Diagnosing Hearing Loss

NYU Langone physicians and audiologists use comprehensive diagnostic tests to determine the cause, extent, and type of hearing loss that’s causing your symptoms. In addition to a reduced ability to perceive sound, symptoms of hearing loss may include a ringing noise in the ears, called tinnitus; a sense of spinning or dizziness, called vertigo; and pain or pressure in the ear. Damage to the inner ear may affect a person’s balance and sense of spatial awareness, which may increase the risk of falls.

Our experts use a variety of sophisticated tests to examine the outer and inner structures of your ears, as well as evaluate the overall quality of your hearing.

Medical History

Doctors use information about your medical history to help determine the cause of your hearing loss. They ask when your symptoms first appeared, whether hearing loss is in one or both ears, and if your job requires exposure to loud noise. They may also inquire about medications you take and whether hearing loss or other medical conditions, such as frequent ear infections, run in your family.

Physical Exam

A physical exam by a trained otolaryngologist, also called an ear, nose, and throat (ENT) doctor, may reveal structural damage to the ear that causes hearing loss. Our doctors use a handheld device with a light and a small magnifying lens, called an otoscope, to examine the ear canal and eardrum. Doctors may also identify a buildup of earwax or other substances that may be interfering with the efficient operation of the ear.

Your ENT doctor may also use a tuning fork to test your hearing and narrow down the cause of hearing loss. A tuning fork is a slim metal instrument shaped like a “U” that vibrates in a specific frequency when it is struck, producing a consistent sound. During a physical exam, the doctor gently places a vibrating tuning fork against parts of the face, head, and ears, as well as in the air just next to your ears. You then identify where the sound created by the vibration is loudest.

Based on these results, your doctor determines whether your hearing loss is caused by damage to the inner or outer ear, and whether it affects one or both ears.

Hearing Test

NYU Langone audiologists conduct a variety of hearing tests, also called audiometric hearing tests, to further determine the location and nature of hearing loss. A complete hearing test can provide information about the function of your ear canal, the middle ear, the inner ear, and the eighth cranial nerve, which carries sound signals from the inner ear to the brain.

A hearing test at NYU Langone takes place in an onsite suite, where you sit in a special booth wearing headphones. Over the course of 30 to 60 minutes, an audiologist evaluates aspects of your hearing to assess certain functions, such as how well the bones in your ears conduct sound, if the eardrum is working properly, and if the tiny hair cells that act as sensory receptors inside the ear are amplifying sound.

While you’re in the booth, doctors test the upper and lower range of your hearing by playing a variety of tones or spoken words across low, medium, and high frequencies in one or both of your ears. The doctor asks you to raise your hand, press a button, or repeat the words when you hear them in your headphones. Based on your responses, doctors can assess whether you’re experiencing symptoms of conductive hearing loss, sensorineural hearing loss, or mixed hearing loss.

Otoacoustic Emission Testing

If a medical history and physical exam indicate that the cause of hearing loss is likely sensorineural, audiologists may perform otoacoustic emission testing to determine if the inner ear, or cochlea, is damaged.

Audiologists conduct this test by placing a small probe into the ear canal that introduces a combination of sounds. If the cochlea is functioning properly, the small hair cells lining the cochlea send back an echo when stimulated by sound. The small probe used during this test can detect this echo and determine if it is weak or absent, indicating hearing loss.

MRI Scans

If hearing loss affects one ear and not the other, called unilateral hearing loss, and if the results of hearing tests indicate that sensorineural hearing loss may be causing your symptoms, doctors may recommend an MRI scan to visualize the inner ear and surrounding structures.

MRI scans use radio waves and magnetic fields to create detailed images of the inside of the body, including the interior components of the ear. An MRI scan may reveal a growth on the nerve pathway that connects the ear to the brain, such as an acoustic neuroma. These growths can prevent the ear from functioning well and may cause hearing loss.

CT Scans

If the results of hearing tests indicate that conductive hearing loss might be causing your symptoms, doctors may recommend a CT scan to visualize the middle ear in sharp detail.

CT scans use electromagnetic radiation to take a series of X-rays of the interior structures of the ear and create a computerized three-dimensional image. CT scans may reveal damage to the bony components of the ear or an abnormal bone growth in the middle ear, a condition called otosclerosis.