Mercy Audiologist, Rachel Raphael, Explains Testing for Hearing Loss

November 12, 2020
McAuley Plaza recently reached out with questions about testing for hearing loss, what patients can learn from testing, and other questions. Rachel Raphael, a practicing audiologist with Mercy otolaryngologist Dr. Alan Oshinsky, offered her insights. 

Since I am a practicing Audiologist for an ENT practice (32 years with Alan E. Oshinsky, M.D., P.A. at Mercy Medical Center in Baltimore, MD), I can certainly answer some of these questions. Contact me should you have any questions or need for clarification.   

Most common tests for hearing loss (after a physical exam of the ears to determine treatable conditions such as cerumen, inflammation, fluid or infections, etc.): 

Tuning fork tests are a quick and simple test usually done by the ENT (Ear Nose and Throat doctor or Otolaryngologist) to roughly access conductive (middle ear) versus sensorineural (inner ear) hearing loss, and which ear. 

The Audiologist performs the more comprehensive Audiometric Evaluation, usually in a sound proof booth, with equipment that has been calibrated annually. This usually includes Immittance testing (tympanometry for middle ear assessment, sometimes middle ear acoustic reflex testing), Air and Bone conduction testing, speech threshold and speech discrimination testing.  Using proper masking techniques, air-bone gaps can determine type of hearing loss (conductive, sensorineural, or mixed), while air conducted thresholds determine the degree or severity and frequencies of the loss. A high frequency loss is most often associated with age-related and noise induced hearing losses, while low frequency hearing losses are often conductive (middle ear based, with possible etiology of Otosclerosis, or may be sensorineural as in the case of Meniiere’s disease.  Since tinnitus (“ringing”, “humming”, ”buzzing”, etc. in the ears) often accompanies hearing loss, sometimes a subjective tinnitus frequency (pitch) match is also attempted.   

In cases of asymmetric sensorineural hearing loss, often with asymmetric tinnitus,  special testing should be done (such as MRI of the internal auditory canal) to rule out benign auditory acoustic tumors.  In cases of sudden onset sensorineural hearing loss, diagnosis and treatment should be immediate, for best results.   

Testing procedures are modified to test children and infants, such as behavioral testing or play audiometry. Often non-behavioral testing  such as Brainstem Auditory Evoked Response (BAER testing) and/or Otoacoustic Emissions testing (OAE’s) can be performed on non-cooperative populations, and can even be done by specialists while patient is under sedation to obtain rough hearing loss diagnosis. Newborn hearing screening will also identify the possibility of genetic or other hearing loss (useful but often with a false positive response).   

Genetic testing for hearing loss can identify the genetic mutations most commonly linked to hereditary/ congenital hearing loss. It should be performed in cases of sensorineural hearing loss of unknown etiology, or where a family history exists.  I am not an expert on this topic, but know of many syndromes (Waardenburg’s, Usher’s, Alport, etc.) with possible associated sensorineural hearing loss, that should be monitored.   

Rachel A. Raphael, M.A., CCC-A, Audiologist, Mercy Medical Center



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About Mercy

Founded in 1874 in downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed acute care university-affiliated teaching hospital. Mercy has been recognized as a top Maryland hospital by U.S. News & World Report; a Top 100 hospital for Women’s Health & Orthopedics by Healthgrades; is currently A-rated for Hospital Safety (Leapfrog Group), and is recognized by the American Nurses Credentialing Center as a Magnet Hospital. Mercy Medical Center is part of Mercy Health Services (MHS), the parent of Mercy’s primary care and specialty care physician enterprise, known as Mercy Personal Physicians, which employs more than 200 providers with locations in Baltimore, Lutherville, Overlea, Glen Burnie, Columbia and Reisterstown. For more information about Mercy, visit, MDMercyMedia on FacebookTwitter, or call 1-800-MD-Mercy.

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