Hearing Evaluation


Audiological Assessments

A&A Audiology is a center of excellence specializing in comprehensive diagnostic evaluations for adults and children. A thorough diagnostic audiological evaluation is the first step if you suspect a hearing problem and essential before commencing habilitation. A comprehensive audiological evaluation at the A&A Audiology Clinic routinely includes otoscopy, air and bone conduction pure tone audiometry, full immittance testing to determine middle ear status, otoacoustic emissions (OAE), and thorough speech recognition measures, including speech-in-noise testing and/or screening for central involvement, to evaluate the presence, extent and nature of hearing loss.

Evaluation of hearing can take place at any age. Special testing techniques and tests are used to assess the hearing ability in a very young child. Following the testing, your audiologist will present the results of the testing and answer any questions you may have. The audiologist will also give you recommendations based on the evaluation. If the audiologist recommends hearing aids or other assistive device, he/she will recommend that you return for a hearing aid evaluation appointment.

Immittance Audiometry

Acoustic immittance measures provide diagnostic information regarding middle ear functioning and the integrity of the acoustic reflex pathway. Advanced measures such as Multifrequency tympanometry and absorbance/reflectance measures are performed as necessary to increase the diagnostic information regarding the status of the middle ear.

Otoacoustic Emmissions

Measurements of otoacoustic emissions assess the function of the outer hair cells in the cochlea and are a key test in differentiating between cochlear and purely retrocochlear disorder. This objective hearing test can help to determine if normal cochlear function exists even in difficult-to-test populations.

Diagnostic Services

Comprehensive Pediatric and Adult Audiological Assessment

A comprehensive audiological assessment is performed to determine the presence, type, configuration and severity of hearing impairment. In addition to routine audiometry, special testing is conducted such as immittance, otoacoustic emissions and speech-in-noise testing to provide recommendations as needed for medical intervention, further evaluation and/or avenues available to improve communication such as hearing aids or cochlear implants.

Vestibular Assessment

Vestibular services include a comprehensive battery of tests that are designed to evaluate a patient's balance system. Electronystagmography and videonystagmography are used to record and analyze eye movements that help us determine how well the balance system is working. Recordings of those eye movements will be made with electrodes taped around the eyes or by infrared goggles.

Electrophysiological Assessments

Our electrophysiology lab provides a variety of specialized diagnostic testing including electrocochleography, auditory brainstem response, middle latency response, late latency response, auditory steady-state response, stacked auditory brainstem response and vestibular-evoked myogenic potentials.

Auditory Processing Disorder Assessments

Auditory Processing Disorder assessments are available for children (seven years or older) and adults who may have an impaired ability to attend, discriminate, recognize or comprehend auditory information. Audiology-based assessments are combined with language assessments to gain a complete picture of auditory processing as part of our Language, Listening and Learning Program.

Electrophysiological Assessments

Electrophysiological measures, such as those procedures listed below, play an important role in the assessment of hearing in difficult to test populations, such as very young children, as well as in the differential diagnosis of cochlear versus retrocochlear disorders. These tests are considered objective in that a behavioral response is not required of the patient. Auditory evoked potentials are very small electrical voltage potentials originating from the brain. They are usually recorded from the scalp in response to an auditory stimulus (i.e., clicks, tones, speech sounds, etc.). Evoked potentials are typically recorded using small disk-like self-adhesive electrodes which are stuck on the head and face. The electrodes do not hurt, and they come off easily after completion of testing. A typical recording requires the placement of three or four electrodes. These tests require the use of highly sensitive amplifiers and computer averaging equipment.

Electrophysiological services available at A&A Audiology

  • Electrocochleography (ECochG) These responses are comprised of the cochlear microphonic, the cochlear summating potential and the auditory nerve action potential. This hearing exam is useful in intraoperative monitoring and to evaluate possible cases of Meniere's disease.
  • Auditory Brainstem Response (ABR) These waves originate in the eighth cranial nerve and brainstem auditory structures in the region of lateral lemniscus and inferior colliculus. Auditory brainstem response is used in the neurodiagnosis of eighth nerve or auditory brainstem dysfunction.
  • Middle (MLR) and Late (LLR) Latency Responses The middle latency response is from the upper brainstem and/or auditory cortex. The middle latency response is used in the neurodiagnosis of auditory central nervous system disorders above the brainstem level. The late latency response originates primarily in the auditory cortex and is used for frequency specific estimation of hearing sensitivity in cooperative children and adults.
  • Stacked Auditory Brainstem Response (ABR) This is a modification of the standard ABR and involves collection of data using click stimuli mixed with high-pass masking noise. This generates activity in virtually all auditory nerve fibers rather than just a subset as in auditory brainstem response.
  • Vestibular Evoked Myogenic Potentials (VEMP) This potential is a change in the surface-recorded electromyogram (EMG) that can be evoked over neck and spinal muscles following a high-intensity acoustic input. Vestibular evoked myogenic potentials are important in the evaluation of a patient who is dizzy and can help to determine the origin of the problem.
  • Cochlear Hydrops Analysis Masking Procedure (CHAMP) involves looking at the response properties of the basilar membrane for reduced masking effectiveness of high pass noise in an auditory brainstem response when clicks are used. This may be used to establish the presence of cochlear hydrops.


To schedule an appointment, please contact the Clinic.

Auditory Processing Disorder Assessment


What is an Auditory Processing Disorder?

Despite normal peripheral hearing sensitivity and intelligence, children and adults with auditory processing disorder (APD) have an inability or decreased ability to attend, discriminate, recognize or comprehend auditory information. Individuals with APD also have difficulty understanding speech in the presence of background noise, and following spoken instructions. Children with an auditory processing disorder often behave as if they have a hearing loss, and parents and teachers often complain that the child is ignoring them or not paying attention. When concerns exist, an APD evaluation can help to determine if there are medical aspects of the disorder that require treatment, to promote appropriate educational planning and to implement interventions such as environmental modifications, management strategies, auditory training, and/or FM assistive listening devices as necessary. Prerequisites for an APD evaluation include normal hearing sensitivity, normal cognitive abilities and a minimum age of nine years.

  • Characteristics of children with APD
  • Understanding APD in children

What is an APD evaluation?

Our goal is to provide a multidisciplinary approach to evaluating and managing auditory processing disorders. Therefore, a language assessment is recommended with a Speech-Language pathologist.

Tests from the following behavioral categories are included in the APD evaluation:

  • Dichotic
    Dichotic tests present a different stimulus to each ear simultaneously in order to assess binaural integration (repeat everything heard in both ears) or binaural separation (ignore what is heard in one ear and repeat what is heard in the other ear). Linguistically loaded and nonlinguistically loaded dichotic tests are selected.
  • Low-redundancy Monaural Speech
    These tests, presented to each ear separately, modify the acoustic stimulus to reduce the signal's redundancy through low-pass filtering, added noise, etc., in order to test auditory closure ability, the ability to fill in missing components (e.g., phonemes, syllables, words).
  • Temporal Processing
    Tests using tonal stimuli, require the listener to discriminate sound based on a sequence of auditory stimuli or temporal order in order to assess pattern perception and temporal functioning abilities.
  • Binaural Interaction
    These tests present similar stimuli to each ear in a non-simultaneous or sequential manner in order to assess binaural integration or interaction between the two ears.


Additional Resources

  • CAPD management tips for parents
  • CAPD management tips for teachers
  • Auditory processing disorders in children

Have Questions?

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