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Clinical Hearing Tests

Clinical Hearing Tests Clinical Hearing Tests

(i) Finger Friction Test: It is a screening test done to assess hearing threshold and sound localisation. The examiner snaps the thumb and middle finger to create a clicking sound near the patient’s ear and the patient is asked to appreciate the sound with closed eyes.

(ii) Watch Test: It is a screening test which was used by the clinicians before the invent of the audiometer. The examiner brings a watch with a ‘clicking’ sound close to the patient’s ear and measures the distance at which this sound is heard.

(iii) Free field voice/ Speech Test is a structured test of hearing for a clinical setting. Prerequisite: Each ear is tested separately after masking the opposite ear. To produce masking, the assistant rubs the index finger on the patient’s tragus or conchal bowl. A normal person hears sound of conversation at 12 m (40 ft), whisper (with residual air after normal expiration) at 6 m (20 ft). However, 6 m is taken as normal for both conversation and whisper while doing this test.

Procedure: Speech test must be done in quiet surroundings. 

  • The patient is made to stand at 6 metres with his ‘test ear’ facing towards the examiner with his eyes closed to avoid lip reading
  • An assistant blocks the non-test ear of the patient by giving intermittent pressure on the tragus. Barany noise box can also be used for masking.
  • Now the examiner speaks spondee words (such as iceberg, sunlight, bathroom, housewife, suitcase) or numbers with letters (Y3G, 6BZ, K4D) and walks towards the patient. The distance at which this conversational voice is heard is measured.
  • Then the examiner speaks spondee words in a whisper (with residual air after an ordinary expiration). The distance at which the whispered voice is heard is measured.


  • The patients with >30dB hearing loss are not able to hear a whispered voice at 2 feet from the test ear. (sensitivity of test is 95% and false-positive rates are 10%).
  • If a patient is able to hear voice 2 feet away, the pure tone threshold is better than 30dB HL. 


  • The standardisation in intensity and pitch of voice used for testing is doubtful and the ambient noise may interfere with the test results.

——— End of the chapter ———

Learning resources.

  • Scott-Brown, Textbook of Otorhinolaryngology Head and Neck Surgery.
  • Glasscock-Shambaugh, Textbook of  Surgery of the Ear.
  • Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
  • Rob and smith, Textbook of Operative surgery.
  • 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.
  • Anirban Biswas, Textbook of Clinical Audio-vestibulometry.
  • W. Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.
  • Salah Mansour, Textbook of Comprehensive and Clinical Anatomy of the Middle Ear.
  • Susan Standring, Gray’s Anatomy.
  • Ganong’s Review of Medical Physiology.


Dr. Rahul Bagla ENT Textbook

Dr. Rahul Kumar Bagla
MS & Fellow Rhinoplasty & Facial Plastic Surgery.
Associate Professor
GIMS, Greater Noida, India

Please read. Glomus Tumour.

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