1.) Detailed Hearing Health History: As with any clinical examination, a careful history is required to review symptoms and put all concerns into perspective. The history helps determine the source of hearing loss and is also important for planning rehabilitation. Certain questions must be answered to determine if a referral to a physician is required. Questions include: Do you have a family history of hearing loss? Ringing in the ears? Is your loss in one or both ears? Is one ear much better? Do you have any pain or drainage from your ears? Is there any sensation of fullness in your ears? Do you have a history of frequent wax accumulation? Do you experience dizziness?
2.) An Otoscopic Exam: Your provider should examine your ear canals and eardrums with an otoscope (ear light) to determine the need for wax removal and check for signs of ear infections. It will also reveal problems such as deformities of your external ear or ear canal, previous injury, and/or disease, scarring, or perforation of your eardrums. These problems affect your success with hearing aids, and should be ruled out, or care of the problem discussed. If needed and appropriate, cerumen (earwax) will be removed by your provider. In more difficult cases of wax build-up, your provider may refer you to a medical specialist for wax management. It is very important that your ear canal is free of wax build-up before testing is performed, and especially before hearing aids are fit.
3.) Lifestyle Discussion: Your examiner should listen carefully to your concerns, your frustrations, your perception of the severity of the problem and your motivation for dealing with your hearing difficulties. This discussion is crucial in order to make the best recommendations. It’s important for you to convey your goals for better hearing.
4.) Air Conduction for Hearing Thresholds: Your provider will seat you in a soundbooth, explain the tests, and position your earphones. A series of tones is presented from low pitch to high pitch, to achieve thresholds for each ear. Thresholds are the softest levels detectable. Competent examiners will assess several tones (250, 500, 1000, 1500, 2000, 3000, 4000, 6000 and 8000 Hz) to get a clear picture of your hearing loss configuration. Each of your ears must be assessed separately.
5.) Bone Conduction Hearing Thresholds: A nerve conduction stimulator is placed behind each ear using a headband to measure the bone conduction thresholds. This component of the test is essential because it determines whether the hearing loss is due to permanent nerve deafness (clinically know as sensorineural) or a temporary condition (know scientifically as conductive which will resolve with medical intervention).
6.) Speech Recognition Capabilities: Your provider must determine how severely your hearing loss affects your understanding of speech. The speech reception threshold test is a measurement of the softest speech you can understand 50% of the time without the use of visual cues. Word recognition testing is completed at a normal conversational loudness level of 50-60 dB depending on your hearing loss. This is an important indicator of your prognosis for success with hearing aids.
7.) Binaural Speech Discrimination Testing at Most Comfortable Level (MCL): This test is used to determine the need for one vs. two aids. It determines your understanding for each ear separately and then together at your most comfortable loudness level. A provider cannot ethically recommend one vs. two hearing aids until this test is done.
8.) Speech UCL for each ear: It is imperative that your clinician obtain a speech UCL for each ear before fitting hearing aids. UCL is the abbreviation for uncomfortable loudness level. Because many people are overly sensitive to loud sounds once nerve deafness begins, special prescriptions are designed to address low tolerance levels and ensure a comfortable fitting. If UCL testing is omitted, you may be doomed to wear aids that constantly exceed your comfort zone, causing you to eventually give up on wearing your aids.
9.) Tympanometry: This is a measurement of the volume, mobility and integrity of the middle ear system. It is important that this test is included in your initial consultation because it provides information about the nature of your hearing loss; i.e., temporary (conductive and usually correctable) vs. permanent nerve loss (sensorineural). In cases of severe middle ear disease, hearing aids may be more harmful than helpful.
