Wellbeing / 04 Aug, 2020

Audiometry explained

Dr Lau Pik Onn

What is audiometry?

Audiometry is a basic hearing test that helps to measure the softest sound a person can hear at different sound frequencies. It is performed to evaluate your hearing and determine if there is any hearing loss.

Hearing loss can be gradual and can affect one or both ears. It is highly recommended to have your ears checked if you experience one or more of the following symptoms:

  • Family members complaining that your TV volume is too loud
  • Frequently asking others to repeat themselves
  • Speaking louder than normal
  • Giving wrong answers because you misunderstood the questions
  • Difficulty in holding a normal conversation, especially against background noise
  • Ringing in the ears (tinnitus)
  • Earache or discharge from the ear due to infections

How is audiometry carried out?

This test can be done as part of our health check-up at Icon Health Screening.

It is a painless and non-invasive test and takes about 10 to 20 minutes to complete. The test will be carried out seated in the sound booth. During the test, you will wear a headset and hear a range of sounds and beeps at different intensity and tones.

When a sound is heard, you need to respond by pressing a button. This will assess your hearing across the sound spectrum. The softest sound that you can hear will be marked on the graph called an audiogram which will then be reviewed by the doctor.

How common is hearing loss and what are the causes?

Hearing loss refers to reduced hearing that results from a problem in one or both ears and can affect people of all ages. It usually develops gradually over the years and you may not realise it until damage is done. A study conducted by Singapore’s Ministry of Health in 2010 found that almost 10% of Singaporeans in their 60s suffer from disabling hearing loss. Hearing loss that occurs gradually as you age (presbycusis) is common.

Conductive hearing loss

This happens when sound waves cannot be transmitted properly from the external environment to the cochlea (a sense organ that translates sound into nerve impulses which is sent to the brain). This could be due to a problem in the external ear canal, ear drum, middle ear bones or middle ear space such as:

  • Obstruction in the external ear canal – from ear wax, foreign body or infection (otitis externa)
  • Perforated ear drum – as a result of trauma or chronic infection
  • Dislocated/damaged ossicles – from trauma/ chronic disease
  • Otitis media – middle ear infection

Sensorineural hearing loss

This happens when there is damage to the cochlea or the hearing nerve (auditory nerve). This is the most common type of hearing loss in 9 out of 10 people with hearing loss. Sensorineural hearing loss can occur from:

  • Ageing (presbycusis)
  • Acute/chronic exposure to loud noise
  • Infection in the inner ear from viruses and bacteria, e.g. mumps, measles, influenza
  • Meniere’s disease, a disease that causes tinnitus, hearing loss and dizziness
  • Acoustic neuroma, a tumour of the vestibular nerve
  • Ototoxic drugs, certain antibiotics or cancer drugs

Mixed hearing loss

This a combination of both conductive and sensorineural hearing loss.

How does hearing loss affect people?

Hearing loss has been found to negatively impact a person’s quality of life and mental state, especially in the elderly. Dementia has now been suggested in many studies to be aggravated by hearing loss.

If you have difficulty understanding others due to hearing loss, this may increase your anxiety levels and lead to depression and social isolation.

It is important for seniors (anyone aged 60 and above) to screen for hearing loss, as this can lead to:

  • Communication breakdown – When you can’t hear well others may raise their voices impatiently, which can lead to misunderstanding and tension in the family
  • Social isolation and depression – Difficulty in hearing may lead seniors to avoid social activities that could otherwise engage them mentally and emotionally. This will than lead to social isolation and depression. This may also impact them physically as they will stop going out.

Can hearing loss be prevented?

You are at greater risk of hearing loss due to the following reasons:

  • Aging – degeneration of inner ear structures over time
  • Loud noise – exposure to loud sounds can damage the cells of your inner ear. This can occur with long term exposure to loud noises or from a short blast of noise, such as a gunshot
  • Hereditary
  • Occupational noise – such as where loud noise is part of working environment (e.g. construction or in a factory)
  • Recreational noises – exposure to high noise levels from listening to loud music or carpentry
  • Some medications (e.g. antibiotic gentamicin, certain chemotherapy drugs)
  • Some illnesses (e.g. meningitis)

There are many preventive measures you should consider taking, such as:

  • Protecting your ears – Use safety equipment if you work in areas with loud noises (e.g. construction, heavy machinery) and wear ear plugs when swimming. Decreasing the duration and intensity of exposure to noise is your best protection.
  • Go for regular hearing tests
  • Avoid prolonged exposure to loud noise or music – Noise induced hearing loss is irreversible and progresses with each exposure
  • Seek help for ear infections

Treatment and management

Treatment and corrective measures for hearing loss will depend on the underlying problem and the severity.

Medical treatment

  • If hearing loss is due to obstruction by ear wax or a foreign body, an ENT specialist can remove this and hearing should be restored
  • In the case of an infection, antibiotics will be prescribed
  • For hearing loss caused by perforation of the ear drum, this can be repaired surgically
  • If hearing loss is caused by medications, the medications will be stopped or changed
  • If hearing loss is caused by aging, there is no cure. Treatment is focused on protecting your hearing as much as possible and slowing down further loss by going for regular checks

Hearing aids

  • Hearing aids are amplification devices that detect environmental sounds and amplify them into the external ear canal
  • Modern aids can range from very small devices that sit completely in the canal to traditional hearing aids which sit behind the ear
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