Audiology Services

Evaluation & Testing Procedures

Ear Canal, Dr.Jennifer Maw, San Jose Ca

Ear Associates and Rehabilitation Services provide audiology services, evaluation, and diagnostic testing for adults and children of all ages. Hearing tests are used to determine the type and degree of hearing loss. The results of the tests are evaluated to determine the most appropriate treatment options. Audiometric testing is also used to monitor a previously identified hearing loss issue to assess treatment results.

How is Hearing Measured?

The Pure Tone Audiogram

This is the basic hearing test that is performed to determine the softest sounds a client can hear at different pitches, or frequencies. This hearing test is conducted by an audiologist while the client sits in a sound-treated booth. The test includes an assessment of the middle and inner ear function. The results of the test are recorded on a graph called an audiogram. The audiogram is a "picture" of the softest sound a client can hear at different pitches.

The hearing test results indicate if a client has normal hearing or a hearing loss ranging from mild to profound. The test also determines if the loss is conductive, which means the problem is in the middle ear, or sensorineural, which means the problem is in the inner ear or nerve of hearing.

Sound levels are measured in decibels (dB); 0 dB is the softest level measured during the test, and 120 dB is the loudest level. Hearing loss is categorized based on the intensity/loudness level at which a client is able to hear.


Hearing loss measurment chart, Ear Associates

Normal hearing 0-25 dBHL
Mild Loss 25-40 dBHL
Moderate Loss 40-55 dBHL
Moderate to Severe Loss 55-70 dBHL
Severe Loss 70-90 dBHL
Profound Loss 91 dBHL +

(dbHL = decibels hearing level)

Acoustic Immittance

This test is an objective means of assessing the integrity and function of the middle ear system. It is used to determine ear drum mobility, eustachian tube function, acoustic reflex threshold, and ossicular chain integrity and mobility. This test does not require any participation from the patient and is very easy to administer. Acoustic immittance testing is of great importance in the evaluation of adults and children with ear issues.

Immittance testing consists of two parts: tympanometry and acoustic reflex test.

Tympanometry measures the mobility of the eardrum. Tympanometry aids assessment of the outer and middle ear system, including the eustachian tube. Tympanometry is administered by placing a soft probe in the patient’s ear and varying the pressure levels causing the eardrum to move.

Acoustic reflex testing consists of subjecting the ear to a loud sound and determining if it causes a reflexive stiffening of the eardrum due to the tightening of the stapedius muscle in the middle ear. The tightening of stapes muscle is called as an acoustic reflex and the lowest intensity level at which this occurs is called as the acoustic reflex threshold. Acoustic reflex test results give the clinician valuable information regarding the severity of your hearing loss and the possible cause of your hearing loss. It is also a valuable test in detecting problems in the auditory pathway.

Advanced Diagnostic Audiologic Testing

Additional follow-up or specialized diagnostic testing may be recommended for further evaluation. Both Auditory Brainstem Response (ABR) and Electrocochleography (ECochG) testing provide diagnostic information to determine the cause of hearing loss, tinnitus, ear fullness, dizziness, and other conditions.

Auditory Brainstem Response (ABR)

Auditory Brainstem Response (ABR) is a widely used objective test to assess hearing sensitivity and auditory nerve function. A test sound is given to the ear and the responses from auditory neural activity are recorded using electrodes attached to the skin of the head with a sticky substance. Patient participation is not required during the test. The entire test procedure takes approximately 45 minutes.

Electrocochleography (ECochG)

ECochG measures the electrical potentials generated in the inner ear in response to stimulation by sound. Electrodes are placed on the ears and eardrums. A series of loud clicks are delivered to the ears through earphones. Patient participation is not required during the test. The entire process takes approximately one hour.

Pediatric Hearing Evaluation


Hearing loss in infants is now diagnosed more frequently due to the neonatal screening programs. As per the National Institute on Deafness and Other Communication disorders, approximately 12,000 new babies are diagnosed with a hearing loss. All newborns undergo an ABR screen in the hospital. If a newborn does not pass the test he/she is referred for an audiological evaluation. The audiologists at EARS Inc. are highly skilled in the work-up and diagnosis of hearing loss in infants. Our evaluation includes state of the art diagnostic testing with ABR, ASSR, Immittance and OAE testing. ABR, ASSR and OAE tests provide information about the integrity of specific sites within the auditory system. Behavioral tests like Visual Reinforcement Audiometry and Conditioned Play Audiometry tests provide a direct measure of hearing. It is therefore very important to follow the infant or child with serial tests over time until we achieve behavioral test results. The choice of hearing tests depends on the infant’s age. The ultimate goal is to determine if the child has sufficient hearing for age appropriate speech and language development.

ABR: Auditory Brainstem Response (ABR) is a widely used objective test to assess hearing sensitivity and auditory nerve function. A test sound is given to the ear and the responses from auditory neural activity are recorded using electrodes attached to the skin of the head with a sticky substance. While testing an infant, we look for the lowest intensity at which a repeatable waveform can be produced. The ABR test is a non-invasive procedure and does not require active cooperation from the patient. Infants are tested using sedation or under natural sleep.

ASSR: Auditory Steady State Response (ASSR) is another test to evaluate infants who fail newborn screening in the hospital. Electrodes are again stuck to the skin of the head and a test sound is delivered to the ears. ASSR test is conducted under natural sleep or with the use of sedation.

OAE: Otoacoustic Emissions (OAE) are acoustic signals generated by the normal inner ear, either in the absence of acoustic stimulation (spontaneous emissions) or in response to acoustic stimulation. OAE’s can be measured by presenting sound through a probe which is inserted in the outer ear canal. Emissions generated by the outer hair cells of the healthy cochlea are reflected back through the middle ear to the outer canal. The resulting sound is picked up by the probe microphone and processed by a special software and hardware. Emissions test is conducted in a quiet room and requires no participation from the patient. They are used in the diagnosis of hearing loss from infancy to adulthood.

Babies and Children

Visual Reinforcement Audiometry (VRA): VRA is used to test hearing of infants and toddlers between 6 months to 2 years. When VRA is used, a head turn response following an auditory stimulus is rewarded with an interesting visual event or reinforcer, such as an animated toy. This test is well suited for normally developing infants and toddlers. Sound is presented through insert earphones or through sound field speakers. A test assistant is used during the test to help the child focus on the visual reinforcer following the acoustic stimulus.

Conditioned Play Audiometry: Conditioning play audiometry (CPA) is used to test children between age of two (2) and four (4). It is a form of instrumental/operant conditioning in which a child is taught to wait and listen for a stimulus. The child is then to respond by performing a motor task in response to the stimulus. For example, the child is taught to put a block in the bucket every time a sound is heard. Sound is presented through insert earphones or through sound field speakers. A test assistant is used during the test to help the child understand the task. After the child understands the task, softer sounds are presented to find the lowest level at which a response is obtained.

Tinnitus Therapy

The audiologists at EARS Inc. are skilled in the evaluation of tinnitus. Testing for dysfunction of the auditory system can be performed with extensive audiometric testing including a diagnostic audiogram, immittance, OAEs and ABR testing. The tone and loudness of the tinnitus can be evaluated, and the amount and type of sound it takes to “mask” or stop the tinnitus is measured. Counseling and recommendations are then made to help the patient achieve alleviation of this annoying symptom.

Amplification with hearing aids or the use of masking devices can be considered in the treatment of tinnitus. When a patient with tinnitus obtains hearing aids, the tinnitus is frequently improved or eliminated when the devices are worn. Giving the person suffering with tinnitus a break from the noise and providing a sense of control over this problem can be very relieving. The specialists at EARS Inc. have also recommended that patients with severe tinnitus consider a trial of the Lyric hearing aid. Although not labeled by FDA for the treatment of tinnitus, it is the only device that can be worn 24/7 and can be left on at night when tinnitus tends to be most bothersome.

Masking devices look like hearing aids, and supply the ear with a noise matched to the tone the patient experiences to “mask out” the patient’s tinnitus sound. These can be considered for the treatment of severe tinnitus.

The Neuromonics Tinnitus treatment is delivered by the Oasis device. The Oasis device is a FDA approved medical instrument and is available by prescription only. The Oasis™ device is small and light weight. The device comes with headphones which deliver precisely designed music embedded with a pleasant acoustic neural stimulus.

Ear Canal, Dr.Jennifer Maw, San Jose Ca

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