Hearing Testing
Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.
Formal audiological testing is a cornerstone of the investigation of ear conditions and hearing loss in both children and adults. Tests range from simple objective measurements of middle ear function to sophisticated psychoacoustic assessments of the entire auditory pathway. Understanding what each test measures and why it has been requested helps patients engage meaningfully with their results and the management decisions that flow from them.
Northern Beaches Audiology is co-located within Dr Roth’s Dee Why consulting rooms, providing seamless access to comprehensive audiological services before or after ENT consultations. northernbeachesaudiology.com.au →
Why Hearing Testing is Ordered
Dr Roth requests audiological assessment as part of the evaluation of a wide range of conditions, including:
- Suspected hearing loss — in children (including following glue ear or recurrent ear infections) and adults
- Tinnitus — to characterise the pattern of hearing function associated with the symptom and guide investigation
- Vertigo and balance disorders — to assess cochlear involvement
- Pre- and post-operative assessment for ear surgery (grommets, myringoplasty, tympanomastoid surgery)
- Monitoring of hearing in patients on potentially ototoxic medications
- Assessment of suitability for hearing aids or implantable hearing devices
- Pre-employment or medicolegal hearing assessment
- Acoustic neuroma surveillance
Understanding the Audiogram
The audiogram is the standard graphic representation of hearing test results. It plots hearing threshold — the softest sound detectable — on the vertical axis (in decibels, dB, with 0 dB at the top representing perfect threshold) against frequency on the horizontal axis (from low frequencies at the left — 250 Hz — to high frequencies at the right — 8,000 Hz). The right ear is conventionally plotted with circles and the left ear with crosses.
Results are recorded separately for air conduction (testing through headphones — assessing the entire auditory pathway from the outer ear to the auditory cortex) and bone conduction (testing through a vibrator placed on the mastoid bone — bypassing the outer and middle ear and testing the inner ear directly). Comparing the two measurements is the key to determining whether a hearing loss is conductive, sensorineural, or mixed:
Normal hearing
Air conduction thresholds within 20–25 dB across all frequencies. No air-bone gap. Both lines on the audiogram sit near the top of the chart.
Conductive hearing loss
Air conduction thresholds elevated (lines lower on the chart) but bone conduction thresholds normal. An air-bone gap is present — the difference between the two lines represents the magnitude of the conductive component. The inner ear is functioning normally; sound is simply not being transmitted efficiently to it. Common causes: earwax, glue ear, perforated eardrum, otosclerosis.
Sensorineural hearing loss
Both air and bone conduction thresholds are elevated, with no air-bone gap. The inner ear or auditory nerve is the site of the problem. Common causes: age-related hearing loss (presbycusis), noise damage, viral labyrinthitis, ototoxic medications, Ménière’s disease.
Mixed hearing loss
Both air and bone conduction thresholds elevated, but an air-bone gap is also present — indicating concurrent conductive and sensorineural pathology. Common in long-standing chronic ear disease.
Hearing loss is graded by the pure tone average (PTA) — the average of thresholds at 500, 1,000, 2,000, and 4,000 Hz:
- Normal: 0–20 dB HL
- Mild: 21–40 dB HL — difficulty in noisy environments and with soft speech
- Moderate: 41–55 dB HL — difficulty with conversational speech at normal distances
- Moderately severe: 56–70 dB HL — difficulty with loud speech; benefits from hearing aids
- Severe: 71–90 dB HL — only very loud speech or amplified sound audible
- Profound: 91+ dB HL — hearing aids of limited benefit; cochlear implant candidacy may be considered
Individual Tests Explained
Pure Tone Audiometry (PTA)
The standard hearing test for cooperative adults and children from approximately four years. Tones at different frequencies are presented through headphones and a bone conductor at progressively decreasing volume levels; the patient responds when they hear each tone. Results are plotted on the audiogram. Testing takes 20–30 minutes. Requires quiet, consistent responses from the patient.
Tympanometry
An objective test of eardrum mobility and middle ear function. A probe is placed at the entrance to the ear canal, creating a gentle seal. A tone is played and the pressure in the canal varied systematically. The resulting tympanogram — a plot of eardrum compliance against ear canal pressure — characterises middle ear status. Type A (peaked, normal pressure): normal. Type B (flat): fluid behind the eardrum, perforation, or non-mobile eardrum. Type C (peak at negative pressure): Eustachian tube dysfunction. Tympanometry is quick, objective, and can be performed in infants and toddlers who cannot cooperate with behavioural testing.
Visual Reinforcement Audiometry (VRA)
Behavioural hearing test for infants from approximately six months to two and a half years. Sounds are presented from loudspeakers in a sound-treated room. When the child turns toward the sound source, they are rewarded with an illuminated toy — the visual reinforcer. Repeated trials establish the minimum sound level that reliably elicits a head turn response, providing frequency-specific hearing thresholds. Requires a paediatric audiologist and appropriate testing environment.
Conditioned Play Audiometry (CPA)
For children approximately two and a half to four years. The child is taught a play-based response to hearing a sound — for example, dropping a peg into a bucket or placing a brick on a tower. Once conditioned, frequencies and intensities are varied to establish hearing thresholds. More precise than VRA and can be used with insert earphones for ear-specific testing.
Speech Audiometry
Measures the ability to hear and correctly identify spoken words at different volume levels. Speech reception threshold (SRT) determines the softest level at which 50% of words can be repeated correctly — should correspond closely to the PTA. Word recognition score (WRS) tests the percentage of words correctly identified at a comfortably loud level. The WRS is particularly important: poor word recognition despite adequate threshold suggests cochlear or retrocochlear (auditory nerve/central) pathology rather than simple conductive loss, and guides further investigation and hearing aid fitting decisions.
Otoacoustic Emissions (OAE)
OAEs are sounds produced by the outer hair cells of the cochlea in response to a brief click or tone — a byproduct of their active amplification function. They are measured by a sensitive microphone placed in the ear canal. Presence of OAEs indicates normal or near-normal outer hair cell function; absence indicates cochlear hearing loss of 35–40 dB or greater at that frequency. OAEs are quick, entirely objective, and require no response from the patient — they are used in newborn hearing screening programmes and in the evaluation of young children and uncooperative patients.
Auditory Brainstem Response (ABR)
Records the electrical activity of the auditory nerve and brainstem in response to click or tone stimuli via surface electrodes on the scalp and earlobes. Provides frequency-specific hearing thresholds independent of patient cooperation — the gold standard for hearing assessment in infants who have failed newborn screening, or in children too young or too developmentally challenged to participate in behavioural testing. ABR is also used diagnostically in the assessment of auditory neuropathy spectrum disorder and in the evaluation of acoustic neuroma.
Hearing Aid Fitting and Management
Northern Beaches Audiology offers assessment, prescription, fitting, and ongoing management of hearing aids from leading manufacturers across a range of styles — including behind-the-ear (BTE), receiver-in-canal (RIC), and custom in-the-ear devices. Fitting is guided by the audiogram and the patient’s communication needs. Modern digital hearing aids provide directional microphones, adaptive noise reduction, Bluetooth connectivity to phones and televisions, and remote control from a smartphone app.
Custom Ear Protection
Northern Beaches Audiology produces custom-moulded ear protection for a range of applications: swim plugs for patients with grommets, perforations, or exostoses; musician’s earplugs (with flat attenuation filters that preserve sound quality while reducing volume); occupational noise plugs; and sleep plugs. Custom moulds are made from an impression of the ear canal and outer ear and provide a superior fit and performance compared with generic devices.
Implantable Device Assessment
Patients being considered for bone-anchored hearing devices (BAHA/Osia) or cochlear implants undergo comprehensive audiological assessment to confirm candidacy and provide pre-implant baselines. Bone-anchored devices are suitable for patients with conductive or mixed hearing loss, or single-sided deafness, where conventional hearing aids cannot provide adequate benefit. Cochlear implant assessment is coordinated in a multidisciplinary setting.
Northern Beaches Audiology — Location and Contact
Northern Beaches Audiology is located within the Dee Why Grand consulting rooms at Suite 4205, 834 Pittwater Road, Dee Why NSW 2099. Audiology appointments are available on Thursdays. A referral from Dr Roth or your GP can be arranged to coordinate hearing testing as part of your ENT assessment.
Phone: (02) 9982 3439
Website: northernbeachesaudiology.com.au →
Contact us to arrange a consultation → | Hearing Loss → | Glue Ear →
Dr Roth’s Clinical Perspective
A full audiological assessment — pure tone audiogram, speech discrimination, and tympanogram — is the baseline investigation for any ear complaint involving hearing change, tinnitus, or aural fullness. The tympanogram in particular is underused in general practice: it tells you immediately whether the middle ear is normally pressurised, negatively pressurised, or fluid-filled, which directs the investigation and management efficiently. I arrange formal audiological testing for the large majority of patients presenting with ear symptoms because clinical examination alone does not characterise the hearing pathology adequately.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
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Speak with Dr Jason Roth
Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.
Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.
Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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