Hearing Evaluation


Audiological Assessments

A&A Audiology is a leading provider of comprehensive diagnostic evaluations for adults and children. Our evaluations are the first step in identifying and addressing hearing problems.

Our evaluations include a variety of tests, such as otoscopy, air and bone conduction pure tone audiometry, full immittance testing, otoacoustic emissions, and speech recognition measures. We use special techniques and tests to assess the hearing ability of very young children.

Following the evaluation, your audiologist will present the results and answer any questions you may have. They will also give you recommendations based on the evaluation. If hearing aids or other assistive devices are recommended, we will schedule a hearing aid evaluation appointment.

We understand that hearing loss can be a challenging condition, but we are here to help you every step of the way. Our team of experienced audiologists is dedicated to providing you with the highest quality care.

Immittance Audiometry

Acoustic immittance measures are a set of tests that assess the function of the middle ear and the acoustic reflex pathway. Tympanometry and acoustic reflex thresholds are the most common measures, and they can provide information about the presence of hearing loss, middle ear disorders, and other conditions that affect hearing. Advanced measures, such as multifrequency tympanometry and absorbance/reflectance measures, can provide more detailed information about the function of the middle ear. Acoustic immittance measures are noninvasive and painless, and they can be performed on people of all ages.

Otoacoustic Emmissions

Otoacoustic emissions (OAEs) are sounds produced by the outer hair cells in the cochlea. They can be used to differentiate between cochlear and retrocochlear hearing loss. OAEs are objective and noninvasive and can be used to assess hearing in difficult-to-test populations.

Diagnostic Services

Comprehensive Pediatric and Adult Audiological Assessment

A comprehensive audiological assessment is conducted to determine the presence, type, configuration, and severity of hearing impairment. Routine audiometry is performed, as well as special testing such as immittance, otoacoustic emissions, and speech-in-noise testing. The results of these tests are used to make recommendations for medical intervention, further evaluation, and/or avenues available to improve communication, such as hearing aids or cochlear implants.

Vestibular Assessment

Vestibular services offer a comprehensive battery of tests to evaluate a patient's balance system. Electronystagmography (ENG) and videonystagmography (VNG) are used to record and analyze eye movements, which can help us determine how well the balance system is working. Eye movements can be recorded using electrodes taped around the eyes or by infrared goggles.

Electrophysiological Assessments

Our electrophysiology lab offers a variety of specialized diagnostic tests, including:

  • Electrocochleography (ECochG)
  • Auditory brainstem response (ABR)
  • Middle latency response (MLR)
  • Late latency response (LLR)
  • Auditory steady-state response (ASSR)
  • Stacked auditory brainstem response (SABER)
  • Vestibular-evoked myogenic potentials (VEMPs)

These tests are used to assess the function of the auditory and vestibular systems. They can be used to diagnose hearing loss, vestibular disorders, and other neurological conditions.

Auditory Processing Disorder Assessments

Auditory Processing Disorder (APD) assessments are available for children (7 years or older) and adults who may have difficulty attending to, discriminating, recognizing, or comprehending auditory information. Audiology-based assessments are combined with language assessments to provide a comprehensive 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) is a hearing exam that measures three electrical potentials in the inner ear: the cochlear microphonic, the cochlear summating potential, and the auditory nerve action potential. ECochG is useful in intraoperative monitoring and for evaluating possible cases of Meniere's disease.
  • The Auditory Brainstem Response (ABR) is a test that measures the electrical activity of the auditory nerve and brainstem in response to sound. The waves that are recorded in an ABR originate in the eighth cranial nerve and brainstem auditory structures, including the lateral lemniscus and inferior colliculus. ABRs are used in the neurodiagnosis of eighth nerve or auditory brainstem dysfunction.
  • The middle latency response (MLR) and late latency response (LLR) are two types of auditory evoked potentials that are used to assess auditory function. The MLR originates from the upper brainstem and/or auditory cortex, while the LLR originates primarily in the auditory cortex. The MLR is used in the neurodiagnosis of auditory central nervous system disorders above the brainstem level, while the LLR is used for frequency-specific estimation of hearing sensitivity in cooperative children and adults.
  • The stacked auditory brainstem response (SABR) is a modification of the standard ABR that uses click stimuli mixed with high-pass masking noise to generate activity in virtually all auditory nerve fibers, rather than just a subset as in the standard ABR. This makes the SABR more sensitive to small acoustic tumors that may be missed by the standard ABR.
  • Vestibular evoked myogenic potentials (VEMPs) are a type of electromyography (EMG) that measures the electrical activity of neck and spinal muscles in response to high-intensity acoustic input. VEMPs are important in the evaluation of patients who are dizzy because they can help to determine the origin of the problem.
  • The cochlear hydrops analysis masking procedure (CHAMP) is a test that measures the response properties of the basilar membrane in an auditory brainstem response (ABR) to clicks. The CHAMP is used to establish the presence of cochlear hydrops, which is a condition that causes the inner ear to swell.


To schedule an appointment, please contact the Clinic.

Auditory Processing Disorder Assessment


What is an Auditory Processing Disorder?

Auditory processing disorder (APD) is a condition that affects how the brain processes auditory information. People with APD have normal hearing sensitivity and intelligence, but they have difficulty attending to, discriminating, recognizing, and comprehending auditory information. This can make it difficult for them to understand speech in noisy environments, follow spoken instructions, and learn in a traditional classroom setting.

There is no cure for APD, but there are treatments that can help. These treatments may include environmental modifications, management strategies, auditory training, and/or FM assistive listening devices.

If you are concerned that your child or you may have APD, it is important to see an audiologist for an evaluation. An audiologist can assess your hearing and cognitive abilities and determine if you have APD. They can also recommend appropriate treatments.

The prerequisites for an APD evaluation include:

  • Normal hearing sensitivity
  • Normal cognitive abilities
  • A minimum age of nine years

If you meet these prerequisites, you may be eligible for an APD evaluation. An evaluation can help you to understand your condition and develop a treatment plan.

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 different stimuli to each ear simultaneously to assess binaural integration and separation. Linguistically and non-linguistically loaded tests are used.
  • Low-redundancy Monaural Speech
    These tests present filtered or noise-added speech to each ear separately to assess auditory closure ability, the ability to fill in missing components of speech (e.g., phonemes, syllables, words).
  • Temporal Processing
    Tonal pattern perception and temporal functioning abilities can be assessed by tests that require listeners to discriminate sound based on a sequence of auditory stimuli or temporal order.
  • Binaural Interaction
    Binaural integration and interaction between the two ears can be assessed by tests that present similar stimuli to each ear in a non-simultaneous or sequential manner.


Additional Resources

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

Have Questions?

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