Audiology: hearing tests, hearing aids, tinnitus and balance assessment explained

Audiology covers measurement of hearing, diagnosis of the type and degree of hearing loss, rehabilitation with hearing aids and implants, tinnitus management, and the assessment of balance disorders that arise from the inner ear. The work is shared between audiologists, who are health professionals with a degree-level qualification in the field, and ear, nose and throat (ENT) consultants, who deal with the medical and surgical causes of hearing and balance problems.

In most hearing clinics the audiologist is the first specialist you meet. They carry out the tests, explain the results, and fit and adjust hearing aids. If the tests suggest a medical cause such as a perforated eardrum, a middle ear problem or an uneven loss between ears, you are passed to ENT. Children are usually looked after by paediatric audiologists, and cochlear implant programmes have their own multidisciplinary teams including surgeons, audiologists, speech therapists and psychologists.

Hearing loss is common, particularly with age. The NHS lists signs including misunderstanding other people in noisy places, needing people to repeat themselves, turning the volume up, finding it hard to hear on the phone and feeling tired from concentrating. It also warns that hearing loss can affect a child speech development and progress at school.

• Gradual loss in both ears: the NHS links this to ageing or damage from loud noise over many years.

• Conductive loss: sound is blocked on its way to the inner ear, for example by earwax, an ear infection or a perforated eardrum. The NHS notes earwax build-up usually causes difficulty hearing in one ear with a blocked feeling, and that ear drops or removal can treat it.

• Sensorineural loss: damage to the inner ear or hearing nerve, which tends to be permanent and is the main target of hearing aids.

• Tinnitus: noises with no outside source such as ringing, buzzing or hissing. The NHS says it is not usually a sign of anything serious and may get better by itself, but is often linked to hearing loss.

• Dizziness and balance disorders: such as benign paroxysmal positional vertigo and Meniere disease, which can come with hearing change and ringing.

• Childhood hearing problems: including glue ear and, rarely, permanent loss present from birth.

The NHS lists three tests commonly used for adults. Pure tone audiometry has you listen to different sounds through headphones and press a button or raise your hand each time you hear something. Speech audiometry is similar but uses spoken words. Tympanometry places a small device in the ear to check how well the eardrum moves and whether there is a blockage behind it.

Children are tested in ways suited to their age: visual reinforcement audiometry in which a child turns towards a toy or screen that lights up when a sound is heard, play audiometry where a child performs a simple task such as putting a ball in a bucket, and, for older children, pure tone audiometry, tympanometry and a bone conduction test that identifies which part of the ear is not working properly.

The tests together produce an audiogram, a chart of the quietest sounds you can hear at different pitches. It shows whether loss is mild, moderate, severe or profound and whether it is the same in both ears. Results are usually given at the end of the appointment and the specialist advises whether further tests, such as scans, are needed.

RNID says hearing aids can make quieter sounds easier to hear, make loud sounds more comfortable, make conversations easier and help in noisy places. A fitting appointment programs the aid to your audiogram, and it normally takes time to get used to the new sounds. Regular cleaning, new tubing or batteries, and follow-up adjustments are part of ownership.

When hearing aids do not give enough benefit, or cannot be worn for medical reasons, a hearing implant may be considered. RNID describes cochlear implants as an option for severe to profound hearing loss in both ears when hearing aids are not helping, auditory brainstem implants where the hearing nerve is damaged, and bone conduction implants, sometimes called bone anchored hearing aids, which send sound vibrations through the skull directly to the inner ear. The NHS describes implants as devices attached to the skull or placed deep inside the ear. Implants need assessment by a specialist team, surgery and programming sessions afterwards.

Practical tools help alongside any device: telephone and television amplifiers, flashing or vibrating alarms, and phone or tablet apps. The NHS suggests facing people when they talk, reducing background noise and asking people to repeat or write things down.

For tinnitus, the NHS advises seeing a GP if it is regular or constant, getting worse, or affecting sleep, concentration or mood. A GP will look in your ears and may check hearing. If there is no treatable cause, referral may be for talking therapy: digital cognitive behavioural therapy is usually offered first, with tinnitus counselling and tinnitus retraining therapy as other options. The NHS says it is unclear whether retraining therapy works for everyone, and that it is widely available privately. Hearing aids may be recommended if you also have hearing loss, and soft background sound is better than total silence.

Balance assessments in audiology clinics look at the inner ear using tests of eye movements and positional manoeuvres, and rehabilitation can include specific exercises that help the brain adapt, known as vestibular rehabilitation. Tinnitus that beats in time with your pulse needs an urgent GP appointment according to the NHS.

NHS audiology can be reached by GP referral, and in England the maximum waiting time for non-urgent consultant-led care is 18 weeks from referral, although many hearing services are not consultant-led, so check local waiting information. Cochlear implant work is carried out in specialist centres and starts with an assessment.

Privately, audiology is largely self-referral, so you can book a hearing assessment without seeing a GP. Prices depend on the type of assessment, the technology level of any hearing aids, number of follow-up visits and warranty, so ask for a written breakdown. Insurers often cover consultant ENT review but may not cover hearing aids. The Private Healthcare Information Network provides independent information on private consultants and hospitals.

Ask for an urgent GP appointment or call NHS 111 if you have sudden hearing loss in one or both ears, hearing that has been getting worse over days or weeks, or hearing loss together with earache or discharge from the ear. Go to A&E or call 999 for tinnitus after a head injury, or tinnitus with sudden hearing loss, facial muscle weakness or a spinning sensation. Do not use cotton buds or objects in your ears.