Hearing Exams

Comprehensive Hearing Evaluation

A comprehensive hearing evaluation (also known as a hearing evaluation, hearing exam or hearing test) is performed to determine if hearing loss is present, and if so, the severity of the hearing loss, how well the ear drum and middle ear is functioning and your ability to understand speech in quiet and background noise. Individuals often self-refer for hearing evaluations because they notice they are not hearing well and would like to confirm their hearing levels. Others are referred for a hearing evaluation by their physician for the following reasons:

  • General worsening of hearing and speech understanding over many years, often attributed to aging
  • Unexpected, sudden hearing loss over a short period of time, often only in 1 ear
  • Ringing, or other sound in one or both ears, often of sudden onset
  • Full or plugged feeling in one or both ears
  • Active ear infection
  • Recent vertigo or severe dizziness, often accompanied by nauseousness
  • Delayed speech and /or poor academic performance in a child
  • Seeking hearing aids

Insurance Coverage

Peninsula Hearing Services is in-network with most major PPO health insurance plans, including Medicare, Cigna, Anthem Blue Cross, Blue Shield, United Healthcare, Aetna, TriCare, Medi-Cal, Care Advantage and the HMO plan Hills Physician’s Medical Group. The office is not in-network with HMO’s from Kaiser, Sutter, or the Palo Alto Medical Foundation.

In general, insurance plans will cover most or all of the cost of a hearing evaluation. However, each individual plan can vary regarding deductibles, copays and annual out-of-pocket minimums that might be required to be met before a health insurance will pay for some or all medical visits and/or treatments. Please contact Peninsula Hearing Services if you are unsure about coverage for a hearing evaluation or contact the customer service phone number listed on the back of your health insurance card.

What Tests Will Be Done?

The audiologist will first collect your hearing and balance history to best understand the details of your primary concern(s).  A comprehensive hearing evaluation will then be performed. This includes video otoscopy, pure-tone testing, bone-conduction testing, speech testing in quiet and in-noise, tympanometry and otoacoustic emissions testing. For patients who experience tinnitus, a tinnitus evaluation will be performed. The hearing evaluation is approximately 30-40 minutes in length and the results are immediate. See below for a description of each subtest.

Each subtest is painless and some take as little as 1 minute to complete. It is common for many patients to arrive anxious not knowing what to expect.  However, most patients quickly relax and find the testing is not only easy but  informative and they are relieved they had the evaluation.  The hearing exam results will be reviewed with you at the visit. If a medical condition is found, you will be referred to a specialist. If a recommendation is made for hearing devices, they may be ordered through Peninsula Hearing Services. The audiologist will advise which hearing aid is best for you and provide details with how they can be ordered.


Otoscopy is a magnifying instrument that shines a beam of with a light in your ear canal for a healthcare provider to visualize the health of the ear canal and ear drum. This allows the examiner to assess the general health of the ear canal, including whether excessive cerumen (ear wax) is present or if a perforation (hole) in the ear drum is present. Peninsula Hearing Services utilizes “video” otoscopy so that the patient can see their ear canal and ear drum on a monitor.


A tympanometer is a handheld instrument that blows a gentle puff-of-air and presents several tones into the ear canal to evaluate how well the ear drum vibrates to sound, the pressure behind the ear drum and whether a perforation or hole in the ear drum exists.  The resulting information from the test is referred to as tympanometry. This test is important to determine the overall health and functioning of the ear drum and middle ear cavity.

Pure-Tone Air and Bone Conduction Testing

Using headphones in a sound-treated hearing booth, pure-tone air conduction testing determines the quietest tones that a person can hear at different pitches or tones, all the way from a deep, bass frequency (think of a fog-horn) up to more high-pitched frequencies (think of a whistle or tea-kettle sound). The test measures sound as it travels from the opening of the ear, down the ear canal, through the ear drum and middle ear space to the hearing nerve. It is somewhat similar to an eye exam in which an optometrist evaluates the smallest letters that each eye can see clearly.

Bone-conduction testing measures the same tones as pure tone air conduction. A specialized headset named a bone-vibrator is placed behind one ear and sound is transmitted, through vibration of the skull directly to the hearing nerve.

These two different measurements determine if hearing loss originates from the ear canal and ear drum space or from the hearing nerve deep inside the brain.

Speech Testing

Under headphones, speech testing measures how well you understand speech in a quiet listening environment. The examiner presents a standardized list of words at a comfortable listing level that you will be asked to repeat back. This test is important to assess the health of the hearing nerve and, if hearing loss is present, guide treatment options, as some people report they can hear sound, but the speech is distorted, no matter how loud the volume level.

Speech-in-Noise (SIN) Testing

Speech-in-noise testing assesses how well one hears in various levels of background noise. Many people seeking a hearing exam often report they hear fine in quiet but struggle to understand speech in a restaurant or other noisy environment. This test will quantify that degree of difficulty. Using a CD, 6 short sentences with increasing levels of noise are presented The patient is tasked with repeating each sentence back as best they can. At the end of the 6th sentence, a score is tabulated that identifies degree of difficulty understanding speech in noise. For those wearing hearing aids, this test is administered with and without the hearing aids to determine benefit for listening in background noise.

Otoacoustic Emissions (OAE) Testing

Otoacoustic emissions testing measures how well specific inner ear nerve receptors named “outer hair cells” are functioning. Using a handheld instrument, a soft ear tip similar to an earbud is placed in the ear and gentle melody of tones is presented to the ear.  The nerve receptors of a healthy hearing nerve will emit robust responses that are received and assessed by the instrument as “normal”, “borderline” or “absent”.  This test is highly sensitive to changes in hearing that often are not detected by simple pure-tone and bone conduction testing. It is also widely used on newborns to screen for hearing loss and for individuals undergoing life-saving treatments like chemotherapy that can damage the delicate hearing neve receptors before the patient or physician is aware of hearing loss (referred to as ototoxic hearing loss).

Tinnitus Assessment Testing

A tinnitus assessment is used to evaluate reports of a buzzing, ringing or a noise in the ear(s), referred to as tinnitus.  This assessment allows the healthcare provider identify  a) the specific tone or pitch of the reported tinnitus  b) the volume or intensity of the tinnitus  c) whether  “white noise” or static can make the tinnitus go away (a term known as masking).  The results of this test are useful for diagnosis of the problem that might be causing the tinnitus as well as prognosis for certain treatments, if needed. Other assessments include several scientifically validated questionnaires that probes difficulties a patient is experiencing because of the tinnitus.