What This Guide Covers
This article explains what each common hearing test measures, what normal results look like, and how to interpret what your results mean for real-world situations. If you want to learn specifically how to read your audiogram (the graph with X's and O's), check out our detailed audiogram reading guide.
The Gap Between Numbers and Real Life
Your audiologist hands you a sheet of paper covered in numbers, percentages, and that graph with X's and O's. They say things like "mild sensorineural loss" and "speech discrimination at 88 percent." You nod along, but inside you're thinking: "What does any of this actually mean?"
Here's the disconnect: hearing test results are presented as clinical data, but what you really want to know is what they mean for your actual life. Will you be able to hear your grandchildren? Can you still go to restaurants? Is this why phone calls are so exhausting?
This guide bridges that gap. Let's break down what each test measures and translate those numbers into real-world impact.
Pure Tone Audiometry: The Foundation
The pure tone test—where you listened to beeps at different pitches and volumes—forms the foundation of your hearing assessment. This is what creates your audiogram, the graph showing your hearing thresholds.
What the Numbers Mean
The results are measured in decibels (dB HL—Hearing Level). Here's how the degrees of hearing loss translate:
| Decibel Range | Classification | What It Means in Daily Life |
|---|---|---|
| -10 to 15 dB | Normal | You can hear whispers, soft sounds like leaves rustling, and quiet conversations without difficulty. |
| 16 to 25 dB | Slight | You might miss some soft speech sounds. Background noise starts becoming noticeable. |
| 26 to 40 dB | Mild | You miss parts of conversations in noisy environments. Phone calls may require more concentration. Distant speech is difficult. |
| 41 to 55 dB | Moderate | You need people to speak louder. Group conversations are challenging. TV volume is noticeably higher than others prefer. |
| 56 to 70 dB | Moderately Severe | Even one-on-one conversations require raised voices. You rely heavily on lipreading. Hearing aids become very helpful. |
| 71 to 90 dB | Severe | You can only hear very loud sounds without amplification. Communication is very difficult without hearing aids or other devices. |
| 91+ dB | Profound | You may only hear extremely loud sounds. Hearing aids provide limited benefit; cochlear implants may be appropriate. |
Frequency Matters: Why Pattern Is Important
Where you have hearing loss matters as much as how much you have. The most common patterns include:
High-Frequency Loss (Ski-Slope Pattern): Good hearing for low pitches, drops off in high pitches. This makes it hard to hear consonants like "s," "f," and "th," which carry critical information for understanding speech. Women's and children's voices become especially difficult because they're naturally higher-pitched.
Low-Frequency Loss (Reverse-Slope Pattern): Rare. Affects vowels and men's voices more than high-pitched sounds. Background noise becomes overwhelming because you can't hear the low-frequency rumble that normal-hearing people naturally tune out.
Flat Pattern: Similar loss across all frequencies. Sounds are quieter overall but not necessarily distorted. Often easier to fit with hearing aids because all frequencies need similar amplification.
Cookie-Bite Pattern: Good hearing for very low and very high pitches, but loss in the middle frequencies where most speech occurs. Makes conversations frustrating because you catch some words but miss others unpredictably.
Speech Audiometry: Understanding Words
The pure tone test tells you what sounds you can detect, but detecting sound isn't the same as understanding speech. Speech audiometry measures how well you actually understand words.
Speech Reception Threshold (SRT)
This measures the softest level at which you can repeat simple two-syllable words correctly 50% of the time. It should match your pure tone average—if it doesn't, that's a red flag that needs investigation.
Word Recognition Score (WRS) / Speech Discrimination
This is the percentage of words you correctly understood when presented at a comfortable loudness level. This number is crucial because it predicts how well hearing aids might help you.
| Score Range | Category | What It Means |
|---|---|---|
| 90-100% | Excellent | You understand almost everything when it's loud enough. Hearing aids should provide excellent benefit. |
| 75-90% | Good | You miss some words but follow conversations well. Hearing aids should help significantly. |
| 60-75% | Fair | You miss enough words that conversations are effortful. Hearing aids help but communication remains challenging in complex situations. |
| Below 60% | Poor | Even when sounds are loud enough, you struggle to understand words. Hearing aids may provide limited benefit; cochlear implants may be considered. |
Critical Distinction: Hearing vs. Understanding
You can have good hearing thresholds (can detect soft sounds) but poor word recognition (can't understand what you hear). This often indicates damage to the inner ear or auditory processing issues. It's also why two people with the same audiogram might have very different experiences—one understands speech well, the other doesn't.
Tympanometry: Middle Ear Function
The pressure test (tympanometry) doesn't measure hearing directly—it checks how well your middle ear is working. The results come as a graph called a tympanogram, classified by letter types.
Type A: Normal
Your eardrum moves normally in response to pressure changes. This indicates good middle ear function. If you have hearing loss with a Type A tympanogram, the problem is likely in your inner ear or auditory nerve.
Type B: Flat
Your eardrum barely moves. This suggests fluid in the middle ear, a perforated eardrum, or earwax blocking the ear canal. This type usually needs medical attention before considering hearing aids.
Type C: Negative Pressure
Your eardrum moves but with reduced mobility, indicating negative pressure in your middle ear. Common with Eustachian tube problems or mild fluid buildup. May resolve on its own or need medical treatment.
Type As: Shallow
Your eardrum moves but less than normal, suggesting it's stiffer than it should be. Can indicate otosclerosis (bone growth) or scarring from previous infections.
Type Ad: Deep/Hypermobile
Your eardrum moves more than normal, possibly indicating a thin or flaccid eardrum or disruption of the middle ear bones.
When Abnormal Tympanometry Matters
If your tympanometry is abnormal (anything other than Type A), your audiologist should either refer you to a physician or retest after any ear issues are resolved. Hearing aids fitted on top of untreated middle ear problems often don't work well and can mask treatable conditions.
Acoustic Reflex Testing: Protective Mechanisms
This test measures whether your ear's protective reflex—a muscle contraction in response to loud sounds—is working properly. Results are recorded as either "present" or "absent" at specific volumes.
What Normal Looks Like
Reflexes should be present at 70-100 dB for pure tones. If you have significant hearing loss, reflexes may be present at elevated levels or absent entirely.
What Abnormal Results Suggest
- Absent reflexes with normal hearing: May indicate nerve pathway problems (rare but worth investigating)
- Present reflexes at very low levels: May suggest otosclerosis or other middle ear issues
- Absent reflexes with hearing loss: Usually expected with significant sensorineural hearing loss
- Reflex decay (weakening during sustained sound): May indicate auditory nerve problems requiring additional testing
Otoacoustic Emissions (OAE): Inner Ear Function
This test measures sounds your inner ear produces in response to clicks or tones. It's testing whether the hair cells in your cochlea are functioning.
What Absent OAEs Mean
If OAEs are absent or you "fail" the test, it indicates outer hair cell damage or dysfunction. This is common with sensorineural hearing loss and helps confirm that the hearing loss originates in the inner ear rather than the middle ear or nerve pathways.
Absent OAEs with normal hearing thresholds may warrant monitoring, as it can indicate early cochlear changes not yet affecting hearing.
Putting It All Together: What Your Results Mean
Your audiologist considers all test results together to determine:
Type of Hearing Loss:
- Sensorineural: Inner ear or nerve damage. Permanent. Treated with hearing aids or cochlear implants.
- Conductive: Middle or outer ear problem. Often treatable medically or surgically.
- Mixed: Combination of both types. May need medical treatment plus hearing aids.
Candidacy for Treatment:
- Good word recognition scores (70%+): Excellent hearing aid candidate
- Poor word recognition with severe loss: May be cochlear implant candidate
- Asymmetric loss (one ear much worse): May need specialized fitting approach
- Abnormal middle ear function: Needs medical evaluation before amplification
Expected Real-World Impact:
- Mild high-frequency loss: Difficulty in noise, with women/children
- Moderate loss: Needs amplification for comfortable conversation
- Severe loss: Significant communication barriers without technology
- Asymmetric loss: Difficulty localizing sounds, understanding in noise
Questions to Ask About Your Results
When reviewing your results with your audiologist, consider asking:
- "What type of hearing loss do I have, and what caused it?" Understanding the source helps you know what to expect going forward.
- "How does my hearing loss pattern affect what I hear in daily life?" Connect the numbers to real-world situations.
- "Are my results symmetric, or is one ear better than the other?" This affects treatment recommendations.
- "What do my word recognition scores tell you about how hearing aids might help me?" This predicts realistic expectations for treatment.
- "Is my hearing loss likely to stay stable, improve, or worsen?" Know what to watch for and when to return for retesting.
- "Do any of my results warrant seeing a physician?" Rule out medical issues that need treatment beyond hearing aids.
- "How do my results compare to my last test?" If you've been tested before, understand if things have changed.
Next Steps
If you want to learn how to read the audiogram graph specifically—understanding what those X's, O's, and lines mean—check out our guide on how to read your audiogram. And if you're wondering what treatment options are appropriate based on your results, our treatment comparison guide can help you understand your options.
The Bottom Line
Hearing test results are tools—they help you and your audiologist understand what's happening with your hearing and make informed decisions about next steps. But numbers alone don't tell your story.
The most important questions aren't "What's my hearing level?" but rather "What does this mean for my life?" and "What can we do about it?" A good audiologist translates clinical data into practical guidance tailored to your specific needs and lifestyle.
Understanding your results empowers you to participate actively in your hearing healthcare decisions rather than just following recommendations you don't fully understand. The more you know about what your results mean, the better equipped you are to advocate for yourself and choose the path forward that makes sense for you.
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