Hearing can be tested through professional audiometry at an audiologist’s office, quick screening tools online, or simple self-checks at home. Professional testing remains the gold standard for accuracy, but each method serves a different purpose. The type of test you need depends on whether you’re screening for a potential problem or diagnosing one.
Pure Tone Audiometry: The Standard Test
The most common professional hearing test is pure tone audiometry. You sit in a soundproof booth wearing headphones, and tones are played at different pitches and volumes. Each time you hear a tone, you press a button or raise your hand. The test covers frequencies from 250 to 8,000 Hz, which represents most of the speech spectrum, even though the human ear can technically detect sounds from 20 to 20,000 Hz.
The audiologist is looking for the quietest sound you can detect at each frequency. This is your hearing threshold. Normal hearing falls at 25 decibels (dB) or better. From there, hearing loss is graded on a scale:
- Mild (26 to 40 dB): You may struggle to follow conversation in noisy environments and find yourself working harder to listen.
- Moderate (41 to 60 dB): Everyday speech becomes difficult to understand without raising the volume.
- Severe (61 to 80 dB): Most normal-volume speech is inaudible without amplification.
- Profound (81 dB or greater): Nearly all sounds are undetectable without hearing aids or cochlear implants.
The whole process typically takes 20 to 30 minutes and is painless. Before your appointment, avoid loud noise for at least 14 hours. Exposure to loud music, power tools, or even a noisy commute can temporarily shift your hearing thresholds and skew your results. Your provider should also look in your ears beforehand with an otoscope, since impacted earwax alone can cause a temporary conductive hearing loss that resolves once it’s removed.
Speech Testing
Pure tones tell you what volumes you can detect, but they don’t tell the full story of how well you understand language. That’s where speech testing comes in. The most common version is the speech reception threshold (SRT) test, which measures the softest level at which you can correctly repeat words about half the time.
During the test, you listen to a series of two-syllable words played through headphones and repeat them back. The audiologist adjusts the volume up or down in small increments until they find the level where you get roughly 50% correct. That volume becomes your SRT score. It serves as a cross-check against your pure tone results and gives a real-world picture of how hearing loss affects your ability to process speech.
Bone Conduction: Pinpointing the Type of Loss
If your hearing test shows a loss, the next question is where the problem is located. This is where bone conduction testing becomes critical. A small vibrating device is placed on the bone behind your ear, sending sound vibrations directly through your skull to the inner ear. This completely bypasses the outer and middle ear.
The audiologist then compares your bone conduction results to your air conduction results (from the standard headphone test). If both show similar levels of loss, the problem is in the inner ear or auditory nerve, known as sensorineural hearing loss. If bone conduction is significantly better than air conduction, creating what’s called an “air-bone gap,” something in the outer or middle ear is blocking sound. That’s conductive hearing loss, which is often treatable with medication or surgery.
A quick version of this same principle is the Rinne tuning fork test, which your doctor may do in the office. A vibrating tuning fork is placed on the bone behind your ear, then held next to your ear canal. If you hear it louder through the bone than through the air, that points to a conductive problem.
Tympanometry: Checking the Middle Ear
Tympanometry doesn’t test hearing directly. Instead, it evaluates how well your eardrum and middle ear are functioning. A small probe is placed in your ear canal and changes the air pressure while measuring how your eardrum responds. The whole thing takes about two minutes per ear.
This test is particularly useful for detecting fluid behind the eardrum, blocked eustachian tubes, a perforated eardrum, scarring from past infections, or problems with the tiny bones in the middle ear. If you’ve been experiencing muffled hearing, pressure, or recurrent ear infections, tympanometry helps identify the mechanical cause.
How Hearing Is Tested in Newborns
Babies and very young children can’t raise their hand when they hear a beep, so entirely different methods are used. Most hospitals screen newborns before discharge using one of two approaches.
The first is otoacoustic emissions (OAE) testing. A tiny probe is placed in the baby’s ear and plays soft sounds. A healthy inner ear produces faint echo-like sounds in response, and the probe picks these up. The test takes about four minutes and checks whether the sensory cells in the inner ear are working. The second method, auditory brainstem response (ABR) testing, places small sensors on the baby’s head to measure electrical activity in the hearing nerve and brainstem when sounds are played. ABR takes longer, averaging around 12 minutes, but it tests more of the hearing pathway.
The practical difference matters. OAE only checks the inner ear itself, while ABR tests the entire chain from the inner ear through the auditory nerve to the brainstem. A condition called auditory neuropathy, where the inner ear works fine but the nerve doesn’t transmit signals properly, will pass an OAE screening but fail an ABR. For this reason, ABR is recommended for high-risk newborns. ABR also has higher accuracy overall: 100% sensitivity and 96 to 98% specificity, compared to 90 to 95% sensitivity and 89 to 91% specificity for OAE.
Reading an Audiogram
Your results are plotted on an audiogram, a graph with frequency (pitch) along the top and volume along the side. Low-pitched sounds sit on the left, high-pitched sounds on the right. Volume increases as you move down the chart, so a mark near the top means good hearing at that frequency, while marks further down indicate loss.
Results for the right ear are typically shown in red and the left in blue. Air conduction and bone conduction each get their own symbols, so you can visually spot an air-bone gap just by looking at the distance between the two lines. The pattern of the audiogram also reveals the shape of your hearing loss. A curve that drops steeply on the right side of the graph, for example, indicates high-frequency loss, the most common pattern in age-related hearing decline.
Online and App-Based Hearing Tests
Smartphone apps and web-based hearing tests have become widely available, and they can be a reasonable first step if you’re wondering whether your hearing has changed. A validation study comparing an internet-based hearing test against clinical audiometry found a correlation of 0.93 to 0.94 between the two, with 75% sensitivity and 96% specificity for detecting moderate or worse hearing loss.
That 75% sensitivity number is the catch. It means one in four people with meaningful hearing loss could get a “pass” result from an online test. Several factors limit accuracy: most people don’t own calibrated headphones, background noise in your home can mask quiet tones, and many consumer headphones have “dead points” where certain frequencies are distorted or weakened. Online tests are useful for flagging a problem, but they can’t diagnose one. If an online screening suggests hearing loss, or if you suspect a problem despite a passing result, professional testing is the next step.
Signs That Warrant Urgent Testing
Most hearing changes develop gradually, but certain patterns demand fast evaluation. Sudden hearing loss in one or both ears that develops over hours or days, particularly within the previous 90 days, is considered a medical urgency. Rapidly progressive hearing loss over weeks also falls into this category. Both the FDA and the American Academy of Otolaryngology list these as red flags requiring prompt medical attention, because early treatment for sudden sensorineural hearing loss significantly improves the chances of recovery. If you wake up one morning and can’t hear out of one ear, that’s not a “wait and see” situation.