Many hearing loss sufferers complain about a lack of empathy from those with normal hearing in understanding how hearing loss affects them. Not all sound is affected in the same way. Spoken word may be easier or more difficult to hear than music. To provide a broader understanding, below are samples of music and speech, altered to show what could be missed through typical age-related hearing loss. Click the tabs below to hear each of the samples.
NB. Please note this is designed for use by those without hearing loss.
This sample is the original musical recording. Listen to this one first - it will allow you to better gauge the differences between it and the following recording.
Note the line that represents what you can hear is near flat from left to right. This indicates that the sound is being heard evenly throughout the entire spectrum. This would be the ideal scenario.
This sample is exactly the same as the one to the left but now simulates what a person with mild to moderate, age-related, hearing loss may experience.
Note that the line is now falling when we get into higher frequencies. This indicates that higher-pitched noises would be more difficult to hear.
If you would like to know more about hearing loss and how it may affect someone you know, please contact us by clicking here
Try out our FREE Hearing Check, it uses a range of tones played at varying levels and you will be asked to press a button whenever you hear a tone.
Regardless of their design, all hearing aids require the same basic assembly of components - microphone/s, chips, speakers (receivers) and a battery to supply power. How these components are placed within the hearing aids is determined by the model.
Hearing aid design continues to evolve with manufacturers providing an extensive range to suit every taste and requirement. This guide gives you an overview of the types of hearing aids available:
Behind-the-ear hearing aids
Receiver in canal (RIC) hearing aids
In the canal hearing aids
Completely in the canal hearing aids
Body-worn hearing aids
Spectacle worn hearing aids
Behind-the-ear hearing aids are often abbreviated to BTE or occasionally OTE (on-the-ear). They are one of the most popular types of hearing aids. As the name suggests, behind-the-ear devices are designed with the electronic components in a casing which sits behind the ear, with a tubing of some
kind allowing the amplified sound to travel into the ear canal itself.
On the casing, there may be controls that can be accessed by the wearer – usually a volume and/or programme button. Remotes can also control some BTEs.
Wireless connectivity is currently very popular, with hearing aids able to link via a transmitter or even directly to TVs, smartphones, and external microphones, offering even greater help to the wearer for specific listening situations.
Advances in electronics and component design have allowed many manufacturers to produce extremely small and light BTE products; in some cases the part that goes behind someone’s ear is not more than an inch in length.
A traditional BTE fitting uses an earmould. An impression of the outer ear and ear canal is taken using quick-drying silicone material. This impression is sent to a lab, and a customised earmould is created.
Earmoulds, which can be made of hard or soft materials, and are usually clear or pinkish in colour, but brightly coloured or decorative earmoulds are also manufactured on request. A hole (bore) is drilled through the earmould and an earmould tubing inserted. The tubing then attaches to an ear hook on the BTE.
In the past decade, the so-called thin-tubing fitting has increased in popularity. Thin-tubing fitting usually refers to ‘open-fit’ BTEs. Substantial improvements in hearing aid technology and design have enabled hearing aid users to move away from earmould fittings and consider open-fittings instead, of the customised ear mould.
Thin tubings are very thin (2mm diameter or so) tubings that direct the sound from the casing into the ear canal. Instead of the tubing going through the bore of the earmould, they are pre-shaped to bend into the ear canal and a soft ‘dome’ is attached to the end of the thin tubing to improve wearing comfort.
Domes vary in size and most manufacturers have a range of sizes and styles.
One of the advantages of open-fitting products is improved wearing comfort compared to earmould fittings. The thin tubing and dome allow for more natural airflow in and out of the ear canal, something which was is difficult to achieve with earmoulds.
Having the ear canal less blocked up helps to keep the sound of one’s own voice more natural and chewing and drinking sounds are not over-amplified.
A disadvantage of open fitting BTEs is that very severe hearing loss usually cannot be accommodated, as the risk of feedback or whistling from the hearing aids increases substantially as the degree of hearing loss increases
BTEs come in a wide range of sizes.
Different sized hearing aid batteries are used in some designs, as
well as bigger or smaller amplifier units for more or less amplification. Smaller batteries (e.g. size 10) will need to be replaced much more frequently than bigger batteries (e.g. size 13).
‘Power’ and ‘Super-power’ BTEs will have bigger amplifiers, and usually also operate on bigger batteries. Even these powerful products are now produced in considerably smaller designs than a decade ago.
Having an electronic component in the ear canal does increase the risk of it being affected by wax build-up or skin debris or moisture. In most RIC designs, the receivers also have a wax guard built into them, which can be changed as part of the general care and maintenance required for the hearing aid.
Some RIC wearers only change their wax guards every few months; others may need to change them much more frequently.
Because one of the major electronic components is not in the casing behind the ear, space is saved, allowing RICs to be made in surprisingly small designs. The fact that the receiver component lies in the ear canal means that the distance between it and the hearing aid microphone is increased, certainly compared to the distance between these components in a traditional BTE. The risk of
feedback is thus decreased by this physical design element.
Pros
+ Small Design
+ Choice of amplification
+ Less risk of feedback than with the equivalent thin-tubing BTE
Cons
- Risk of wax build-up & more careful maintenance required
- Cost of replacement receiver
Despite the increase in the availability of small RIC and thin-tubing BTE products, many people still prefer the idea of in-the-canal hearing aids. For most people without hearing aid experience, ITC (in-the-canal) or ITE (in-the-ear) hearing aids are still thought to offer a more cosmetic fit and many
people ask for these initially when investigating hearing aids for the first time.
Most manufacturers distinguish between the ITC and ITEs, usually on the basis of size. ITC models are generally manufactured smaller than ITEs (the ‘ear’ part of the description referring to the product filling some of the actual concha or bowl part of the outer ear, rather than just the canal and entrance to the canal sections). ITEs may also be further categorized as ‘full-shell’ or ‘half-shell,’
which describes how much of the concha section is filled.
If a comfortable fit is achieved, many people find ITC products easy to wear, and easy to put in and take out. However, even if the fit is physically comfortable within the canal, many people, particularly those with more mild/moderate high-frequency losses do report feeling rather ‘blocked up’ with
something now in their ear. This is referred to as ‘occlusion. ’ Some people will acclimatize to this sensation very quickly; others may struggle to get used to it.
Occlusion can be minimized by drilling a hole through the shell, known as a ‘vent.’ This can, however, rise to an increase in feedback so we recommend you take advice before drilling a hole!
Pros
+ Easy to put in/take out
+ Cosmetic Design
+ Good with spectacles
Cons
- High maintenance
- Blocked up sensation
Care and maintenance of ITCs is more involved than with BTEs, and similar to what is required for a RIC device. The most important thing is to keep the instrument free from wax build-up and as dry as possible – something which can be difficult, as all the components are now worn inside the canal.
All ITCs will be manufactured with some form of wax guard in place, which will need to be inspected daily (or whenever the ITC is put in the ear) for any wax build-up. Most wax guards can be replaced by the wearer, some people replace as frequently as once a week, others once every few months.
An advantage of ITC fittings over those of RIC and BTEs comes to the fore when people complain about having to wear spectacles as well as hearing aids.
While most people do get used to wearing a BTE/RIE with their glasses, it can be troublesome for some and an ITC device does not interfere with the arms of ones glasses at all.
Not surprisingly, the components used for CIC products are the smallest available – which does mean that battery life and available amplification is limited. User controls are also limited, at most a programme button only (although some can still be controlled via remote control).
For most CICs, the quality of the ear impression taken for the shell is critical and some manufacturers insist on providing further training to those hearing health professionals who wish to fit their CIC products.
The same advantages and disadvantages apply to CICs as for ITCs.
Body-worn hearing aids are devices where the electronic components are situated in a little box- shaped container, which is not worn on or in the ear, but on the body.
The box is usually clipped to a pocket or belt or worn around the neck and the amplified sound is delivered to the ear via a cord and earphone or cusom-made earmould.
The microphone is situated on the box, so wearers must be aware that if they wish to have any sound amplified, the microphone on the box must be able to pick up that sound.
Body-worn hearing aids were very popular a few decades back, as they were, at the time, the only way to provide a lot of power for more severe hearing losses.
As technology in smaller BTEs improved, the need for body worn products decreased sharply. However, some body-worn hearing aids are still produced by some hearing aid manufacturers. New markets have opened up within developing countries – where body worn hearing aids are used for less severe hearing losses because the batteries powering the devices are AA or AAA types; which are much more accessible and cheaper than hearing aid battery options.
Some body-worn products have also been produced to run on solar power.
Pros
+ Battery life/cost
+ Powerful amplification
+ User controls
Cons
- Size
- Visibility
Spectacle devices are often recommended for those individuals with ‘conductive hearing loss.’ This is where the inner ear is functioning well, but the outer and/or middle ear parts are affected, such that the transmission of sound through to the inner ear is obstructed to a large extent.
The hearing instrument part of the glasses is designed to sit right on or very close to the mastoid bone of the skull, within protects the inner ear. The amplified sound coming out of the transmitter will then stimulate the inner ear via vibrations of the bone.
Pros
+ Recommended for conductive hearing loss
+ Can offer a disguised hearing solution
Cons
- Difficult to fit
- Removing glasses removes the hearing ability
More common sensorineural hearing losses can be accommodated by spectacle hearing aids which deliver the amplified sound to the ear via a tube or earmould.
These types of fittings are not popular; as one’s choice of glasses frames and hearing aid is severely restricted and when the glasses are removed, the hearing aid needs to be taken out as well.
As a type of hearing loss, it can still impact lifestyles on a daily basis. For many people, mild hearing losses do not have mild consequences. Mild hearing loss can mean reduced speech intelligibility in general, but especially in noise and over distances. Another consequence is increased listening fatigue with the risk of affecting social life.
People with a mild hearing loss tend to be able to hear speech when someone is speaking close to them or if the room is quiet. They can hear when people are talking loudly, too.
Talking over the phone tends to be mostly manageable too. However, they may feel that people are mumbling and/or that their ears are constantly plugged up. They also struggle when there are competing sound signals (for example speech and noise together).
Soft consonant sounds (e.g. ‘s’ ‘p’ ‘t’ or ‘sh’) are particularly difficult to hear, which is a frustration as the sound may be heard but remain unintelligible for the listener. This can drastically affect the ability to follow conversations.
Hearing loss is broken down into four main categories according to the degree or severity of the loss. It is measured on a scale of decibels of hearing loss against a ‘normal’ hearing person.
The number of decibels required above the normal level to hear will define the severity of the loss according to the categories below (these reflect the dB loss for the majority of frequencies):
To establish the degree of hearing loss a hearing test is carried out to establish how loud a sound needs to be played for the person to hear it. The test plays sounds at different frequencies – high pitch, low pitch etc. to establish the degree of hearing loss at different frequencies.
Depending on the type of hearing loss, there are a number of potential causes:
Deterioration due to the natural aging process
There is currently no medical cure for many types of hearing loss. Those with mild hearing loss have a choice of continuing to suffer an ever more isolating hearing loss or investigate the use of amplification. For example, via the use of hearing aids.
Digital hearing aids can improve the quality of life for the suffer providing the gift or improved sound and clarity.
Also, other products such as TV listeners and amplified phones can provide numerous benefits for the hard of hearing.
She has accumulated a wealth of experience within the hearing aid and hearing rehabilitation fields in particular; working in private and public healthcare settings. Joan also spent time working in manufacturing environments with two hearing aid companies, one of the world’s largest hearing aid manufacturers ReSound.
As ReSound's UK Product Manager, Joan spent time in the Danish headquarters working with the development teams on new product ideas. Her role also involved rolling out the new technologies via various training events and conferences to other hearing care professionals around the world, and in the UK - particularly within the NHS.
Throughout her career Joan has also enjoyed teaching students; and has been employed as an ad-hoc clinical supervisor and lecturer at the University of Cape Town and the University of KwaZulu-Natal when based in South Africa in 2002-2004; and again in 2013-2015.
Joan has been involved with Hearing Direct since its launch in 2010; and enjoys the online retail environment which seeks to provide easier access to hearing products and accessories. Being in constant communication with hearing-impaired customers and their families across the globe provides ongoing challenges to find the best products and services to support them remotely.
Joan is also a regular writer and speaker on the causes of hearing loss, living with hearing impairment and future breakthroughs that could help support those affected by hearing loss. You can find a number of Joan’s articles below on the subject:
Risk & Safety Plus - What Was That You Said?
Caring Homes - Guideance on Managing Age Related Hearing Loss
Enable Magazine - Hearing Loss in the Ageing Population
Starkey - Should You Wear Earplugs at Night?
Cirrus Research - Noise Induced Hearing Loss: An Introduction
Deaf Umbrella - The Importance of Dealing with Hearing Loss
CuraCare - Age related Hearing Loss Factsheet
Armscare - An Article from Hearing Direct
ASHA Leader Live - How Gene Therapy is Revolutionising Hearing Loss Restoration
designed2enable - Guest Blog - Joan McKechnie, (BSc Hons Audiology & Speech Pathology) of Hearing Direct
Disability Horizons - Hearing aids: the end to a muted world
Evenbreak - Guest blog: Employing people who are deaf or hard of hearing
Caregiving Cafe - Guest Blog: Tinnitus and Age-Related Hearing Loss
ROSPA Workplace Safety - Speaking up for hearing loss
Hallmark Care Homes - Special Guest Blog: Age related hearing loss
Healthy Men - Hearing Loss and Gene Therapy
When They Get Older - Benefits for the hearing disabled
The Hearing Professionals - Using Apple Watch with Hearing Aids
Telegraph - Deafness Can Lead to Divorce
Hascat Safety Blog - Noise At Work
Deaf and HoH - The Connection Between Dementia and Hearing loss
HPP Resource Center - The Link Between Age-Related Hearing Loss and Dementia
Intentional Caregiver - Hearing Loss of the Age-Related Type
Healthy Voices - 10 Facts About Age Related Hearing Loss In The UK
prime50plus - Age-Related Hearing Loss Explained
Buying a Hearing Aid online is easy with Hearing Direct. You can choose from a wide range of hearing aids including Digital Hearing Aids, Invisible Hearing Aids, Behind the Ear Hearing Aids and more.
Once you find the right hearing aid, simply add it to the basket and check out. We will ship it to your door free on orders over 20€. With every hearing aid, we offer a 'no quibble' 30-day money-back, Freepost return guarantee.
We also have a dedicated team of experts available to help you with any further questions; why not call us free on (+44)1 264 313 110.
Our website is home to a large range of different types of hearing aids. The main types of hearing aids to choose from are:
You can compare hearing aids on our handy guide here to find the most suitable device for you.
Along with buying hearing aids online, we stock a large range of essential items needed to effectively manage hearing loss.
Alternatively, our blog is home to further advice, guidance, and reviews so you can assess how and what you can do to tackle your hearing impairment head-on.
Our digital hearing aids come with a 30-day money-back guarantee, as well as a 12-month manufacturers warranty. Free delivery is available so you can have your device delivered directly to your front door.
If you have any questions regarding any of our behind the ear hearing aids or need advice from our expert audiologist then please do contact us and our expert team will do their best to help.
Experiences of tinnitus are very common across all age groups (especially following exposure to loud noise).
Tinnitus can vary in the way it sounds, its severity, as well as its annoyance. Ringing, chirping, or even clicking sounds may occur a few times a month or many times in one day; for a few moments or hours; or can even be constant.
For some individuals, tinnitus may also have a pulsating or repetitive
pattern. Mild tinnitus is common - about 10 per cent of the population have it all the time and, in up to one per cent of adults, this may affect the quality of their life.
Tinnitus can be a complex issue and no ‘magic wand’ treatment exists. There are however options available to help you understand your tinnitus better and provide relief.
Your GP or hearing healthcare professional may discuss one of the following:
Tinnitus is very real, as it is a ‘sound’ that is heard by the person experiencing it, regardless if someone else can hear it. As tinnitus can be a sign of certain medical complications, it shouldn't be dismissed or underestimated. You should see your GP should you have persistent tinnitus, or if your tinnitus is accompanied with any dizziness and/or balance problems.
Joan McKechnie
BSc Hons Audiology & Speech Pathology
My name is Joan, one of the audiologists here at HearingDirect.com. The following is a guide to hearing that covers many of the questions I receive on a regular basis about all things hearing.
If you would like to see more information on a particular subject I would be delighted to hear from you - contact us to submit a question/subject or feel free to email me audiology@hearingdirect.com.
Hearing is a precious gift which helps us make sense of the world around us. Scientists tell us that our ears pick up air waves and translate them into sounds in our brain but hearing is so much more than that; chatting with friends, listening to our children, talking through problems or relaxing to music. Sounds provide information and evoke thoughts and feelings that give meaning to our lives.
This guide to hearing covers the following:
What is sound?
How do we hear?
What can go Wrong?What does a hearing assessment involve?What happens during a hearing test?
What do the results of an audiogram mean?
What does it mean to have hearing loss?
An introduction to hearing aids
What is Tinnitus?
Put simply, “Sound” is waves or vibrations of air. A healthy ear is able to pick up vibrations that are measured in a basic unit of frequency known as Hertz or Hz. The ear converts vibrations into electrical signals sent to the brain, where they are translated into meaningful information such as speech and music.
Our brain works out what type of sound it is according to the volume and the pitch of the vibrations. The volume of sound is measured in decibels. The greater the volume the further the sound travels and the louder it sounds.
The rate at which a sound vibrates is called its frequency and the higher the frequency the higher-pitched the sound, such as a flute or birdsong. An example of a lower-pitched sounds could be the rumble of distant thunder. Frequency is physical measurement and pitch is a measure of how we
perceive frequency.
Loudness varies from person to person, how we describe a sound as being inaudible, very soft, soft, moderate, loud, very loud or too loud. For the same volume of sound, people might rate them differently. For example, one might rate rock music as loud and another might rate it as too loud.
The characteristics of different sounds vary widely. Simple sounds such as pure tones contain only one frequency. However, most everyday sounds are complex sounds consisting of many frequencies.
Speech, for example, consists of vibrations at different volumes and numerous frequencies and most are between 250 and 8000Hz.
Sound travels in waves of pressure through water, gases (like air) and other matter. It is the means of auditory communication but how do we make sense of what we hear? The human ear is designed to be a receiver of sounds but also plays a major role in balance and body position.
Our ears are divided into three parts – the outer ear, the middle ear and the inner ear. Sound waves travel through each part of the ear to the brain where they are analysed and interpreted into meaning.
The best way to describe how our ears work is to describe the pathway sound takes through each part:
1. The outer ear
The outer ear includes the pinna, the ear canal and the eardrum (tympanic membrane). The pinna is the external part of the ear made of cartilage, tissue and skin. It collects and directs sounds into the ear canal and protects the ear canal. The ear canal is a tube that directs sounds onto the eardrum.
2. The middle ear
The middle ear is an air-filled chamber connected to the nasal and throat passages by the Eustachian tube which equalises air pressure on both sides of the ear drum. Usually closed, the Eustachian tube opens naturally when you swallow or yawn.
Sound reaching the eardrum causes it to vibrate, transmitting that sound to the three smallest bones in the body. These bones or ‘ossicles’ are commonly referred to as the hammer (Malleus), the anvil (Incus) and the stirrup (Stapes) that connect the eardrum to the inner ear. These tiny ossicles amplify the vibrations and direct the waves of sound into the inner ear.
3. The inner ear
The inner ear is filled with a fluid and consists of the spiral shaped Cochlea, named from the ancient word for the shell of a snail. The passageways of the cochlea are lined with over 15,000 microscopic haircells (referred to as inner and outer hair cells) that convert sound vibrations into nerve pulses
which are then sent to the brain.
The auditory nerve contains thousands of nerve fibres that help our
brains interpret these pulses into meaning. The inner ear also contains our ‘vestibular system’ in the form of the ‘semi-circular canals’, and is important in maintaining balance and body position.
Whilst there are many reasons for hearing loss, the condition itself falls into two main categories - Conductive and Sensorineural. Hearing loss can also be attributed to a combination of both types – a mixed hearing loss.
Conductive hearing loss is caused by any obstruction that prevents sound waves from reaching the inner ear. Some of the causes of conductive hearing loss can include:
Sensorineural hearing loss refers to problems in the cochlea or the auditory nerve. Deterioration of the tiny inner or outer hair cells in the cochlea is the cause of most permanent hearing losses and although it may be a natural part of aging other causes can include:
It is possible for a conductive hearing loss to occur together with a sensorineural hearing loss. When this occurs, the hearing loss is referred to as a mixed hearing loss.
Hearing tests are quick and relatively simple for the person being tested. Results are instant, and you will know immediately if you do have a hearing problem and what steps to take. To many the results of a test, whatever they are, come as a huge relief. Once they have sought that initial help they find
the subsequent process straightforward and altogether life changing.
Your hearing healthcare professional will usually begin by asking you questions about the health of your ears and general health and your lifestyle. By asking these questions they can determine the possible damage that may have been caused to your ears from such things as illness, age, your job, your hobbies etc.
Amongst all the tests that can be performed on your hearing, pure tone audiometry is the most common. This evaluates the sensitivity of your sense of hearing at different frequencies.
A set of headphones is worn over the ears or foam earphones placed in the ear canal; and you may be required to sit in a sound-proof test room. The headphones are then connected to the audiometer.
This piece of specialised equipment produces tones at specific frequencies and levels to each ear independently. The patient will communicate that they have heard the tone by either raising their hand or pressing a button. As the test progresses, the hearing professional will plot your ‘thresholds’ on a graph called an audiogram.
A threshold is the softest volume you respond to a tone. Once each
frequency has been tested and plotted, the points are joined by a line and the hearing healthcare professional will help explain how your results compare to what is considered to be normal hearing.
Human hearing is designed for two ears. The technical term is binaural listening, and the auditory system is wired for it to allow for the best possible hearing and understanding.
If a hearing professional evaluates that you have hearing loss in both ears, the recommendation will usually be to wear two hearing aids. However, it’s all too often the case that people try to ‘get by’ with just a single hearing aid, maybe to reduce costs or simply because they feel that they only need to wear a device in the ear with the greater degree of hearing loss.
Whatever the reason, restricting yourself to a single hearing aid is a false economy because the truth is that one simply cannot do the job of two.
Our two ears and the two halves of our brain all work together to create what is known as auditory awareness. Each ear sends the different sound signals it collects to your brain via neural pathways, and the brain interprets those two sets of signals to enable us to understand and react to the world around us. It’s how we know someone is speaking to us; it’s how we know that a car is approaching us, say, from the left-hand side of our body; it’s how we gauge the kind of environment we’re in. For example, the ambient sounds in a carpeted living room sound completely different from the ‘echo chamber’ of a swimming pool.
Our brains are designed to listen in stereo as our default position – that’s the natural way we’re supposed to hear, and it’s the reason why listening to music in stereo just sounds better than in mono. It’s not just that the music sounds richer and fuller in stereo… if our brain doesn’t get the full audio picture from both sides, things don’t sound right and we miss out on vital areas of perception.
So using one hearing aid when two are really needed means that the brain won’t get the full input it needs. And the results are more significant than you might imagine.
With only one hearing aid, noises blend together and it becomes much more difficult to discriminate between the sounds you want to hear and those you don’t. Plus, the subconscious extra effort that the brain has to make in filtering out noise is proven to be very tiring.
Whereas, the stereo signals from two hearing aids help the brain to focus on the voice of the person who is speaking.
Receiving sound signals from both ears lets the brain not only locate the source where sounds are coming from but also identify if the source of that sound is moving… and, if so, how fast. In a social situation, it’s vital to be able not only to switch attention between different people speaking in a group, but also to still be able to hear conversation from people on your left and right. It’s tiring to continually turn yourself around and point your ‘good ear’ at people.
From a safety perspective, being able to identify – in a fraction of a second – the sound of an approaching vehicle can make the difference between staying on the kerb or going to hospital! And in a driving scenario, it's also true that wearing two hearing aids will keep you better ‘in tune’ with your environment and the traffic around you.
A common complaint that we at Hearing Direct hear from customers is that "Everything sounds too loud!" Now this is especially true when people are first getting used to wearing hearing aids – there’s a period of adjustment where the natural temptation is to turn everything up to 11 to ensure maximum benefit. And with just one hearing aid, there’s often an even greater temptation to turn up the volume to an uncomfortably high level in order to compensate.
Within a couple of days though, customers usually get the hang of using just enough volume to make the difference to their hearing without giving themselves a decibel-related headache.
By replicating the body’s natural design with two hearing aids rather than one, there’s even less reason to turn up the volume because you’re inputting twice the amount of signal; so you can keep them both at a lower volume and still hear adequately.
Hearing aids are frequently recommended to relieve the ringing in the ear associated with tinnitus, and they work extremely well for many tinnitus sufferers. However – and, yes, it sounds obvious –if you choose to limit yourself to one hearing aid, the ringing in the unaided ear may continue unchanged, and that’s a wasted opportunity to enjoy a world of relief.
Audiograms present our ability to hear plotted on a graph. You can obtain an audiogram by completing a hearing test. These graphed results reveal how well people responded to sounds and can be used to identify hearing loss.
There are a number of different diagnostic procedures and tests available to hearing healthcare professionals to measure hearing competency. Pure-tone audiometry is by far the most common method. This guide aims to help you understand hearing test results obtained from audiometry - these results are usually shown in the form of an audiogram.
If you would like to send us your audiogram, we would be delighted to review it with you, talk through what it may mean and of course, advise as to whether our range of hearing aids may be suitable.
Please click here to upload a copy of your audiogram and send it to us. Alternatively, you can scan it and email it to us at: audiology@hearingdirect.com
An audiogram graphically represents how individuals responded to a series of calibrated sounds which are produced by an audiometer; usually via headphones. The person being tested is asked to push a response button or raise their hand every time they think a sound is played.
Each ear is tested separately. The first aim of the test procedure is to determine the hearing thresholds for the different tones or frequencies. A threshold refers to the softest decibel level (volume) of a frequency required for a reliable response from the individual; i.e. the softest sound they are able to hear. The frequencies tested are within the range of 250Hz (low) through to 8000Hz (high). One of the main reasons for this is that this 250-8000Hz range covers the frequencies of human speech production. Some audiometers are however capable of producing much higher tones, but are not commonly used in standard audiometry.
Once the test is complete, the results get plotted onto a graph to reveal insights into our level of hearing. It is worth noting that some people with very similar audiograms can "hear" quite differently. While an audiogram can help explain much of the auditory behaviour of a person, it does not explain it all. There are other dimensions to auditory experiences that cannot be explained by the audiogram. Still, the audiogram is a good place to begin when trying to understand someone's hearing difficulties.
Your audiogram may look like this, where each ear is shown on a separate graph. This is an example of the right ear:
Or where both ears are combined into one graph, it can look like this:
First the fundamentals: Frequency (or pitch) is depicted on the horizontal axis, from low frequencies on the left (250 Hz) to high frequencies on the right (8000 Hz). The amount of hearing loss is shown on the vertical axis with the higher numbers indicating a greater degree of hearing loss. If the results are shown in colour, red is used for the right ear; and blue for the left.
The symbols used are circles for the right ear and crosses for the left. A mark on the graph thus shows a measure of the person’s hearing threshold at this frequency; i.e., the loudness (intensity) point where the sound is just audible. Thresholds from 0 to 20 dBHL (decibel Hearing Level) are considered to be within the normal hearing range for adults. After that point, people will usually begin to display some communication difficulties because of the elevated hearing thresholds. The higher the number, the greater the impact of the hearing loss.
It is important to be familiar with the details of your audiogram so changes over time may be tracked. Hearing loss, particularly adult-onset hearing losses, may get gradually worse (anybody experiencing rapid changes in their auditory thresholds should check with their GP as soon as possible).
The circles and crosses for the right and left ears are referred to as air-conduction thresholds. They measure how an individual hears when the sound is presented via headphones or foam ear-inserts. The sound has travelled through the whole of the auditory system; from the air in/around the outer ear, through the middle ear and into the inner ear where it is transmitted to the brain via the nerve fibres. This determines the overall look of the audiogram.
In order to rule out any potential problems in the outer or middle ears, bone conduction testing may also be done as part of standard pure-tone audiometry. Here, the pure tones are not transmitted via headphones, but via a transducer that is put directly onto what is known as the mastoid bone – which is the bone you can feel just behind your ear. The inner ear is stimulated directly. The same frequencies are tested with the same procedure (respond to the softest level you can hear); and then plotted on the audiogram as bone-conduction results. If there is a significant difference between the air conduction and bone conduction results; it will alert the tester to a potential problem in the outer or middle ears. Bone conduction results are indicated by arrows or brackets on the audiogram.
Uncomfortable loudness testing may also be done as part of audiometry. This is to check a person’s range of hearing ability in terms of loudness. UCL or ULL measurements are indicated by the 'L' type symbols; and should occur towards the bottom of the audiogram. The difference between the thresholds and ULLs is referred to as the 'dynamic range' of hearing; and can be useful when a hearing aid is considered.
Once all the frequencies have been tested; a hearing loss, if present, can be described in terms of its degree; shape, and type.
The degree of loss is usually one of the following:
The 100dB point should not be confused with a 100 percent hearing loss, (or a total lack of hearing). Hearing sensations do continue past this point, with some audiometers able to produce loudness levels up to 120dB.
The shape of hearing loss refers to the way the different thresholds follow on from each other. The audiogram in our example shows a sloping loss – meaning the thresholds gradually slope down as the frequencies get higher. Other terms could be:
Type usually refers to the suggested cause of the hearing loss. This may be described as 'sensorineural' or 'conductive'.
Sensorineural implies the cause of the loss is due to damage within the inner ear – either the cochlea or nerve fibres. This is usually the case in age-related hearing loss.This condition is classed as a permanent hearing loss and it irreversible, often requiring digital hearing aids to properly manage the impairment. Conductive loss refers to the hearing loss being caused by a problem in the middle ear or outer ear (e.g. perforated ear drum or middle ear infection). 'Mixed' losses can be a combination of both conductive and sensorineural elements. E.g. where a person with age-related hearing loss has a perforated ear drum. Conductive hearing loss is more often temporary than a permanent affair.
If the ears are different in terms of degree; shape or type, they are described separately. If they are similar, the loss is usually referred to as 'bilateral'.
Having completed hearing tests, visited hearing care professionals, and reviewed audiograms, you may need to take further action if hearing loss is present. The next steps may include hearing aids.
Digital hearing aids can bridge the gap between a hearing impairment and one's ability to enjoy the sounds they love. Many devices can be preprogrammed based on audiogram results so the hearing aid matches your hearing needs. Depending on the severity, certain instruments may be more valuable than others. For example, those with a more severe degree of loss may require more features on their device to manage their impairment. Alternatively, amplified phones and other extra loud items can help with the day-to-day antics and improve the quality of life for the hard of hearing.