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Hearing tests for older people and those with dementia

What happens in a hearing test

Hearing specialists recommend that once we reach the age of 55 we should have a hearing test every three years, and every ten years below that age. An early check provides a base line against which they can measure any degradation in our hearing as we age.

Most people do lose some level of hearing in their later years, but for many visiting an audiologist will be a new experience. It’s helpful to know what you and your parent can expect from a hearing test, so that anxiety can be kept to a low level. It’s particularly useful to know how the process will work if you’re accompanying someone with cognitive impairment or dementia, who may need reassurance.

What happens during a hearing test?

Whether it’s you or your parent that is having the test, the first thing the hearing specialist should do is ask some questions about any concerns or problems you are experiencing with your hearing.

After a series of tests, you’ll have a discussion with your specialist about whether a hearing aid is going to make a positive difference. If it looks likely, you can discuss options and even start the fitting process. Alternatively of course you can go home and think about what you would like to do.

How long does a hearing test take?

Depending on the number of tests you or your parent undergoes, the tests could take from just a few minutes to around half an hour. If you factor in discussion time, then the total appointment may take as long as an hour.

What should we bring to the appointment?

If you’ve had a hearing test before elsewhere, then any history you can bring would be very useful.

Other than that, it would be a good idea to bring any relevant medical records, such as any otolaryngic (ear, nose, or throat) procedures you’ve had, and the names of any medication you’re taking. That means all medications, as some can affect the health of your ears.

The specialist may ask about lifestyle choices too. While it may feel intrusive, it could be to your benefit if you answer truthfully questions about alcohol and smoking, for example.

What kinds of hearing tests are there?

If a quick initial test suggests that you or your parent does have some hearing loss, then there are a number of different tests that the hearing specialist can perform to find out more.

This set of air, bone, and speech testing is known as an audiogram.

  • Otoscopy. This simple test involves looking into the ear canal to check whether there are any obstructions or abnormalities.
  • Air conduction audiometry. The patient sits in a soundproof booth (if one is available) wearing headphones. Beeps of varying intensity and frequency are played into one ear at a time, and the patient responds by pressing a button when they can hear them. This tests the hearing threshold of the patient at each frequency, to determine the severity and nature of the patient’s hearing loss.
  • Bone conduction audiometry. This is very similar to the air conduction test, but it’s undertaken with the patient wearing a headband with a pad on the bone behind their ear (the mastoid bone). The two tests together can determine whether the patient’s hearing loss is conductive, mixed, or sensorineural loss.

The final test, based on how well speech is heard, can be carried out in three different ways:

  • Speech reception threshold. The patient is asked to repeat words of varying loudness, presented to one ear at a time. This measures their speech threshold level in each ear.
  • Word recognition testing/speech discrimination testing. This is much the same as the speech reception threshold test, but this time with white noise being played in the opposite ear. This test helps the hearing specialist look at the patient’s speech-processing ability – the connection between what their ears hear and what their brain understands.
  • Speech-in-noise testing. The patient repeats sentences they hear with varying degrees of background noise. This helps the specialist determine their ability to process speech in the presence of external distractions.

The specialist may decide to carry out further tests, which could include:

  • Tympanometry. The specialist inserts a plastic probe into the ear canal to measure the canal’s volume and the eardrum’s response.
  • Acoustic reflex testing/acoustic reflex decay testing. Using the same plastic probe used during tympanometry testing, the specialist adds a loud beeping noise to the procedure. This test checks the status of the acoustic nerve.

Hearing tests for those with cognitive impairment or dementia

Tests for older people will generally follow this process, but might differ slightly for patients with significant dementia or cognitive impairment.

In these cases, the audiogram can be a bit trickier to reliably measure, and the patient might need to be re-instructed on the rules of the test and how they should respond. This makes the tests a bit more hands-on than they would be otherwise, but mechanically they remain unchanged.

The hearing professional needs to be flexible when testing a patient with cognitive impairment or dementia.

If the patient is having difficulty understanding or remembering the instructions for the test, the test will need to be modified to get reliable responses. For example, if the patient is having trouble pushing a button when they hear the beep sound, perhaps they can try raising their hand, or saying “yes” out loud when they hear the sound instead.

A response that will keep the patient engaged and comfortable with the task should be used. The professional needs to be willing to give the patient extra time to complete the hearing exam.

Image by Mary Theresa McLean from Pixabay

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