But not all people know that they have a problem. You may not realize that you have hearing loss, because it’s often a gradual process. That’s why it’s important to have your ears checked when your doctor says you should, even if you think you’re fine.

• Being around loud noises often at work
• Mowing the lawn or using power tools
• Shooting guns or other weapons
• Loud music, both live and recorded
• Too much ear wax
• Getting hit on the head
• Having an infection
• Taking certain drugs
• Problems with hearing that run in the family

Type of Hearing Test

PTA (Pure Tone Audiometry)

Pure-tone audiometry is a behavioral test used to measure hearing sensitivity. This measure involves the peripheral and central auditory systems. Pure-tone thresholds (PTTs) indicate the softest sound audible to an individual at least 50% of the time. Hearing sensitivity is plotted on an audiogram, which is a graph displaying intensity as a function of frequency.

Impedance

The primary purpose of impedance audiometry is to determine the status of the tympanic membrane and middle ear via tympanometry. The secondary purpose of this test is to evaluate acoustic reflex pathways, which include cranial nerves (CN) VII and VIII and the auditory brainstem. This test cannot be used to directly assess auditory sensitivity, although results are interpreted in conjunction with other threshold measures.
Acoustic immittance is a measurement of energy or air pressure flow, which involves the ear canal, eardrum, ossicular chain, tensor tympani, stapedius muscle, cochlea, CNs VII and VIII, and the brainstem. Mass, mobility, and resistance of the outer and middle ear systems affect this test

OAE

OAE stands for otoacoustic emissions, the name for the sounds produced by the cochlea. These sounds can be used to test the function of the cochlea (specifically hair cell function) and other parts of the ear, including the auditory nerve.

Otoacoustic Emissions Hearing tests are usually performed on newborn babies to detect deafness.2 The test can also partially estimate hearing sensitivity and test for functional hearing loss. Functional hearing loss is also sometimes referred to as non-organic hearing loss and is a condition where you have symptoms or behaviors of hearing loss but there is nothing actually wrong with your hearing.

Some sources might refer to this as feigned hearing loss but that's probably not completely accurate as this implies that someone is "faking it" and this type of hearing loss has multiple origins that are not always within an individuals control.

Otoacoustic Emissions Hearing tests are commonly used in conjunction with the ABR (Auditory Brainstem Response) hearing test or other hearing tests.

BERA (Brainstem Evoked Response Audiometry)

Brain Evoked Response Auditory (BERA) is a hearing examination performed on children aged 1 to 3 years. Meanwhile, for children with a smaller age, Oto Acoustic Emission (OAE) examination can be carried out. If the BERA test results are stated in good condition, it can be concluded that the child’s hearing function is within normal limits and no further medical treatment is necessary. However, if the BERA test results are declared abnormal, then the examination will continue with the estimation or prediction of the hearing threshold and hearing rehabilitation must be carried out as early as possible by using hearing aids. BERA test itself will take approximately one hour.

Why do the BERA Test?

Hearing loss in children is difficult to know from the beginning. Hearing loss can cause speech, language, cognitive, social and emotional problems. Therefore, it will be better if the hearing test in children is done early.
Healthy hearing is when the auditory nerve is able to transmit sound impulses from the ear to the brain at a certain speed. The BERA test can provide information on whether nerves convey sound impulses to the brain and whether the speed of sound delivery is within normal limits. This hearing examination can determine the type of abnormality (conductive or sensorineural), severity (hearing threshold), and hearing loss (inner ear or other parts) of the child.
In addition, in determining the hearing threshold, BERA is also used in otoneurologic diagnosis. This is useful for patients with unilateral or asymmetrical hearing loss (hearing nerve tumors, brain tumors, other nerve disorders, multiple sclerosis, etc.).

BERA Test Procedure

BERA can be done without the patient needing to do anything. Patients only need to lie down and preferably in a calm attitude or while sleeping. For children, this examination can be done in the wake, sleep, or in anesthesia (although rarely). Electrodes will be placed on the patient’s head and behind the ear during the BERA test procedure. When the examination is done, the patient will be heard various sounds through headphones. This examination measures changes in brain electrical activity (EEG) in the provision of acoustic stimuli. Abnormalities that occur in the transmission of signals when the sound is heard indicates hearing loss.
This examination has no risk of complications, is painless, and does not require special preparation for the BERA test.

ASSR (Auditory Steady State Response)

The auditory steady-state response (ASSR) can be thought of as an electrophysiologic response to rapid auditory stimuli. The goal of ASSR is to create an estimated audiogram from which questions regarding hearing, hearing loss, and aural rehabilitation can be answered.
ASSR allows the hearing care professional to create statistically valid audiograms for those unable or unwilling to participate in traditional behavioral tests. ASSR relies on statistical measures to determine if and when a threshold is present. ASSR design and functionality vary across manufacturers. Authors’ note: ASSR was previously referred to as SSEP (Steady State Evoked Potential) and/or AMFR (Amplitude Modulation Following Response).
This article offers a basic orientation to ASSR, using examples based on the most recent refinements and offerings from Interacoustics.

ECOG

Electrocochleography is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter. ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear. ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged

VEMP (Vestibular Evoked Myogenic Potential Testing)

Vestibular evoked myogenic potential (VEMP) is an emerging diagnostic tool for identifying vestibular lesions. The VEMP test is noninvasive and causes little or no discomfort to the patient. The VEMP test is administered like the traditional auditory brain stem response [ABR] test using surface electrodes placed on sternocleidomastoid muscles to detect sound evoked potentials due to inhibitory muscle activity in response to suprathreshold tonal sounds in each ear. VEMP testing targets the vestibule and neural connections to the sternocleidomastoid muscles of the neck. The VEMP neural pathway consists of the saccule, inferior vestibular nerve, and vestibulospional tract. [10] VEMP so far has been mainly useful in documenting abnormally low thresholds in persons with the Tullio effect, which mostly occurs in patients with fistulae or superior canal dehiscence syndrome (SCD).