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Clinical Hearing Tests Clinical Hearing Tests

Clinical Hearing Tests

Hearing assessments are crucial for diagnosing auditory function and identifying potential hearing impairments. Several clinical tests are employed to evaluate hearing thresholds and sound localisation. The Finger Friction Test, the Watch Test, and the Free Field Voice/Speech Test are among these tests.

i. Finger Friction Test

The Finger Friction Test is a simple, qualitative screening tool to assess gross hearing thresholds and sound localisation.

  • Procedure: The examiner gently snaps their thumb and middle finger together, producing a soft clicking sound. They present this sound near the patient’s ear. The patient closes their eyes and indicates when they hear the sound.
  • Interpretation: This test subjectively evaluates a patient’s ability to perceive faint, high-frequency sounds.

ii. Watch Test

Historically, the Watch Test was a common method used to estimate auditory sensitivity before audiometers became widely available.

  • Procedure: The examiner brings a ticking watch close to the patient’s ear, gradually moving it closer or further away. The distance at which the patient can reliably hear the ticking sound is noted.
  • Interpretation: A shorter distance suggests a hearing impairment, whereas a longer distance indicates better auditory sensitivity.

iii. Free Field Voice/Speech Test

The Free Field Voice/Speech Test is a structured, yet simple, assessment conducted in a clinical environment. It evaluates hearing in each ear separately.

  • Procedure:
    • Environment: Conduct this test in a quiet room to minimise ambient noise interference.
    • Patient Positioning: The patient stands 6 meters (20 feet) away from the examiner. The examiner faces the test ear, while the patient keeps their eyes closed to prevent visual cues from lip-reading.
    • Masking: An assistant or the examiner masks the non-test ear to prevent sound interference. They achieve this by rubbing an index finger on the patient’s tragus or by using a Barany noise box, which delivers a masking noise.
    • Testing:
      • The examiner speaks spondee words (e.g., “iceberg,” “sunlight,” “bathroom”) or alphanumeric combinations (e.g., “Y3G,” “6BZ”) at a conversational voice level. The examiner gradually moves closer to the patient until the patient can correctly hear the words. The distance is then recorded.
      • Subsequently, the examiner whispers spondee words, and the distance at which the whispered voice is heard is also measured.
  • Interpretation:
    • If a patient can hear a conversational voice from 6 meters, their hearing is likely within normal limits.
    • A patient with a hearing loss greater than 30 dB HL typically cannot hear a whispered voice from a distance of 2 feet (approximately 60 cm) from the test ear.
    • The test’s reported sensitivity is around 95%, with a 10% false-positive rate. Therefore, if a patient can hear a whispered voice from 2 feet away, it suggests their pure tone threshold is better than 30 dB HL.
  • Disadvantages: Despite its utility, the Free Field Voice/Speech Test has limitations. The standardisation of the intensity and pitch of the voice used during testing is often questioned, and external ambient noise can interfere with the accuracy of results. These factors can affect the reliability of the test outcomes, highlighting the need for careful consideration during clinical assessments.

 

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    Reference Textbooks.

    • Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
    • Glasscock-Shambaugh, Textbook of Surgery of the Ear.
    • P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
    • Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
    • Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery
    • Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
    • Salah Mansour, Middle Ear Diseases – Advances in Diagnosis and Management.
    • Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
    • Rob and smith, Textbook of Operative surgery.
    • Anirban Biswas, Textbook of Clinical Audio-vestibulometry.
    • Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.

    Author:

    Dr. Rahul Bagla ENT Textbook

    Dr. Rahul Bagla
    MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
    Fellow Rhinoplasty & Facial Plastic Surgery.
    Renowned Teaching Faculty
    Mail: msrahulbagla@gmail.com
    India

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