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What is Hearing Screening?


Screening for hearing loss in the general population should be an important part of all physical examinations. The most common general populations for hearing loss are young children and aging adults. The most common types of hearing loss are:

1 - Aging Hearing Loss
2 - Conductive Hearing Loss
3 - Sensorineural Hearing Loss

As our exposure to noise increases with the many opportunities and changes in our world, so does the probability of some degree of hearing loss. In days gone by, one's environment had the sounds of nature. Now we enjoy concerts, sporting events, electronic games, cell phones, home theater and other leisure time activities with an increase in loudness of what we hear. Our ears and their ability to hear are constantly challenged.

The SOAR Protocol

The S-O-A-R Protocol was developed for the health professional for hearing screening, but is equally important for parents and other health care providers to utilize. It gives the very basic steps needed to quicly assess if a problem may exist.


Frequency (Hz)







20 dB HL

20 dB HL

20 dB HL

General Population

May Omit

25 dB HL

25 dB HL

25 dB HL



40 dB HL

40 dB HL

40 dB HL

SCREEN -   Use the OtoScreen device and screen at 500, 1000, 2000 & 4000 Hz
OBSERVE - Look for signs of Hearing Loss
ASK -         "Do you have any trouble with your hearing?"
REFER -       All abnormal or questionable results for appropriate follow-up

See the user manul for more detailed information.

Common Types of Hearing Loss

Aging Hearing Loss

Significant hearing loss is experienced by 20 to 30 million Americans. Presbycusis, or aging hearing loss is the most common type. At age 65, approximately one third of the population could benefit from amplification (use of a hearing aid). Aging causes abnormalities in the inner ear (cochlea) such as stiffening of membranes and loss of sensory cells (hair cells). There is typically no medical cure for aging hearing loss unless the cause is the outer or middle ear. An audiologist or otolarynologist (ear, nose and throat physician) should be consulted in all cases of hearing loss to determine the cause and possibilities for remedication (improvement in a patient's ability to hear). Hearing aids usually benefit aging hearing loss but should be applied early for better results.

Conductive Hearing Loss

Conductive hearing loss is due to abnormalities of the outer or middle ear where the eardrum and "ossicles" (hammer, anvil and stirrup) are located. Because these structures serve to merely conduct sound into the deeper neural structures of the cochlea, problems are more readily correctable than is the case with "sensorineural" hearing loss.

Common causes of "conductive" hearing loss are fluid in the middle ear, "cerumen" (ear wax) and stiffening of the middle ear bones (ossicles). All of these conditions lend themselves well to surgical or medical correction. Such procedures are usually very successful and effective since there is no neural damage or accompanying loss of clarity. If hearing aids are the preferred treatment, these are also nearly always successful.

Sensorineural Hearing Loss

This is the most common type of hearing loss and is the type found in most cases of aging loss (prebycusis), hereditary loss, noise damage as well as sequalai to certain medical conditions. It's cause is damage to the delicate sensory and/or nerve structures found in the snail-shaped "cochlea". This type of loss may occasionally be caused by more serious medical conditions such as tumors or neurological conditions. Because the cochlea is such a delicate structure, most major diseases have the capability of damaging it as is also true of many medicines. Fortunately, most cases of sensorineural hearing loss can be rehabilitated by use of hearing aids or other medical treatment. Audiological or medical consultation is always warranted prior to purchase of a hearing aid in order to determine need for alternative follow-up. Sensorineural loss may also be accompanied by tinnitus (ringing in the ear), vertigo (dizziness), or reduced clarity of words. Common complaints of persons with this type of loss are inability to hear in noisy places such as restaurants or at parties. The loss is so gradual in onset that the patient often accuses his family or friends of mumbling. "People just don't speak up these days" is a common theme. The loss is typically worse in the high frequencies, affecting mainly consonant's sounds, which give rise to the loss of clarity of words

Hearing Aids

Hearing aids come in many forms and have generally been greatly improved over the last few years. Not only has size greatly decreased, but sound quality has been greatly improved due to a combination of advanced technology and knowledge concerning the "prescription methods"

Hearing aids, when properly fit by audiologists or other hearing professionals, amplify only the frequencies corresponding to the patient's loss on the "audiogram". Though two hearing aids may look identical, internally their circuitry should differ according to the type of hearing loss of the individual. While hearing aids cannot cancel all background noise, there has been progress in this area. The greatest strides in noise reduction have come in the form of "directional" microphones, "completely-in-the-canal" (CIC) configurations in which the entire aid fits deep within the canal allowing for the natural amplification of the outer ear, "active filtering" circuits which change the amplification of certain sounds depending on the background noise conditions, and finally, true "digital" circuitry. Sometimes such innovations when first introduced are over prescribed as a panacea for all cases. In certain instances, sound processing of these types may actually degrade the signal. Proper consultation and a trial period are essential to choosing the right instrument.

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