

• Pure tone audiometry (air conduction): tones delivered through headphones or insert earphones; gives the overall hearing threshold.
• Bone conduction audiometry: a vibrator on the mastoid bypasses the outer and middle ear. The gap between air and bone thresholds (air-bone gap) is what separates conductive from sensorineural loss.
• Speech audiometry: speech reception threshold and word recognition scores, how well speech is understood, not just detected.
• Masking: noise applied to the non-test ear so the better ear does not answer for the worse ear.
• Tympanometry and acoustic reflexes: not audiometry, but usually done alongside, to assess the eardrum and middle ear.

Findings are plotted on an audiogram, with frequency on the horizontal axis and hearing level on the vertical axis.

Why an audiometry test is done

• To confirm whether hearing loss is present, and in which ear.
• To classify the loss as conductive, sensorineural or mixed, which directs treatment towards medical, surgical or amplification options.
• To assess difficulty hearing speech in noise, muffled hearing or asking others to repeat themselves.
• To investigate tinnitus (ringing in the ears) or a blocked-ear sensation.
• To assess hearing as part of dizziness or balance evaluation, alongside vestibular tests.
• To monitor hearing during ototoxic treatment, aminoglycosides, cisplatin-based chemotherapy, and long-term high-dose loop diuretics, and in drug-resistant tuberculosis regimens that historically included injectable aminoglycosides.
• Occupational and industrial hearing conservation programmes in noisy workplaces.
• Before and after ear surgery, and before hearing aid or cochlear implant candidacy assessment.

Who should get an audiometry test

• Anyone who finds speech muffled, struggles in restaurants or on phone calls, or repeatedly raises the television volume.
• Anyone with ringing, buzzing, blocked-ear feeling or ear discharge.
• Anyone with sudden or rapidly worsening hearing loss, urgently.
• Children with delayed or unclear speech, poor response to name, recurrent ear infections, school difficulty, or a failed newborn screen.
• Older adults noticing conversational difficulty, especially where hearing loss is affecting social participation or mood.
• Workers exposed to industrial noise, drilling, generators, textile or metal workshops, and people exposed to high-volume personal audio devices.
• People on ototoxic drugs, or with a family history of hearing loss, head injury, or prior ear surgery.

What an audiometry test cannot detect or exclude

Audiometry maps function, not anatomy. This limitation matters because a clean audiogram is often misread as "nothing is wrong".

• Audiometry does not image anything. It cannot show an acoustic neuroma (vestibular schwannoma), cholesteatoma, otosclerosis, inner-ear malformation or brain lesion. Asymmetrical sensorineural loss may prompt MRI of the internal auditory meatus; the audiogram only raises the suspicion.
• A normal audiogram does not exclude a hearing complaint. Difficulty hearing in noise can occur with normal pure-tone thresholds (often described as hidden hearing loss or auditory processing difficulty). Persistent difficulty despite a normal result needs further testing, not dismissal.
• Audiometry does not diagnose the cause of tinnitus and does not measure tinnitus loudness or distress.
• Audiometry does not test balance. Vertigo requires vestibular testing (VNG/vHIT, caloric testing) and clinical examination. A normal hearing test does not rule out M閚i鑢e's disease, vestibular neuritis or BPPV.
• Standard audiometry stops at 8000 Hz and can miss early ultra-high-frequency ototoxic or noise damage; extended high-frequency audiometry is a separate test where available.
• Audiometry is effort-dependent. It needs understanding and cooperation, so it is unreliable in infants, some people with intellectual disability or dementia, and where responses are inconsistent. Objective tests are then used.
• A negative or normal finding describes what was recorded on that day, not what exists in your ear permanently. If symptoms persist or worsen despite a normal audiogram, return to your doctor.

Related but different examinations

These tests answer different questions. None is universally superior; the right first test depends on the presentation, age, whether the person can cooperate, and whether the question is threshold, middle-ear function or nerve pathway.

How to prepare for an audiometry test

Preparation details, booth availability, appointment length and report format are operational matters that differ between hospitals and audiology units. Instructions given by the unit performing your test take precedence over general advice.

• Avoid loud noise before testing: many units advise avoiding loud noise exposure (concerts, machinery, firing ranges, loud headphone use) for around 12-24 hours, because temporary threshold shift can make hearing look worse than it is.
• Mention ear symptoms: discharge, pain, recent cold, ear surgery, perforation or a recent ear infection, these change how the test is done.
• Do not self-treat earwax. Cotton buds, ear candling, oil or over-the-counter drops can worsen impaction or harm a perforated eardrum. Ask the clinic whether wax needs clearing first.
• Bring current devices and prior reports: hearing aids, old audiograms, and a list of medicines, particularly aminoglycosides, chemotherapy or diuretics.
• Be rested: the test relies on concentration; fatigue lowers reliability.
• Speak to your prescriber before changing any medicine, never stop a prescribed drug to prepare for a hearing test.

Children

Choose a time when the child is alert rather than sleepy or hungry. Test technique is chosen by age and developmental level; more than one session may be needed. If an ABR under sedation is planned, the unit will give separate fasting instructions.

Older adults and people with cognitive impairment

A familiar companion may help. Responses can be slower, so the audiologist may use simpler tasks or repeat measurements. Bring spectacles and any communication aids.

Pregnancy

Audiometry uses sound only, no radiation, medicines or contrast, so pregnancy is not a barrier to routine pure-tone testing. Tell the unit if you are pregnant so that any planned sedation-based test is reviewed first.

Recent ear surgery, perforation or active discharge

Insert earphones and tympanometry may be modified or deferred. Tell the audiologist beforehand so the technique can be adjusted safely.

What happens during an audiometry test

• History and otoscopy: the audiologist or ENT doctor asks about symptoms and looks in the ear canal for wax, discharge or perforation.
• Middle-ear testing (if planned): a soft probe seals the canal briefly for tympanometry; you may feel gentle pressure and hear loud tones during reflex testing.
• Pure tone testing: sitting in a quiet booth with headphones or inserts, you press a button or raise a hand each time you hear a tone, however faint. Each ear and several frequencies are tested.
• Bone conduction: a small vibrating device is placed behind the ear or on the forehead and the same task repeated.
• Speech testing: you repeat words or sentences at different levels, sometimes with background noise.
• Explanation: the audiologist plots and explains the audiogram; ENT review follows where needed.

The test is non-invasive and should not hurt. Some sounds, particularly during reflex testing, are deliberately loud and may feel uncomfortable for a moment, tell the audiologist if so.

Understanding your audiogram

An audiogram shows, for each ear, the softest level heard at each frequency. Lower on the chart means poorer hearing. Air conduction is usually marked with circles for the right ear and crosses for the left; bone conduction uses separate symbols.

Three questions shape interpretation:

• How much? The degree of loss is described in broad descriptive bands (for example mild, moderate, severe, profound). These bands are conventional categories, not disease diagnoses, and different classification systems draw the boundaries at slightly different decibel values. Your report will state the system used.
• What type? If bone conduction is normal but air conduction is poorer, the pattern suggests a conductive loss, wax, middle-ear fluid, perforation, otosclerosis, and is often treatable medically or surgically. If air and bone thresholds are equally reduced, the pattern suggests sensorineural loss involving the cochlea or nerve. Both together is mixed.
• What shape? High-frequency sloping loss is typical of noise damage and age-related change; a low-frequency or fluctuating loss may prompt evaluation for M閚i鑢e's disease; a notch around 4000 Hz suggests noise exposure. Shape is suggestive, never conclusive.

Descriptive bands are often over-interpreted. A "mild" loss can cause real difficulty in a noisy classroom or workplace, while two people with identical audiograms may function very differently depending on speech understanding, tinnitus and hearing demands. The audiologist and ENT surgeon interpret the audiogram alongside your symptoms and examination, the graph alone is not a diagnosis.

When audiometry results can be misleading

Results that falsely suggest worse hearing

• Temporary threshold shift after recent loud noise exposure, thresholds recover over hours to days.
• Wax impaction, or a collapsing ear canal under supra-aural headphones, adding an artificial conductive component.
• Fatigue, inattention, anxiety or poor understanding of the task, leading to under-response.
• Ambient noise in a room that is not adequately sound-treated, masking soft tones.
• Language barrier in speech testing: using word lists in a language the person does not use fluently lowers scores without a hearing cause. In multilingual Indian settings, test material should match the person's primary language.
• Non-organic or exaggerated hearing loss, sometimes seen in compensation or fitness-for-duty settings; inconsistencies prompt objective testing.
• Crossover without masking, which can also distort the picture in the other direction.

Results that falsely suggest better hearing

• Failure to mask the non-test ear: the better ear "answers" for the worse ear, making a dead ear look partially hearing.
• Response to vibration or button-pressing habit rather than genuine sound perception.
• Normal thresholds masking real disability: speech-in-noise difficulty and high-frequency loss above 8000 Hz can both be missed by a standard audiogram.
• Uncalibrated equipment, which can shift results in either direction; calibration is checked periodically in the unit.

If the audiogram does not match how you actually hear, say so. Repeat or objective testing is reasonable.

Risks and safety

Different tests in this group carry different considerations, so a single safety statement does not apply to all of them.

Pure tone and speech audiometry

No needles, radiation or medication are involved. The main discomforts are the pressure of headphones and brief loud tones. Very high-level test stimuli are used sparingly and are limited by protocol.

Tympanometry and acoustic reflex testing

Generally well tolerated, but the probe seal and pressure change may be uncomfortable and are usually avoided in a recently operated ear, an acute perforation with discharge, or active severe ear pain. Reflex testing uses loud sounds and is used cautiously in people with hyperacusis or severe tinnitus.

Paediatric ABR under sedation or anaesthesia

The recording itself is harmless, but sedation and anaesthesia carry their own risks and require pre-anaesthetic assessment, monitoring and consent. This is a different risk profile from an awake booth test.

Results vary depending on individual clinical circumstances.

Special situations

Newborns and infants

Behavioural audiometry is not suitable at this age. Newborn hearing screening uses OAE and/or automated ABR. A failed screen needs diagnostic ABR, not a booth test. Early identification matters because the first years shape speech and language development.

Children

Technique is matched to age: behavioural observation in infancy, visual reinforcement audiometry in toddlers, play audiometry in preschoolers, and standard testing later. Glue ear (otitis media with effusion) is common and can cause fluctuating conductive loss, so repeat testing after treatment is often needed.

Older adults

Age-related hearing loss usually affects high frequencies in both ears and develops gradually. Untreated hearing loss in later life is associated with social withdrawal and communication difficulty. Asymmetry, sudden change or one-sided tinnitus should not be dismissed as age.

People with diabetes, CKD or on multiple medicines

Hearing loss is more common with diabetes and chronic kidney disease, and several drugs used in these conditions can affect hearing. Baseline and periodic audiometry are often advised when ototoxic treatment is planned. Discuss monitoring schedules with the treating team.

Tinnitus without measurable hearing loss

Audiometry is still worth doing, because it guides management and screens for asymmetry. A normal audiogram does not mean the tinnitus is imagined; extended high-frequency testing and ENT review may be appropriate.

Occupational and medico-legal testing

Baseline audiograms before noisy employment, and periodic tests thereafter, allow real change to be distinguished from expected variation. Testing after a noise-free interval is important for validity in these settings.

Audiometry in the Indian context

• Burden: the National Programme for Prevention and Control of Deafness (NPPCD), Ministry of Health and Family Welfare, was launched in 2006 to address disabling hearing loss, screening and rehabilitation across districts. Hearing impairment is recognised as a disability under the Rights of Persons with Disabilities Act, 2016, which supports certification and assistive-device access.
• Chronic suppurative otitis media remains a common and preventable cause of conductive hearing loss in India, often from untreated childhood ear infections. Persistent discharge should be treated, not tolerated.
• Noise exposure from traffic, generators, firecrackers, loudspeakers at festivals and unprotected industrial work is widespread. Noise limits are set under the Noise Pollution (Regulation and Control) Rules, 2000.
• Anti-tubercular and drug-resistant TB regimens historically included injectable aminoglycosides such as streptomycin, kanamycin and amikacin, which can cause permanent hearing loss. Audiometric monitoring during such treatment is important; report any hearing change to the DOTS or TB clinic promptly rather than stopping medication.
• Self-treatment practices: oil instillation, ear candling, cotton buds, unregulated "ear cleaning" on the street, frequently cause wax impaction, canal injury or infection. Ear cleaning should be done by a trained clinician.
• Language and test validity: speech audiometry needs word lists validated in the patient's own language. Indian centres use materials developed in Hindi, Tamil, Telugu, Kannada, Malayalam, Marathi, Bengali and other languages; testing in an unfamiliar language underestimates performance.
• Workforce and access: audiologists are registered with the Rehabilitation Council of India. Availability of sound-treated booths, paediatric ABR and cochlear implant services is concentrated in larger cities, so rural patients are often referred onward.

Cost and insurance in India

Pure tone audiometry is one of the less expensive diagnostic tests in India. Charges vary widely between government facilities, standalone speech-and-hearing clinics and corporate hospitals, and between cities. Costs quoted anywhere are indicative only; confirm the current charge with the facility before booking.

Factors that affect cost:

• Which tests are bundled, pure tone alone versus pure tone with tympanometry, reflexes and speech audiometry.
• Whether objective testing (OAE, ABR/BERA) is needed, and whether sedation or anaesthesia is involved, which raises cost substantially.
• Paediatric assessment requiring multiple sessions or a specialist paediatric audiologist.
• Sound-treated booth and calibrated equipment availability; teleaudiology or camp settings may differ.
• City, hospital category, and whether the test is part of an ENT consultation package, employment or medico-legal certification.
• Hearing aid trials, real-ear measurement and fitting, which are charged separately from diagnostic audiometry.

Insurance: outpatient diagnostic audiometry is often not covered by standard indemnity health insurance, which typically pays for admitted care, although OPD riders, corporate plans, government schemes and ESIC coverage may reimburse it. Audiometry done as part of a covered admission, for example before ear surgery or cochlear implantation, is usually included in that claim. Hearing aids are frequently excluded. Check the specific policy wording and pre-authorisation requirements with the insurer.

Myths and facts

Frequently asked questions

What does an audiometry test measure?

Audiometry measures the softest sound level you can hear at each tested pitch in each ear, and how accurately you repeat speech. Comparing air and bone conduction shows whether the problem lies in the outer or middle ear, or in the cochlea and nerve. Interpretation belongs to the audiologist and ENT surgeon.

How long does an audiometry test take?

Pure tone audiometry alone usually takes about 15-30 minutes. Adding tympanometry and speech audiometry brings the visit to roughly 30-60 minutes. Paediatric behavioural testing, ABR or difficult-to-test adults may take longer or need repeat visits. Appointment lengths differ between audiology units.

Does an audiometry test hurt?

The test is non-invasive and should not be painful. Headphones can feel tight, tympanometry involves brief pressure in the ear, and acoustic reflex testing uses deliberately loud tones that may be momentarily uncomfortable. Tell the audiologist immediately if any sound is distressing so the level can be adjusted.

My hearing test is normal but I still struggle to hear in restaurants. Why?

Standard audiometry uses single tones in a quiet booth, which is very different from following speech against background noise. Speech-in-noise testing, extended high-frequency audiometry and auditory processing assessment may explain the difficulty. Persistent problems despite a normal audiogram deserve further evaluation rather than reassurance alone.

How is audiometry different from BERA or OAE?

Audiometry is behavioural, it needs your responses. OAE checks cochlear outer hair cell function objectively, and BERA/ABR records electrical activity along the auditory nerve and brainstem. Objective tests are essential in babies and uncooperative patients but estimate thresholds rather than measure them directly.

Can earwax change my audiometry result?

Yes. Significant wax impaction blocks sound and can create an apparent conductive hearing loss, making hearing look worse than it truly is. The audiologist examines the canal first and may recommend professional wax removal before testing. Avoid cotton buds, oils and ear candling.

How often should audiometry be repeated?

There is no single interval for everyone. Repetition depends on symptoms, occupation and treatment. Noise-exposed workers usually follow their workplace hearing conservation schedule, people on ototoxic drugs need testing as directed by the treating team, and hearing aid users are reviewed periodically. Any new change warrants earlier testing.

Can audiometry be done if my ear is discharging?

Pure tone testing is often still possible, but technique may be modified and tympanometry may be deferred until infection settles, since a probe seal is unsuitable with active discharge or a fresh perforation. Tell the audiologist beforehand. Discharge itself needs ENT treatment, not just a hearing test.

Will one audiogram decide whether I need a hearing aid?

Not by itself. Hearing aid decisions combine the audiogram with speech understanding scores, ear health, your listening demands, dexterity and preferences, and usually a trial with real-ear verification. Results vary depending on individual clinical circumstances, so the recommendation is made after discussion with your audiologist.

Sources

• World Health Organization, World Report on Hearing, 2021, and WHO fact sheet on deafness and hearing loss.
• Ministry of Health and Family Welfare, Government of India, National Programme for Prevention and Control of Deafness (NPPCD).
• Rights of Persons with Disabilities Act, 2016, Government of India.
• Noise Pollution (Regulation and Control) Rules, 2000, Ministry of Environment, Forest and Climate Change, Government of India.
• British Society of Audiology, Recommended Procedure: Pure-tone air-conduction and bone-conduction threshold audiometry with and without masking.
• American Academy of Otolaryngology-Head and Neck Surgery Foundation, Clinical Practice Guideline: Sudden Hearing Loss (Update).
• Rehabilitation Council of India, standards and registration for audiologists.