Hearing Assessments & Diagnostics
Hearing is far more complex than detecting a series of quiet beeps. In everyday life, we need to understand speech, separate voices from background noise, locate where sounds are coming from, follow rapid conversation, and make sense of incomplete or competing information. Much of this work happens in the brain.
This is why a comprehensive hearing assessment should do more than determine the quietest sounds you can hear.
At Deane Audiology, we use a combination of clinical assessment, diagnostics, speech testing, and real-world information to build a more complete picture of how your hearing system is functioning and how hearing is affecting your everyday life. Depending on your needs, this may include conventional pure-tone audiometry, speech testing, QuickSIN® speech-in-noise assessment, Extended High Frequency Audiometry, and middle and inner ear diagnostic measures. Where clinically appropriate, hearing and cognitive health may also be considered together.
What is a Comprehensive Hearing Assessment?
A comprehensive hearing assessment is designed to understand more than whether hearing loss is present. It aims to identify the type, degree, and pattern of any hearing change, investigate where difficulties may lie, and understand how hearing is affecting your communication and everyday life.
The assessment begins with conversation. We want to understand what you have noticed, which situations have become difficult, and what you would most like to improve. We also consider relevant symptoms, medical and family history, noise exposure, and any previous experience with hearing or hearing devices.
Your ears are examined before we select the assessments needed to answer the relevant clinical questions. This will usually include conventional hearing and speech testing. Depending on your history, symptoms, and results, further investigation may include middle and inner ear measures, QuickSIN® speech-in-noise testing, or Extended High Frequency Audiometry (EHF) where indicated.
Importantly, comprehensive does not simply mean doing more tests. Not every person needs every assessment. It means taking enough time to understand you, selecting the right measures for the questions we need to answer, and interpreting the findings together.
A good hearing assessment should leave you with more than a graph. You should understand what we tested, what we found, how it relates to what you are experiencing, and what your options are from here. Not every person needs every test. More testing is not automatically better testing. The value lies in selecting the right assessments to answer the right clinical questions, and taking the time to understand what those results mean for you.
Our measurement process may also continue beyond assessment and diagnosis. If a hearing rehabilitation solution is prescribed, we use different measures to answer a different question: is the solution we have designed actually delivering what we intended?
This creates a clear pathway:
Assessment helps us understand. Diagnostics help us investigate. Prescription determines what may help. Validation confirms whether the solution is doing its job.
Our role is to bring these pieces together. Your experience, concerns, goals, and the objective clinical evidence comes together so that you understand not only what we found, but what it means and what your options are from here.
The goal is not more testing. It is better understanding.
What Does a Standard Hearing Test Measure?
A standard hearing test, known as pure-tone audiometry, measures the quietest sounds you can detect across a range of frequencies. The results are plotted on an audiogram, providing important information about the degree and pattern of hearing loss in each ear.
This helps us identify whether hearing is within the expected range or whether a mild, moderate, severe, or profound hearing loss is present. The pattern of results can also provide clues about the likely type of hearing loss and whether further diagnostic investigation or medical referral may be appropriate.
Pure-tone audiometry is an essential foundation of a comprehensive hearing assessment—but it does not tell the whole story.
An audiogram measures your ability to detect sound in a quiet, controlled environment. It cannot fully explain how clearly you understand speech, how much effort you use to follow conversation, or why you may hear reasonably well in quiet but struggle significantly in background noise.
This is why we interpret your audiogram alongside your experience and, where appropriate, other measures of speech and auditory function.
A standard hearing test tells us what you can hear. It does not always tell us how well you can understand.
Why Is Understanding Speech Different from Hearing Sound?
Many, if not most, clients tell us, “I can hear people talking—I just can't understand what they're saying.” This is one of the most common experiences associated with hearing loss.
Hearing sound and understanding speech are not the same thing. Speech contains a complex mixture of sounds, and many of the softer consonants that give words their clarity can become difficult to detect or distinguish. You may hear that someone is speaking but miss enough detail that words begin to sound unclear or easily confused.
The brain then has to work harder to fill in the gaps using context, attention, memory, and knowledge of language. In quiet, this may work reasonably well. When speech is fast, several people are talking, or background noise is present, there are fewer clues available and the task becomes much more difficult.
This is why two people with similar audiograms may experience very different communication difficulties. Measuring speech understanding helps us explore how well the hearing system and brain are using the sound information available—not simply whether sound can be detected.
A test called QuickSIN®
Why We Test Speech Understanding in Noise
For many people, the greatest hearing difficulty is not hearing in quiet, it is understanding conversation when other sounds are competing for attention. Restaurants, family gatherings, meetings, cafés, cars, and social events can expose difficulties that may not be obvious during a standard hearing test.
The Quick Speech-in-Noise test (QuickSIN®) measures how much louder speech needs to be than the surrounding background noise for you to understand it with ease. This is known as your signal-to-noise ratio loss, or SNR loss.
During the assessment, you listen to sentences while background noise gradually becomes louder and more challenging. Your responses allow us to quantify how much additional separation between speech and noise you need compared with a person who has typical speech-in-noise ability.
This information can be extremely valuable. Two people with similar audiograms may have very different QuickSIN results, and therefore very different real-world listening needs. One may communicate relatively well in noise, while another requires significantly more support to achieve similar understanding.
At Deane Audiology, QuickSIN can help us understand whether the difficulties you describe are consistent with your measured speech-in-noise performance. Where hearing technology is being considered, it can also help inform the level of noise-management performance you may genuinely benefit from.
This is an important part of identifying your Prescription Sweet Spot. Rather than assuming that everyone with a similar hearing loss needs similar technology, we can combine objective evidence with your actual lifestyle and communication requirements.
An audiogram tells us how softly you can hear. QuickSIN helps us understand how much help you may need when listening becomes difficult.
Extended High Frequency Audiometry
Why We Test Beyond Standard Hearing Frequencies
A standard hearing test typically measures frequencies from 250 Hz to 8,000 Hz—the range most commonly used to assess hearing for speech. However, the human auditory system can detect sound well beyond 8,000 Hz, and important changes may occur in these extended high frequencies before they show up and are visible on a conventional audiogram.
Extended High Frequency Audiometry (EHF) allows us to assess hearing above the standard test range. At Deane Audiology, we can test frequencies up to 16,000 Hz where clinically indicated.
Why does this matter? Research suggests that extended high-frequency hearing may contribute to communication in challenging listening conditions such as noisy places and in reverberant spaces, and changes above 8,000 Hz may provide additional information about early auditory damage or difficulties not fully explained by a standard hearing test. EHF testing can be particularly valuable when investigating tinnitus, significant noise exposure, ototoxic medication history, or hearing concerns despite relatively normal conventional results.
For people with tinnitus, testing beyond 8,000 Hz can be especially informative because hearing changes may exist in frequencies that conventional testing does not measure. This does not mean EHF testing explains every case of tinnitus, but it can provide a more complete picture of the auditory system.
Not everyone needs Extended High Frequency Audiometry. We complete it when your history, symptoms, or clinical findings suggest that looking beyond the standard test range may add meaningful information.
Sometimes the answer lies beyond the frequencies routinely tested.
Middle Ear and Inner Ear Diagnostic Testing
Hearing difficulties do not all originate in the same part of the auditory system. Depending on your symptoms, history, and hearing test results, we may use additional diagnostic measures to investigate how different parts of the ear are functioning.
Tympanometry assesses the movement of the eardrum and the function of the middle ear. It can help explain why you feel that you need to ‘pop’ your ears often, and can help identify issues such as abnormal middle ear pressure, fluid, or changes in the mobility of the eardrum and middle ear system. Unlike a standard hearing test, it does not measure how softly you can hear.
Other measures may be used where clinically indicated to investigate the auditory system further. These can include acoustic reflex testing and otoacoustic emissions (OAEs), which provide additional objective information about middle ear pathways and cochlear function.
Not every person needs every diagnostic test. The purpose is not to complete a standard battery simply because the equipment is available, but to select the measures that help answer the clinical questions raised by your history and results.
Good diagnostics are not about collecting more data. They are about knowing what question needs answering.
Understanding Cognitive Screening
MoCA® and MoCA®-H
Hearing and cognitive health are closely connected, which is why cognitive screening may sometimes form part of a broader conversation about healthy ageing and hearing and brain health. This also forms a central component of our Soundwell Program.
The Montreal Cognitive Assessment (MoCA®) is a brief cognitive screening tool that looks across several areas of thinking, such as attention, memory, language, executive function, visuospatial skills, and orientation. It is important to understand what it is, and what it is not. MoCA is a screening tool, not a diagnosis of dementia or any other cognitive condition. A result that raises concern ordinarily requires appropriate medical referral, follow-up and further assessment.
Hearing also matters when cognition is assessed. If a person cannot clearly hear spoken instructions or test material, there is a risk that hearing difficulty may influence performance. The MoCA®-H was developed specifically for people with acquired hearing impairment, using a format designed to reduce the influence of hearing loss on cognitive screening. It has been validated as a sensitive and reliable screening measure for adults with hearing impairment.
As a certified MoCA practitioner, I may recommend cognitive screening where it is clinically appropriate and where the result may help guide a broader conversation about hearing, communication, and brain health. It is not a routine test for everyone, nor is it used to make a diagnosis.
Where hearing loss is present, we believe it is important to understand and address hearing as part of the picture. Better access to sound and communication may reduce unnecessary listening effort and helps ensure that hearing difficulty is not overlooked when broader cognitive concerns are being considered.
Cognitive screening does not provide all the answers. Used appropriately, it can help us ask better questions.
From Assessment to Prescription
Bringing the Results Together
No single test result determines what happens next. The value of a comprehensive assessment comes from bringing the information together: your hearing profile, speech understanding, listening-in-noise ability, symptoms, lifestyle, communication priorities, previous experiences, and the situations in which hearing matters most to you.
For some people, the next step may simply be reassurance and monitoring. Others may require medical referral, further investigation, communication strategies, tinnitus management, hearing rehabilitation, or a combination of approaches.
If hearing technology is being considered, the assessment helps us understand what the solution may need to achieve. Your audiogram is important, but so too are your speech results, real-world listening demands, preferences, and expectations.
This is where assessment becomes prescription. The aim is not to recommend more intervention than you need, or less than may meaningfully benefit you. It is to use the information we have gathered to explain your options and help you make an informed decision.
Better recommendations begin with better understanding.
Is Your Hearing Solution Working?
Real Ear Measures
Once a hearing solution has been prescribed and fitted, the question changes. We are no longer simply assessing your hearing. We need to determine whether the solution we designed is actually delivering what we intended.
This is where Real Ear Measurements (REM) and Live Speech Mapping become valuable. These are not standard hearing evaluation measures. They are hearing solution verification and validation measures.
Real Ear Measurements
Every ear is acoustically different. The size and shape of your ear canal influence how sound reaches the eardrum, which means manufacturer software alone cannot tell us precisely what a hearing aid is delivering in your ear.
Real Ear Measurements use a fine probe microphone placed safely in the ear canal to measure the hearing aid's actual output at the eardrum. We can then compare this with evidence-based prescription targets and make precise adjustments where needed.
Real Ear Measurements objectively verify the acoustic performance of the hearing solution in your individual ears.
Live Speech Mapping
Live Speech Mapping helps make hearing aid performance more meaningful and visible. Using real speech, it may be recorded, your own voice or the voice of someone important to you, we can see for ourselves and demonstrate how speech is being amplified across your hearing range.
While Real Ear Measurements answer the technical question, “Is the solution meeting the prescribed acoustic targets?”, Live Speech Mapping helps demonstrate, “What is this solution doing with meaningful speech in real-time?”
Together, these measures help us move beyond assumptions. We assess the person, prescribe the solution, and then measure the solution itself.
We do not simply want to know that your hearing aids are switched on. We want evidence that the solution is doing the job it was designed to do.
What Your Results Say and What Happens Next
A good hearing assessment should leave you with more than a collection of results. You should understand what we tested, what we found, how the findings relate to what you are experiencing, and what your options are from here.
Sometimes the outcome is reassurance and a plan to monitor hearing over time. Sometimes further diagnostic investigation or medical referral is appropriate. For others, the next step may involve communication strategies, tinnitus management, hearing technology, or a broader hearing rehabilitation plan.
You do not need to make every decision at the assessment appointment. Our role is to explain what we know, maybe what we do not know, what may help, and the likely benefits and limitations of the available options.
If a solution is recommended, it should make sense to you. You should understand why it is being recommended, what we expect it to achieve, and how we will know whether it is working.
Assessment creates understanding. Good clinical decisions turn that understanding into meaningful action, if and when you are ready.
“I’ve worn hearing aids for years but have never had all my options explained so clearly or in so much depth before. I was also able to trial something new before deciding to go ahead.”
– Frank B, Pilot