Audiometric testing is a set of hearing tests that measure how well you detect sounds at different pitches and volumes. It evaluates three core parts of your hearing system: how sound travels mechanically through your middle ear, how your inner ear converts sound into nerve signals, and how well your brain processes speech. The results are plotted on a chart called an audiogram, giving a detailed picture of what you can and can’t hear.
How Pure-Tone Testing Works
The most common part of an audiometric exam is pure-tone testing. You sit in a soundproof booth wearing headphones, and a series of tones are played one at a time. Each tone has a specific pitch (frequency) and volume (measured in decibels). Your job is simple: press a button or raise your hand whenever you hear a sound, even if it’s faint.
A standard test covers pitches from 250 Hz (a low hum, like a bass note) up to 8,000 Hz (a high-pitched whistle). Some extended tests go as high as 20,000 Hz. At each pitch, the audiologist adjusts the volume in small 5-decibel steps to find the quietest sound you can reliably detect. That quietest level is your hearing threshold for that frequency, and it gets recorded as a point on the audiogram.
Air Conduction vs. Bone Conduction
Pure-tone testing is actually done two ways, and comparing the results is what makes the test so useful diagnostically.
Air conduction testing uses standard headphones or earbuds. Sound travels through your ear canal, vibrates your eardrum, passes through the tiny bones of your middle ear, and reaches your inner ear. This tests the entire hearing pathway from start to finish.
Bone conduction testing uses a small vibrating device placed on the bone behind your ear. This sends sound directly to your inner ear, bypassing the ear canal and middle ear entirely. If your bone conduction hearing is normal but your air conduction hearing is reduced, the problem is in the outer or middle ear. That pattern is called conductive hearing loss, and it can result from things like fluid buildup, earwax blockage, or a perforated eardrum.
When both air and bone conduction thresholds are equally reduced, the issue is in the inner ear or auditory nerve. This is sensorineural hearing loss, the type caused by aging, noise exposure, or genetic factors. Some people have a combination of both, called mixed hearing loss.
Speech Testing
Hearing tones in a quiet booth is one thing. Understanding speech in the real world is another. That’s why most audiometric evaluations include speech testing alongside pure tones.
The speech reception threshold test determines the softest level at which you can correctly repeat simple two-syllable words about half the time. This gives a baseline that should roughly match your pure-tone results. If the numbers don’t line up, it can flag issues that need further investigation.
Word recognition testing goes a step further. You listen to a list of single-syllable words played at a comfortable volume and repeat each one back. Your score is recorded as a percentage. Someone with normal hearing typically scores 90% or higher. A low word recognition score, even when sounds are loud enough to hear, suggests the inner ear or auditory nerve is distorting the signal rather than simply making it quieter. This distinction matters because it affects how much benefit you’d get from hearing aids.
Middle Ear Tests
Two additional tests focus specifically on your middle ear and don’t require you to respond to sounds at all.
Tympanometry measures how well your eardrum moves. A small probe is placed in your ear canal and changes the air pressure slightly while playing a low tone. The resulting graph shows whether your eardrum moves normally, is too stiff, moves too much, or has a hole in it. This test is especially useful for detecting middle ear fluid, a common finding in children with ear infections.
Acoustic reflex testing checks a protective reflex you’re not even aware of. A tiny muscle in your middle ear automatically tightens when exposed to a loud sound. The test measures how loud a sound needs to be before this reflex kicks in. If you have significant hearing loss, the reflex may not occur at all. Abnormal reflex patterns can point to problems ranging from middle ear stiffness to issues along the auditory nerve.
Reading Your Audiogram Results
Your audiogram plots frequency (pitch) along the horizontal axis and volume in decibels along the vertical axis. The vertical axis is flipped so that softer sounds are at the top and louder sounds are at the bottom. Each ear gets its own set of markings, typically “O” for the right ear and “X” for the left.
The classification system used by audiologists, based on standards from the American Speech-Language-Hearing Association, breaks hearing into clear categories:
- Normal: -10 to 15 dB
- Slight: 16 to 25 dB
- Mild: 26 to 40 dB
- Moderate: 41 to 55 dB
- Moderately severe: 56 to 70 dB
- Severe: 71 to 90 dB
- Profound: 91+ dB
These numbers represent the quietest sounds you can detect. A person with mild hearing loss, for example, needs sounds to be at least 26 to 40 decibels before they can hear them. For context, that’s roughly the volume of a whisper or quiet conversation. Someone with profound loss can’t detect sounds below 91 decibels, which is about as loud as a lawnmower.
Hearing loss doesn’t always affect all pitches equally. Many people hear low-pitched sounds just fine but have significant loss in the higher frequencies. This is the classic pattern of noise-induced or age-related hearing loss, and it’s why someone might say “I can hear you talking, I just can’t understand what you’re saying.” Consonant sounds like “s,” “f,” and “th” are high-pitched and get lost first.
Workplace Audiometric Testing
If you work in a noisy environment, your employer may be legally required to provide audiometric testing. OSHA mandates a baseline hearing test within six months of your first exposure to workplace noise at or above 85 decibels (an 8-hour average). After that, you need an annual retest for as long as you remain exposed at that level.
The baseline test establishes a reference point for your hearing. Each annual test is compared against it to check for a “standard threshold shift,” defined as an average decline of 10 decibels or more at 2,000, 3,000, and 4,000 Hz in either ear. These are the frequencies most vulnerable to noise damage. If a shift is detected, your employer has 30 days to arrange a retest to confirm the finding before taking further action, which can include refitting hearing protection or reassessing noise controls.
How to Prepare
You should avoid loud noise for at least 14 hours before your test. This means skipping concerts, loud power tools, and even prolonged headphone use at high volume the night before. Exposure to loud sound causes a temporary shift in your hearing thresholds that can take hours to recover, and testing during that window would make your hearing appear worse than it actually is. OSHA uses this same 14-hour quiet period as a requirement for workplace testing.
Beyond noise avoidance, there’s little else to do. The test itself is painless, involves no needles or sedation, and typically takes 20 to 30 minutes for a standard evaluation. If you have excessive earwax, your provider may need to remove it before testing, since a blocked ear canal will artificially elevate your air conduction thresholds and mimic conductive hearing loss.