Audiometry Testing: Understanding Hearing Assessment and Decibel Levels

Most people don’t realize how much they rely on hearing until it starts slipping away. Maybe you’ve been asking people to repeat themselves, turning up the TV too loud, or struggling to follow conversations in noisy rooms. These aren’t just signs of aging-they could be early warnings of hearing loss. The only way to know for sure is through audiometry testing, the gold standard for measuring how well you hear.

What Exactly Is Audiometry Testing?

Audiometry testing is a simple, non-invasive procedure that checks your ability to hear sounds at different pitches and volumes. It doesn’t hurt. You won’t feel anything more than a slight vibration if bone conduction is used. But the results? They’re powerful. They tell you exactly where your hearing starts to fade-and how much you’re missing.

The test measures your hearing threshold: the softest sound you can detect at least half the time. These thresholds are recorded in decibels hearing level (dB HL). Normal hearing is defined as 25 dB HL or better across all tested frequencies. If your threshold is 40 dB HL at 2000 Hz, that means you can’t hear whispers or soft consonants like “s” or “th” unless they’re spoken loudly.

The most common type is pure-tone audiometry. You sit in a soundproof booth, wear headphones, and press a button every time you hear a tone. The tones range from low (250 Hz) to high (8000 Hz)-covering the full range of human speech. The audiologist starts with a tone you can easily hear, then lowers the volume in 10 dB steps until you no longer respond. Then they go back up in 5 dB steps to find the exact point where you just barely hear it. This method, called the modified Hughson-Westlake technique, has been used since the 1940s and is still the most accurate way to map hearing loss.

Why Air and Bone Conduction Matter

There’s a big difference between hearing a sound through the air and feeling it through your skull. That’s why audiometry tests both air conduction and bone conduction.

Air conduction sends sound through your ear canal, eardrum, and middle ear bones before reaching the inner ear. If something’s wrong with your outer or middle ear-like wax buildup, an ear infection, or a perforated eardrum-this path gets blocked. That’s called conductive hearing loss.

Bone conduction skips all that. A small oscillator is placed behind your ear on the mastoid bone. It sends vibrations directly to the cochlea, the inner ear’s hearing organ. If your bone conduction thresholds are normal but your air conduction thresholds are worse, you have conductive hearing loss. If both are equally poor, the problem is in your inner ear or auditory nerve-that’s sensorineural hearing loss, the most common type, often caused by aging or noise exposure.

The key number? A 15 dB or greater gap between air and bone conduction at any frequency. That’s the official red flag for conductive issues. Without testing both, you’re guessing.

Speech Testing: Hearing vs. Understanding

Hearing a tone isn’t the same as understanding a word. That’s why audiometry includes speech testing.

Speech Reception Threshold (SRT) testing finds the quietest level at which you can repeat 50% of two-syllable words like “baseball” or “hotdog.” Your SRT should match your average pure-tone threshold at 500, 1000, and 2000 Hz-within ±10 dB. If it doesn’t, something’s off. Maybe the test wasn’t done right. Or maybe you have a hidden problem, like a tumor on the auditory nerve.

Then there’s speech discrimination, or word recognition testing. You’ll hear a list of single-syllable words-“cat,” “dog,” “ship”-at a volume 25-40 dB above your threshold. You repeat them. A healthy ear should get 90% or more correct. If you only get 60%, even with amplification, your brain isn’t processing sound properly. That’s common with age-related hearing loss or damage from loud noise.

This part is critical. Two people might have the same pure-tone results but wildly different speech understanding. One hears fine in quiet rooms. The other struggles even with hearing aids. Speech testing explains why.

Tympanometry: Checking the Middle Ear

Audiometry isn’t just about tones and words. It’s also about pressure.

Tympanometry measures how well your eardrum moves. A small probe seals your ear canal and changes the air pressure while playing a low tone. The machine records how much sound bounces back. A healthy eardrum moves freely, letting most sound pass through. If it’s stiff-because of fluid, scar tissue, or a collapsed eardrum-the reading looks flat (Type B tympanogram). That’s a clear sign of middle ear fluid, especially in kids with ear infections.

The test takes 3-5 seconds per ear. No discomfort. No noise. Just a quick pressure change. It’s often done alongside pure-tone testing because middle ear problems are one of the most common causes of reversible hearing loss. If you’ve had recurring ear infections or feel like your ears are “plugged,” tympanometry can tell you if it’s just fluid-or something worse.

Who Needs Audiometry Testing?

You don’t need to wait until you’re struggling to get tested. Here’s who should have it done:

• Anyone over 50-age-related hearing loss starts slowly and often goes unnoticed.
• People exposed to loud noise-construction workers, musicians, factory staff, even frequent concertgoers.
• Those with a family history of hearing loss.
• Patients taking ototoxic medications-like certain antibiotics or chemotherapy drugs (cisplatin).
• Children with delayed speech, frequent ear infections, or who don’t respond when called.
• Newborns-screening is required by law in U.S. hospitals, with diagnostic testing needed by age 3 months if they fail.

The CDC reports that 1.7 out of every 1,000 babies are born with hearing loss. Early detection means early intervention-and better outcomes. For adults, untreated hearing loss is linked to social isolation, depression, and even faster cognitive decline.

What the Results Look Like: Reading Your Audiogram

Your results are shown on an audiogram-a graph with frequency (pitch) on the horizontal axis and decibels (volume) on the vertical axis. Lower numbers mean better hearing.

- Circles (○) = Right ear air conduction - Crosses (×) = Left ear air conduction - Brackets ([ ]) = Right ear bone conduction - Less-than signs (<) = Left ear bone conduction

A normal audiogram looks like a straight line near the top-below 25 dB across all frequencies. If the dots drop below that, you have hearing loss. The shape tells you the type:

• Flat: Equal loss across all pitches
• Sloping: Worse in high frequencies (most common with aging)
• Notched: Dip at 4000 Hz (classic sign of noise damage)
• Reverse slope: Worse in low frequencies (rare, often genetic)

Audiologists use these patterns to diagnose the cause. A notched loss at 4000 Hz? Likely from loud music or machinery. A sloping loss starting at 2000 Hz? Probably age-related. A gap between air and bone? Middle ear issue.

How Accurate Is It? What Can Go Wrong?

Audiometry is highly accurate-when done right.

Equipment must be calibrated yearly to ANSI S3.6-2018 standards. If the audiometer is off by even 5 dB, your results are misleading. That’s why reputable clinics check their gear regularly.

Patient factors matter too. Fatigue, distraction, or misunderstanding the task can lead to false results. That’s why tests are limited to 45 minutes. If you’re tired, the audiologist will pause or reschedule.

Masking is another key step. If one ear is much better than the other, the louder ear might hear the tone meant for the weaker ear. To prevent that, noise is played in the better ear to block it out. Skip masking, and you get inaccurate thresholds. About 12% of tests have masking errors, according to Mayo Clinic data.

What Comes After the Test?

Audiometry doesn’t end with the graph. The real value is in what happens next.

If you have hearing loss, your audiologist will explain:

• What type you have
• How severe it is (mild, moderate, severe, profound)
• Whether it’s treatable
• What hearing aids or assistive devices might help
• If you need a referral to an ENT doctor

For conductive loss, you might need surgery or earwax removal. For sensorineural loss, hearing aids are the standard solution. Modern devices can now connect to phones, reduce background noise, and even adjust automatically in different environments.

If you’re a child, early intervention might mean hearing aids, cochlear implants, or speech therapy. The window for language development closes fast-by age 3, if hearing loss isn’t addressed, speech delays become permanent.

Tele-Audiology and New Tech

You don’t always need to go to a clinic anymore.

Since the pandemic, tele-audiology has grown. The FDA now approves remote testing using devices like the KUDUwave mobile booth. You can do a basic hearing screen at home with a smartphone app or tablet. But here’s the catch: these tools aren’t reliable for detecting mild hearing loss below 25 dB HL. They’re great for screening, but not for diagnosis.

New AI tools are starting to help audiologists interpret audiograms faster. Otometrics’ AI software, for example, identifies conductive loss patterns with 92% accuracy in trials. But it’s still a tool-human expertise is irreplaceable.

Where to Get Tested

You can find audiometry testing at:

• ENT clinics
• Dedicated audiology practices
• Hospitals
• Some retail hearing centers (for screening only)

Insurance often covers diagnostic testing if you have symptoms. Medicare doesn’t cover routine audiometry, but many Medicare Advantage plans do. Medicaid covers it for children.

There are 14,300 licensed audiologists in the U.S., but access isn’t equal. Rural areas have only 0.7 audiologists per 100,000 people. Urban areas have more than three times that. If you’re in a remote area, tele-audiology might be your best option.

Final Thoughts: Don’t Wait Until It’s Too Late

Hearing loss doesn’t come with a siren. It creeps in slowly. You adapt. You think you’re fine. But every missed conversation, every misunderstood word, adds up.

Audiometry testing takes less than an hour. It’s painless. It’s accurate. And it gives you back control. Whether you’re 25 and work in a noisy warehouse or 70 and can’t hear your grandchildren, knowing your hearing status is the first step to fixing it.

Don’t wait for someone to tell you to get tested. If you’ve noticed any change in your hearing-ask for an audiometry test. It’s not just about volume. It’s about connection.