An audiometer and a person wearing headphones to represent pure-tone testing

Understanding Pure-Tone Testing: A Guide for Hearing Health Professionals

As a hearing health professional, you already understand the importance of pure-tone testing as a tool for assessing hearing function in your patients. But do you know everything there is to know about conducting these tests accurately and interpreting the results? In this comprehensive guide, we’ll cover everything from the basics of pure-tone testing to the common challenges you may encounter, and provide solutions to help ensure the most accurate results possible.

The Basics of Pure-Tone Testing

What is Pure-Tone Testing?

Pure-tone testing is a type of hearing assessment that measures a patient’s ability to hear different frequencies of sound. The hearing test measures the quietest sound level that a patient can hear at different frequencies, also known as pure tones. The results of a pure-tone test are presented on an audiogram, which displays the patient’s hearing thresholds for each frequency tested.

During a pure-tone test, the patient will typically sit in a soundproof booth or room to ensure accurate results. The audiologist will then present a series of tones at varying frequencies and volume levels to each ear separately. The patient will indicate each time they hear a tone by raising their hand or pressing a button.

The Importance of Pure-Tone Testing in Hearing Assessments

Pure-tone testing is a crucial part of a comprehensive hearing assessment. It helps determine if a patient is experiencing hearing loss, and if so, the nature and degree of that loss. Accurately identifying and diagnosing hearing loss is critical to determining appropriate treatment options.

For example, if a patient is experiencing hearing loss due to damage to the hair cells in their inner ear, they may benefit from hearing aids or cochlear implants. However, if the hearing loss is due to a blockage in the ear canal, such as earwax buildup, the treatment may simply involve removing the blockage.

Components of a Pure-Tone Test

There are several components that make up a pure-tone test, including the equipment used and the testing process itself. These components include:

  • The audiometer: the machine used to generate and present pure tones at specific frequencies and volume levels.
  • Earphones or headphones: patients will typically wear these during the test, as they allow you to present the sounds directly to the ears.
  • An ambient noise level meter: to measure the noise levels in the testing environment and ensure that they are within an acceptable range.
  • A bone conduction oscillator: this is used to test the patient’s ability to hear sounds transmitted through bone, which can help determine if the hearing loss is conductive or sensorineural in nature.

Overall, pure-tone testing is a safe and non-invasive way to assess a patient’s hearing abilities. It can provide valuable information about the nature and degree of any hearing loss, which can help guide appropriate treatment options and improve the patient’s quality of life.

Preparing for a Pure-Tone Test

Setting Up the Testing Environment

The first step in preparing for a pure-tone test is creating the appropriate environment. This means ensuring that the testing room is free from outside noises and distractions. A soundproof booth is ideal for this purpose, but if one is not available, try to position the audiometer as far away as possible from any noise sources, such as traffic or construction.

It’s important to note that even small amounts of ambient noise can affect the results of a pure-tone test. Therefore, it’s recommended to use a sound level meter to measure the ambient noise level in the testing environment. The ideal ambient noise level for a pure-tone test is below 20 decibels.

Calibrating the Audiometer

The audiometer must be calibrated before each use to ensure accuracy. You should follow the manufacturer’s instructions for calibration, but most audiometers come with a calibration tone that you can use to verify that the machine is functioning correctly. It’s also important to regularly check that the earphones or headphones are working correctly and to verify that the ambient noise level is within acceptable levels.

When calibrating the audiometer, it’s important to use a calibrated sound level meter to ensure that the calibration tone is played at the correct level. The calibration tone should be played at a level of 1,000 Hz and 70 decibels.

Patient Preparation and Instructions

Before beginning the pure-tone test, you should explain to your patient what the test involves and what they should expect. You should also make sure that the patient is comfortable and positioned correctly for the test. This may include adjusting the height or position of the audiometer or chair.

It’s important to note that the results of a pure-tone test can be affected by factors such as the patient’s age, hearing history, and exposure to loud noises. Therefore, it’s important to ask the patient about their hearing history and any exposure to loud noises before beginning the test.

You should also instruct the patient on how to respond to the pure-tone stimuli. This may include using a hand signal or pressing a button when they hear the tone. It’s important to make sure that the patient understands the instructions and is comfortable with the response method before beginning the test.

Overall, preparing for a pure-tone test involves creating a quiet and controlled testing environment, calibrating the audiometer, and providing clear instructions to the patient. By following these steps, you can ensure accurate and reliable test results that can help diagnose hearing loss and other auditory disorders.

Conducting the Pure-Tone Test

Hearing loss is a common condition that affects millions of people worldwide. It can be caused by a variety of factors, including age, noise exposure, genetics, and certain medical conditions. To diagnose hearing loss, healthcare professionals often use a pure-tone test, which measures a patient’s ability to hear different frequencies of sound. Let’s take a closer look at how this test is conducted.

Air Conduction Testing

The first type of pure-tone test is air conduction testing. This test is conducted in a soundproof room, and the patient wears earphones or headphones. The audiologist will play a series of tones at different frequencies, starting at a low pitch and gradually increasing in pitch. The patient will signal when they hear the tone by raising their hand or pressing a button. The audiologist will record the softest sound the patient can hear at each frequency. This information is used to create an audiogram, which is a visual representation of the patient’s hearing thresholds.

Air conduction testing is an important tool for diagnosing hearing loss. It can help determine if the hearing loss is due to damage in the outer, middle, or inner ear. It can also provide information about the severity and type of hearing loss.

Bone Conduction Testing

In addition to air conduction testing, audiologists may also conduct bone conduction testing. This test measures how well sound is transmitted through the bones in the skull. The patient will wear a small device called a bone oscillator that sends vibrations directly to the inner ear, bypassing the outer and middle ear. This test is used to determine if the hearing loss is due to a problem in the outer or middle ear versus the inner ear.

Bone conduction testing can provide valuable information about the type and location of hearing loss. It can also help determine if a patient is a good candidate for hearing aids or other hearing devices.

Masking Techniques

Masking is a technique used to ensure that sounds presented to one ear do not interfere with hearing in the other ear. This may be necessary if there is a significant difference in the hearing thresholds between the two ears. Masking involves presenting a sound to the non-test ear, typically at a level slightly louder than the tone presented to the test ear.

Masking is an important tool for ensuring accurate test results. Without masking, sounds presented to one ear could be heard by the other ear, leading to inaccurate results.

Interpreting the Audiogram

The results of a pure-tone test are represented on an audiogram, which charts the patient’s hearing thresholds for each frequency tested. The audiogram can provide insight into the nature and degree of the patient’s hearing loss. It’s important to interpret the audiogram carefully to determine the appropriate course of action.

For example, if the patient has a hearing loss in the high frequencies, it may be due to noise exposure. In this case, the audiologist may recommend hearing protection or other measures to prevent further damage. If the patient has a hearing loss in the low frequencies, it may be due to a medical condition. In this case, the audiologist may refer the patient to an otolaryngologist for further evaluation.

In conclusion, the pure-tone test is an important tool for diagnosing hearing loss. By measuring a patient’s ability to hear different frequencies of sound, healthcare professionals can determine the type and severity of hearing loss, as well as the appropriate course of action. If you’re experiencing hearing loss or have concerns about your hearing, talk to your healthcare provider about scheduling a pure-tone test.

Common Challenges and Solutions in Pure-Tone Testing

Pure-tone testing is a common hearing evaluation method used by audiologists and other healthcare professionals to assess a patient’s hearing thresholds. While the test is straightforward, there are several challenges that can arise during the testing process. Here are some common challenges and solutions to consider:

Testing Patients with Tinnitus

Tinnitus, or ringing in the ears, can make it difficult for patients to hear the pure tones being presented during the test. This can result in inaccurate hearing threshold measurements. One solution is to use narrowband noise to mask the tinnitus and more accurately determine the patient’s hearing thresholds. Narrowband noise is a type of noise that is centered around the frequency of the patient’s tinnitus. By presenting this noise at a level that is just audible to the patient, the tinnitus can be effectively masked, allowing for more accurate pure-tone testing.

Testing Young Children or Uncooperative Patients

Young children or uncooperative patients may have difficulty sitting still for the duration of the test or following instructions. This can make it challenging to obtain accurate hearing threshold measurements. In these cases, alternative testing methods such as visual reinforcement audiometry or play audiometry may be needed. Visual reinforcement audiometry involves presenting a visual stimulus, such as a toy or light, when a sound is heard. Play audiometry involves incorporating play activities into the testing process to keep the child engaged and motivated.

Addressing Ambient Noise and Equipment Issues

Ambient noise or issues with the audiometer or headphones can significantly impact the accuracy of a pure-tone test. Ensuring that the testing environment is as quiet as possible and regularly checking the equipment can help mitigate these issues. If necessary, you may need to purchase new equipment or seek professional help to resolve the issue. Additionally, it is important to ensure that the patient is comfortable and that the headphones fit properly to ensure accurate test results.

By understanding and addressing these common challenges, healthcare professionals can perform more accurate and effective pure-tone testing, leading to better patient outcomes.


Pure-tone testing is an essential tool for hearing health professionals in diagnosing and treating hearing loss in patients. By understanding the basics of pure-tone testing, properly preparing for each test, and addressing common challenges and solutions, you can provide the most accurate and effective treatment options to your patients.