Adult Hearing Evaluations

Obtaining a comprehensive hearing evaluation is typically the first step in determining if a hearing loss is present. A variety of tests are performed by an audiologist, to help determine the amount and type of hearing loss present. This information will be shared with your physician, to help determine the best way to treat your hearing or balance problem.

All audiological services offered at The Listen For Life Center are provided by an ASHA-certified audiologist or clinical fellow, with a minimum of a master’s or audiology doctorate degree. In addition, the entire audiology staff at The Listen For Life Center is licensed by the State of Washington. Audiological testing typically is covered by your insurance plan, and may require a referral from your primary care physician. To see if your insurance plan is accepted at Virginia Mason call Customer Service at (206) 223-6601. Please consult your insurance plan for specific details.

Is hearing loss common?
Approximately 28 million people in the United States experience some degree of hearing loss. More than 54 percent of adults over the age of 65 have significant hearing loss. In fact, hearing loss is the third most prevalent chronic medical condition in the U.S. There are several types and degrees of hearing loss. The good news is that your audiologist can always find some way to help you with your hearing problem, either via hearing aids, cochlear implantation, medical treatment or aural habilitation.

Who should have their hearing tested?
Any person who suspects a hearing problem should request a hearing test. You may have noticed that you are having trouble understanding conversations at work, in restaurants or on the telephone. Maybe you are having trouble understanding certain people or certain types of voices, such as children. Another good reason to get a hearing test is if you have a family history of hearing loss. Anyone who is exposed to loud noise during work or recreation should have regular hearing tests and wear high quality ear protectors.

Sometimes your physician may order a hearing test when you do not feel you have any hearing loss. This may be done because you have noticed a balance problem, ringing in your ears, or if you have experienced symptoms such as ear fullness or ear pain. Sometimes a family member notices your hearing problem before you do. Finally, many hearing losses develop so slowly, over so many years, that you may not have noticed the change.

What is involved in a comprehensive hearing test?
All hearing tests conducted at The Listen For Life Center are performed by an audiologist and take place in a soundproof booth. A case history will be obtained prior to testing in order to discuss areas of hearing difficulty and possibly to explore related medical factors. The following tests will be conducted as part of the comprehensive audiological evaluation:

  • Pure-tone testing:
    The audiologist will insert soft, foam plugs into your ear canals and ask you to indicate whenever you hear a tone. The audiologist will plot the softest sounds you can hear on an audiogram for the frequencies between 250-8000 Hz. The audiologist will also test several frequencies using a bone conductor, which assesses the hearing of the inner ear (cochlea).

  • Speech audiometry:
    The audiologist will first determine the softest level at which you can repeat two-syllable words. A second speech test will determine your ability to understand speech at a comfortably loud listening level. This is called the speech discrimination, or word recognition score.

  • Immittance measures:
    The audiologist will place a soft plug into your ear canal to determine the movement of the eardrum and middle ear system. This procedure helps detect dysfunction in the eardrum, middle ear bones, or eustachian tube.

  • Acoustic reflex testing:
    The audiologist will place a soft plug into each ear canal and will present a series of loud tones. This will measure the acoustic reflex for several frequencies and will provide valuable information regarding the function of the middle ear through the lower brainstem levels.

Specialized audiometric testing:
The following are specialized tests that may be recommended by the audiologist or physician based on the audiometric testing, and/or case history.

  • Auditory Brainstem Response (ABR):
    Diagnostic ABR: This test may be recommended by the audiologist or physician if there is a significant difference in hearing between your ears. This test will assess the auditory system though the level of the brainstem. The audiologist will place electrodes on your forehead, top of head, and each earlobe. They will also place insert earphones into your ear canals. The audiologist will ask you to lie on a bed, and relax or fall asleep during the test. The audiologist will be analyzing the information and comparing information obtained for each ear.

  • Threshold ABR:
    For individuals who are not able to provide accurate hearing levels in the sound booth, a threshold ABR may be recommended. The procedure is set up the same as indicated in the diagnostic ABR description, above. However, the audiologist is now finding the softest level that a response can be obtained. This can be conducted for several different types of stimuli (clicks or frequency specific tonebursts).

  • Electrocochleography (ECoG):
    The test set up is similar to the ABR, but an electrode is placed near the eardrum by an otologist. This tests measures electrical responses of the inner ear. This information is helpful in the diagnosis of disorders such as Meniere’s Disease.

  • Otoacoustic Emissions (OAEs):
    This is a test of cochlear outer hair cell function, and may be recommended when there is a sudden onset hearing loss, a difference in hearing between ears, or when you are taking certain types of medication. A probe is placed into your ear canal and you may hear a series of tones.

What type of support is available for individuals with hearing loss?
There are several support groups for individuals with hearing loss, as well as their family members. The Listen For Life Center has established a support group for cochlear implant users that meets quarterly. Local chapters of the Hearing Loss Association of America (HLA) can be found through the national Web site. For a listing of other support groups, please go to the American Speech Language and Hearing Association’s Self-Help Groups for Hearing and Balance Disorders Web site.

Medicare patients please note:

Audiologic tests provided to Medicare Part B beneficiaries are only payable when a physician orders the audiology testing and when the obtained information is used to determine the appropriate medical or surgical treatment of a hearing deficit or related problem. Routine monitoring of hearing is not a covered benefit; only acute symptoms requiring possible medical treatment and tests ordered by a physician are covered by Medicare. A referral "to Ear, Nose and Throat (ENT)" only is not a valid order for audiometric testing; there must be a separate order for audiology testing.
 
Medicare excludes testing in the following cases:

  1. Routine monitoring of known hearing loss
  2. When the test is conducted for the purpose of obtaining hearing aids.
  3. Hearing exams without an order and medical necessity (as defined below)  

Medical necessity for a hearing test is determined by statements made by the patient to their provider and must be documented as: 

  1. Hearing loss, sudden and acute
  2. Pain in the ear, sudden and acute
  3. Pressure, sudden and acute
  4. Ringing in the ear, sudden and acute
  5. Tinnitus, sudden and acute
  6. Any sign or symptom the patient mentions to the audiologist, sudden and acute in nature
  7. Dizzy, sudden and acute
  8. Ear infection, sudden and acute
  9. History of noise exposure, sudden and acute
  10. New medical condition of a hearing aid patient