S3.1 Comprehensive Diagnostic Hearing Evaluation
for Adult Patients
A standard for the tasks and processes audiologists use to diagnose hearing changes in adults.
- A comprehensive diagnostic hearing evaluation is comprised of valid and reliable assessments of auditory function necessary for differential diagnosis.
- Communication with patients is conducted in a clear, empathetic manner consistent with the patient’s communication mode, comprehension, and their health literacy level. Audiologists encourage involvement of communication partners (e.g., family members, significant others, companions) whenever possible and appropriate.
- A thorough patient history is obtained as part of the evaluation.
- Visual inspection of the outer ear, ear canal, and eardrum are performed.
- Pure tone air conduction thresholds are obtained at a minimum of octave frequencies, 250 Hz – 8000 Hz. Thresholds are obtained at interoctave frequencies when there is a 20 dB or greater difference between octave thresholds or as otherwise deemed necessary by the audiologist.
- Pure tone bone conduction thresholds are obtained at octave frequencies 500 Hz – 4000 Hz to identify conductive, sensorineural, or mixed hearing loss. Thresholds are obtained at other octave and interoctave frequencies as deemed necessary by the audiologist.
- Speech recognition thresholds or speech awareness thresholds are obtained using recorded stimuli to assess agreement with pure tone findings.
- A measure of speech recognition ability is obtained using recorded stimuli at a presentation level that is expected to approximate the patient’s maximum performance. Audiologists perform speech recognition in noise to assess functional capacity.
- Acoustic immittance of the external/middle ear is measured to support differential diagnosis. A tympanogram is obtained for each ear. When indicated by the patient’s history and audiometric findings, acoustic reflex thresholds are measured ipsilaterally and/or contralaterally.
- Results and recommendations are communicated to the patient.
- Written documentation of the diagnostic hearing evaluation is maintained as part of the patient record.