Component	Description	Comments
Hearing health history	Questions about symptom duration and variability, tinnitus, vertigo, trauma, medical conditions, medications, noise and ototoxin exposure, family history	Often completed via questionnaire
Hearing-focused physical examination	Inspection of external ear and otoscopy	Must exclude cerumen impaction before further testing
Pure tone audiometry	Pure tones presented to one ear at a time via headphones or earbuds, typically in a sound booth	Determines softest level at which each frequency can be heard (pure tone threshold)
Speech reception threshold	Recorded or live speech presented to one ear at a time via headphones or earbuds	Determines softest level at which speech can be heard
Speech discrimination (word recognition score)	Syllables repeated to each ear at volume previously identified as hearable	May identify central processing difficulties not expected based solely on hearing ability
Hearing in noise test	Sentences repeated in quiet and with background noise; competing noise comes from varying directions	Patients with presbycusis typically have more difficulty hearing with background noise; helps predict signal-to-noise ratio that may be needed in hearing aids; directional hearing loss not explained by pure tone thresholds may reflect central auditory processing problem
Immittance audiometry: tympanometry and acoustic reflex	Occlusive probe inserted into canal that generates pressure	Can characterize conductive and sensorineural hearing loss; acoustic reflex decay (contraction of middle ear muscles to decrease transmission of sound, which should occur only with loud sounds) suggests retrocochlear (central nervous system) pathology
Bone conduction	Small bone oscillator placed over mastoid	Used to characterize conductive hearing loss
Auditory evoked potentials (auditory brainstem response)	Click introduced by earphone or headphone; transmission through brainstem to auditory cortex measured by scalp electrodes	Often used for newborn hearing screening
Otoacoustic emissions	Click introduced in ear canal with measurement of emissions from inner ear (cochlea) by microphone	Measures integrity of cochlea and, indirectly, middle ear; can be used for newborn screening; highly sensitive but less specific than auditory evoked potentials