Monthly Archives: January 2013

The Hearing Tests, part two

Glen Sutherland, MCIs

HAPPY NEW YEAR! I hope you had a delightful Holiday Season. Here’s to a wonderful year ahead!

In previous posts I have explained some of the tests that you should expect to experience during your first hearing assessment appointment. So far, I have reviewed otoscopy, impedance and puretone testing. Following is a short review of each of these tests but for more detailed information, read my previous posts. Just click on the category “Thoughts from an Audiologist” to the right of the screen on Rosemary’s blog, Read My Lips.

During the otoscopic examination, the clinician checks the outer part of the ear (the part you can see at the sides of your head) to make sure everything looks okay. Then s/he looks down the ear canal to make sure it is clear to proceed with the hearing test.

Impedance testing includes a series of tests that help the clinician determine if the middle ear is working properly or not and if the ear is able to transmit the sound waves through the middle ear into the inner ear.

Perhaps the most familiar hearing test to our readers is the puretone test or “the test where you hear the beeps and you raise your hand or push a button or say ‘beep’ every time you hear a beep”. The puretone test determines your ‘threshold of hearing’ or the lowest level where you just barely hear sounds (the beeps). The clinician records the softest level that you hear on a graph called an audiogram. S/he will be able to compare your hearing graph to a graph of normal hearing to determine your degree of hearing loss.

In addition to the tests I have just reviewed, typically most clinicians conduct a series of speech tests to determine how well you perceive speech, where you find speech comfortable to listen to and where you find speech uncomfortable. These tests include the Most Comfortable Listening test, the Uncomfortable Listening test, the Speech Reception Threshold test and the Word Discrimination test.

The Most Comfortable Listening Test (MCL):

The MCL test determines the loudness at which you prefer to listen to speech. The clinician will talk to you through the audiometer, ask you some questions or have you listen to a poem or a story while the level of the sound is raised and lowered. As you listen, you indicate to the clinician the level when the sound is comfortable to hear. The clinician will record the level at which speech is easy and comfortable for you to hear and understand speech.

The Most Uncomfortable Listening Test (UCL):

The UCL test indicates the loudest level at which you can stand to listen to sound. As the name would suggest, the sound is uncomfortable and anything above that level would approach being painful. The clinician will talk to you through the audiometer, ask you some questions and have you listen to a poem or a story while the level of the sound is slowly increased. As you listen, you determine when the sound is uncomfortable to hear, much too loud! The clinician will record the level that you indicate.

The Speech Reception Threshold Test (SRT):

The SRT determines the threshold of your hearing for speech; that is to say, the lowest level that you can hear two-syllable words 50% of the time. The clinician will acquaint you with some two-syllable words: airplane, iceberg, baseball, etc. Once you know the words that the clinician will say, the clinician will repeat the words through the audiometer and make them softer and softer. You will repeat the words as long as you can hear them. The clinician will record the softest sound for speech on the audiogram.

The Word Discrimination Score (WDS):

The WDS is the percentage of words that you can repeat accurately from a list, typically presented at your most comfortable listening level (MCL). The clinician presents the words at one level and you repeat back the word that you hear. The clinician records which words you repeat correctly and which words you repeat incorrectly and calculates the percentage of correctly repeated words and records that score as your WDS. This test can be completed for each ear and then binaurally (the speech going into both ears at the same time).

These tests, in addition to the tests which have been explained in my last few posts, form the battery of tests used to assess your hearing. Once the hearing assessment is completed, the clinician should review the results with you, thoroughly explaining what they mean and the implications of the results to you. Depending on the outcome of the results, the clinician will make suggestions and recommendations about what you should do next. For example, the clinician may recommend that you see your doctor for a referral to an Ear, Nose and Throat (ENT) specialist or you may be ready to get hearing aids. The results of the hearing assessment will help your clinician guide you in the direction you need to go!

Please note that the information in this blog is presented for the purpose of providing information and should not be used for medical diagnosis or treatment nor should it be used in place of medical advice from your doctor or hearing health care professional.


One piece of advice everyone gave me when I was first approved for a cochlear implant was to hold those expectations in check. So I tried. But I kept exceeding them. I thought I would just hear sounds when my implant was first activated. I actually heard words. I was told that even single notes of music would not sound anything like real music for quite some time. I heard the notes to Twinkle Twinkle Little Star barely four weeks into my new hearing life. Hearing on the telephone using my implant would also take a fairly long time to accomplish, so I was told. Just four months after the initial activation, I now have ten-minute conversations with family and friends – albeit only those that speak pretty clearly – on a whole range of topics. And my hearing tests at the third month showed a marked improvement in my ability to understand language using my hearing-aided ear and my implant together. The implant was really making a difference. I was off to the races!

Well, not quite.

I know that a number of you who read my blog do so out of interest and I am very glad you do. But this post is most particularly for others like me – those who are going to have cochlear implant surgery or are perhaps in the first exciting month or so after activation.

Don’t count your chickens before they are hatched!

One particular aspect of my life that I had to pretty much give up as my hearing worsened was doing things in a group. I just could not manage and when I tried, the fatigue of trying to hear was overwhelming.

I have one group of friends that get together for lunch at one of our homes twice a year. We have been doing this for more years than I care to count and, as many live out of town, these lunches are our way of keeping up with one another. I have not been able to join them for more than five years and miss our conversations immensely. Emails just don’t cut it. Our January luncheon was fast approaching and as some of the group could not manage the trip, resulting in a smaller get-together than usual, I thought I might have a go. While I wouldn’t try to stay for the whole afternoon, I could surely manage an hour. So I went, loved seeing everyone and 30 minutes in felt my entire body slump. Thirty minutes! Only six people including me! But it was too much. I had to leave. Back to the drawing board.

One of my friends from this particular lunch group said to me afterwards, “I think we all probably unintentionally set you up to think that the implant would be an instant fix which of course you knew wouldn’t be the case. But it may have made you also expect to get further, faster than was realistic.” I think she is right. I will get there. It just might take a little longer than I thought.

Now even with setbacks, there are unexpected moves forward. The Twinkle Twinkle Little Star song that I heard a few months ago featured all the notes but they sounded fuzzy and were an octave lower than they should have been. Yesterday I was dusting the piano. I clearly heard all but the very highest and lowest notes sounding just as they are supposed to sound. Music to my ears!

When to tell a stranger that your companion is deaf

A few weeks ago I was introduced as someone who is deaf. I was taken aback and so was the person introduced to me. It was a very awkward moment, at least for two of us and for a second neither of us knew what to do. I got to thinking about introductions and the best time to tell others that your companion is deaf.

The short answer, unless you have agreed to this approach ahead of time, is you don’t! It is a better idea to let the person with the hearing loss share this information. As I now have a cochlear implant, I love telling people about it but I want to be the one to do it.

I was in my thirties before I was comfortable telling strangers early in the introduction stage that I had a hearing loss. Situations like the one described above were extremely uncomfortable for me. Introducing someone by announcing that they are deaf removes the choice from the person with a hearing loss. It can also be misleading. I remember just a few years ago someone introducing me as a person with ‘a little hearing loss’. I think she was trying to be kind but I don’t have a ‘little’ hearing loss. I am REALLY deaf!

Another reason for not leaping in with this information is, inadvertently or not, you immediately label the person and with a characteristic that is only a part of who she or he is. We are much more than our hearing loss. It should not be the primary identifier.

We generally know not only how best to describe our deafness but of greater importance, what helps. “Speak up” doesn’t always work, especially for good lip readers. Sometimes when others speak more loudly, their mouths become distorted and it is more difficult to lip read as a result. For me, speaking without covering your mouth and using your normal tone of voice is much better. I will let you know if I need help and what help I need.

The key issues here are clarity of message and choice. If the person you are with prefers that you explain to others that he or she can’t hear, that’s good. Otherwise, let us do the talking.