Assessment of Hearing

• Whisper Test


  A simple and accurate screening test to detect hearing impairment
• Hearing Tests: Whisper Test

  • Distance: approx. 2 feet - arm's length away
  • Position of examiner: Behind the patient out of the patient's sight
  • Ask patient to cover 1 ear with their finger over tragus
  • Whispers softly from the unoccluded ear
  • The person with normal hearing acuity can correctly repeat what was whispered.
• Tuning Fork Test 


  Test for auditory acuity
• Tuning Fork Test

  2 types:

  • Rinne's Test
  • Weber's Test
• Rinne's Test 


  Compares air conduction from bone conduction
• Rinne's Test 


  Differentiates conductive and sensorineural hearing loss
• Rinne's Test

  The vibrating fork is placed against the mastoid bone (bone conduction); then, it is placed 2 inches from the opening of the ear canal (air conduction)
• Hearing Tests: Rhinne's Test

  • Normal: AC > BC -  tone is louder in front of the ear
  • Conductive HL: BC>AC  - tone is louder behind the ear
  • Sensorineural HL: AC>BC - tone is louder in front of the ear
• Rinne's Test

  This is valuable in the diagnosis of otosclerosis.
• Weber's Test

  The rounded tip of the handle of vibrating tuning fork is placed in the center of the client's head.
• Weber's Test

  Interpretation of results:

  • Normal: tone is heard equally in both ears
  • Sensorineural HL: sound is heard/lateralizes in the good ear
  • Conductive HL: sound is heard/lateralizes in the poor ear
• Sensorineural Hearing Loss - this is valuable in the diagnosis of Meniere's Disease
• Weber's Test


  Useful in cases of unilateral loss
• Audiometry


  It is the single most important diagnostic instrument in detecting hearing loss
• Hearing Tests: Types of Audiometry

  Pure-tone - the louder the tone before the client perceives it, the greater the hearing loss
• Hearing Tests: Types of Audiometry

  Speech - Spoken word is used to determine the ability to hear and discriminate sounds and words
• Hearing Tests: Types of Audiometry

  Speech - The louder the sound before the client perceives it, the greater the hearing loss
• Tympanogram aka Impedance Audiometry
• Tympanogram 


  It measures middle ear muscle reflex to sound stimulation and compliance of the tympanic membrane, by changing the air pressure in a sealed ear canal
• Tympanogram

  Compliance is impaired with middle ear disease
• Oculovestibular Test


  Aka Caloric Test
• Caloric Test

  Irrigate the ear with cold water, then warm water
• Hearing Tests: Caloric Test

  NORMAL: For WARM water, lateral conjugate nystagmus of the eyes towards area of stimulation
• Hearing Tests: Caloric Test

  NORMAL: For COLD water, conjugate nystagmus of the eyes away from area of stimulation
• Hearing Tests: Caloric Test

  ABNORMAL: dysconjugate nystagmus of the eyes