A hearing test is usually carried out after your ears have been examined and you have been referred to a specialist.

Examination

Your GP or practice nurse will first ask about any symptoms you may be experiencing, such as:

• pain or discharge (fluid)
• tinnitus – noise in one or both ears
• vertigo (dizziness)
• hearing loss
• previous, relevant medical problems

Your ear will be examined using an instrument called an auriscope (otoscope). An auriscope is a small hand-held torch with a magnifying glass which allows the doctor to see the eardrum and the passageway that leads to it from the outer ear. It can be used to look for:

• discharge – fluid coming out of the ear
• a bulging eardrum – indicating that there is infected fluid in the middle ear
• a dull eardrum – indicating uninfected fluid in the middle ear (glue ear)
• a retracted eardrum – indicating the Eustachian tube is not working properly
• perforated eardrum – a hole in the eardrum, with or without signs of infection
• ear wax or foreign bodies that might be blocking the ear

Your GP may also carry out simple tests using their voice to help determine the extent of your hearing loss. If there are any concerns, you or your child may be referred to an ear, nose and throat (ENT) specialist for further tests.

Hearing tests in children

A range of different techniques are used to detect hearing problems. Some hearing tests are mainly used for children, including:

• automated otoacoustic emissions (AOAE) tests – a computer attached to a small earpiece plays quiet clicking noises and measures the response from your child's ear
• automated auditory brainstem response (AABR) tests – sensors are placed on your child's head and neck to check the response of their nerves to sound played through headphones
• play audiometry tests – sounds of different volumes and frequencies are played to your child and they carry out a simple task when they hear them

Read more about how hearing and vision tests for children are carried out.

However, some tests, such as pure tone audiometry, speech perception and tympanometry (see below) can be used to test adults and well as children.

Hearing tests in adults

There are a number of different ways to test adult hearing. Some of these are briefly described below.

Pure tone audiometry

Pure tone audiometry (PTA) tests the hearing of both ears. During PTA, a machine called an audiometer is used to produce sounds at various volumes and frequencies (pitches). You listen to the sounds through headphones and respond when you hear them by pressing a button.

Speech perception

The speech perception test, also sometimes known as a speech discrimination test or speech audiometry, involves testing your ability to hear words without using any visual information. The words may be played through headphones or a speaker, or spoken by the tester.

Sometimes, you are asked to listen to words while there is a controlled level of background noise.

Tympanometry

The eardrum should allow as much sound as possible to pass into the middle ear. If sound is reflected back from the eardrum, hearing will be impaired.

During tympanometry, a small plastic bung seals your ear and the machine gently changes the pressure in your ear canal. The test can be used to confirm whether there is any fluid behind the eardrum and can indicate if the Eustachian tube is working normally.

Tympanometry measures the movement of the eardrum and the pressure behind the eardrum.

Whispered voice test

The whispered voice test is a very simple hearing test. It involves the tester blocking one of your ears and testing your hearing by whispering words at varying volumes. You will be asked to repeat the words out loud as you hear them.

Tuning fork test

A tuning fork produces sound waves at a fixed pitch when it is gently tapped and can be used to test different aspects of your hearing.

The tester will tap the tuning fork on their elbow or knee to make it vibrate, before holding it at different places around your head.

This test can help determine if you have conductive hearing loss, which is hearing loss caused by sounds not being able to pass freely into the inner ear, or sensori-neural hearing loss where the inner ear or hearing nerve is not working properly.

Bone conduction test

A bone conduction test is often carried out as part of a routine pure tone audiometry (PTA) test in adults.

Bone conduction involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.

Bone conduction is a more sophisticated version of the tuning fork test, and when used together with PTA, it can help determine whether hearing loss comes from the outer and middle ear, the inner ear, or both.

Bone conduction measures how well your inner ear and hearing nerves are working. The vibrations from the tuning fork go straight to the hearing nerve and bypass any problems in the ear canal, eardrum or hearing bones.

Hearing test results

The results of some hearing tests are plotted on a graph called an audiogram.

An audiogram is used to record the measurements of different volumes and frequencies (pitches) of sounds you are able to hear.

As well as showing a comparison between your ears, an audiogram can also help to determine what type of hearing loss you have, if any.

The type of hearing loss you have is important because it determines what help or treatment is most suitable for you.

Read more about treating hearing loss.