Patient guide · Audiology · 4 min read
Threshold equalizing noise (TEN) test, audiology test that maps cochlear dead regions.
The TEN-HL test is a specialised audiology test that identifies cochlear dead regions — areas where inner hair cells are not functioning. Foundation for hearing-aid fitting and cochlear implant candidacy.
Why patients choose us
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The right hands
We route you to an experienced audiologist familiar with TEN-HL interpretation, gain-shaping and cochlear implant referral pathways.
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Guidance you can act on
The TEN result is only useful if the plan that follows is right — frequency-lowering, gain-shaping, or CI candidacy assessment.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
The TEN test at a glance.
Six things that matter before you agree to the test — what it does, what it needs, and what it changes.
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Definition
A specialised behavioural audiology test that identifies cochlear dead regions — cochlear areas where inner hair cells are non-functioning.
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15–20 minute test
A focused test that adds only a short block onto your audiology appointment.
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Requires PTA first
A recent pure-tone audiogram is a prerequisite — the TEN test builds on baseline thresholds.
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Positive = dead region
A positive result identifies a specific frequency region where cochlear inner hair cells no longer respond.
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Complements PTA + speech audiometry
Sits alongside PTA and speech audiometry to explain poor speech clarity that pure thresholds don’t predict.
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Guides frequency-lowering
A positive TEN often prompts a frequency-lowering hearing aid trial rather than more gain in the dead region.
The diagnostic path
From consultation to a structured plan — what happens, in order.
Seven steps, one audiology visit — with follow-through into fitting, referral or review.
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Audiology consultation
History, otoscopy and a discussion of why the TEN test has been suggested — usually poor speech clarity or a steep high-frequency loss.
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PTA baseline
A current pure-tone audiogram is confirmed as the reference point for interpretation.
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Frequency-specific thresholds in noise
Thresholds are measured at each test frequency in the presence of threshold-equalising noise in the same ear.
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Positive criteria applied
The Moore criteria are applied: masked threshold ≥10 dB above the noise level and ≥10 dB above the absolute threshold indicates a dead region.
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Frequency-lowering trial
Where indicated, a frequency-lowering hearing aid is trialled so unusable regions are re-mapped to audible ones.
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Structured report
A written report notes affected frequencies, laterality, and implications for amplification.
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Structured plan
A clear plan follows — gain-shaping, frequency-lowering, CI referral or audiological follow-up.
What it shows
What a positive TEN test tells you.
Where the dead regions are, whether frequency-lowering is likely to help, and when it’s time to think about a cochlear implant.
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High-frequency dead regions
The most common pattern — dead regions in the basal cochlea affecting 2–8 kHz.
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Mid-frequency dead regions
Less common but important for speech clarity, especially consonant discrimination.
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Low-frequency dead regions
Rare, seen in some genetic and progressive losses; affects vowel perception and prosody.
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Response to frequency-lowering
Predicts whether frequency-lowering technology is likely to help in the affected regions.
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Gain-shaping decision
Guides whether to reduce gain at dead-region frequencies rather than push more amplification into unusable areas.
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CI candidacy trigger
Severe or widespread dead regions can prompt cochlear implant candidacy assessment.
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Complex SNHL pattern
Explains why speech understanding is worse than pure-tone thresholds alone would predict.
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Red flag: severe bilateral dead regions — CI assessment
Widespread bilateral dead regions warrant timely referral to a cochlear implant centre.
Treatment options
What follows a positive TEN — the eight routes.
Not every dead region needs a cochlear implant. What actually helps depends on where the dead region is, and how much usable hearing remains.
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Frequency-lowering hearing aid
Re-maps sound from dead-region frequencies to areas of usable hearing — often the first response to a positive TEN.
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Traditional HA
Standard hearing aid with prescription gain-shaped to avoid over-amplifying dead regions.
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BAHA
Bone-anchored hearing aid where conductive or mixed loss coexists with dead regions.
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CI candidacy
Formal cochlear implant assessment for severe bilateral dead regions or poor aided speech performance.
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Auditory training
Structured listening therapy to maximise use of residual cochlear function.
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ALDs
Assistive listening devices — remote microphones, streamers, loop systems — for real-world listening.
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Audiology follow-up
Scheduled reviews to refine fitting, monitor progression and repeat TEN as needed.
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MDT review
Multidisciplinary review with ENT, audiology and CI team where the picture is complex.
Red flags
When a TEN result needs urgent onward review.
A positive TEN isn’t a red flag on its own — these are the clinical settings where it becomes one.
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Severe bilateral dead regions
Widespread bilateral dead regions — prompt cochlear implant assessment.
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Post-meningitis
Any hearing loss after bacterial meningitis needs urgent audiology and CI-team review.
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Auditory neuropathy
Poor speech understanding disproportionate to thresholds warrants specialist evaluation.
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Post-ototoxicity
Hearing loss after aminoglycosides, platinum-based chemotherapy or high-dose loop diuretics.
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Sudden SNHL
Sudden sensorineural hearing loss is a medical emergency — same-day ENT assessment.
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Vestibular schwannoma
Asymmetric loss or unilateral tinnitus with dead regions raises retrocochlear suspicion — MRI IAM.
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Post-chemotherapy
Ongoing changes after platinum-based therapy need surveillance audiology.
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Congenital hearing loss
Paediatric or long-standing congenital loss with new dead regions needs specialist input.
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Post-noise trauma
Acute acoustic trauma with dead regions merits urgent audiology and steroid consideration.
Sources
Where this guide comes from.
Clinically reviewed against current audiology guidance. Reviewed 2026-07-30. Next review 2027-07-30.
- British Society of Audiology. Recommended procedure: Determination of cochlear dead regions using the TEN(HL) test.
- American Speech-Language-Hearing Association (ASHA). Adult audiologic assessment.
- European Federation of Audiology Societies (EFAS). Clinical guidance.
- Moore BCJ et al. Ear and Hearing — TEN(HL) test development and validation.
Frequently asked
Everything patients ask about the TEN test.
Quick answers on what the test does, how it differs from a PTA, and what a positive result means.
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What is a TEN test?
The threshold equalising noise (TEN) test is a specialised behavioural audiology test that identifies cochlear dead regions — parts of the cochlea where the inner hair cells no longer transduce sound. It is performed by an audiologist and takes about 15–20 minutes on top of a standard hearing assessment.
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How is a TEN test different from a normal hearing test?
A pure-tone audiogram (PTA) measures the quietest sound you can hear at each frequency. The TEN test asks a different question — whether the response at a given frequency is coming from that frequency’s hair cells at all, or from a neighbouring region "listening in". It builds on a PTA rather than replacing it.
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Why does identifying a dead region matter?
Amplifying a dead region rarely helps and can distort sound. A positive TEN often prompts a frequency-lowering hearing aid — which shifts sound from the dead region into an area of usable hearing — or a cochlear implant assessment where dead regions are widespread.
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Does the TEN test hurt?
No. It is a behavioural test — you listen and respond, just as in a standard hearing test. The only difference is that a background noise is played in the same ear to mask off-frequency listening.
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Do I need a referral for a TEN test?
Most private audiology clinics accept self-referral. Because the TEN test builds on a PTA, expect the audiologist to run or review a current audiogram in the same visit.
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What happens if the TEN test is positive?
The audiologist will typically trial a frequency-lowering hearing aid, adjust prescription gain around the dead region, and — where the pattern is severe or bilateral — refer for cochlear implant candidacy assessment.
Related tests
Looking for a different test?
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Pure-tone audiometry (PTA)
The baseline hearing test — thresholds at each frequency.
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Speech audiometry
How well you understand words at different levels.
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Private audiology assessment
Full private audiology work-up with an experienced audiologist.
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All tests
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Tinnitus
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Chronic Sinusitis
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Cochlear Implants
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Cholesteatoma Surgery
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In practice, in London
Getting threshold equalizing noise test sorted in London, without the guesswork
With threshold equalizing noise test, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for threshold equalizing noise test is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
The mechanics are straightforward: a consultant appointment, any tests done at a nearby CQC-registered site, and a written report back within a few days. London’s density of private diagnostics — Marylebone, the City, Chelsea, Canary Wharf — means most patients can find something that fits around work without a cross-town trek. For threshold equalizing noise test specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for threshold equalizing noise test isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.
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