Short answer: pure tone audiometry measures how softly you can hear at each pitch, impedance audiometry checks the eardrum and middle ear, OAE screens the inner ear, and BERA measures the hearing nerve pathway without needing a response. Together they show the type and degree of hearing loss.
Why more than one test?
Hearing loss can come from the outer or middle ear (conductive), the inner ear or nerve (sensorineural), or both (mixed). Each test looks at a different part of this chain, so the combination tells the doctor where the problem is and whether medicine, surgery or a hearing aid is the right answer. The WHO fact sheet on hearing loss describes how common the problem is worldwide.
| Test | What it checks | Who it suits | Your part |
|---|---|---|---|
| Pure tone audiometry (PTA) | Softest sounds heard at each pitch, air and bone conduction | Adults and older children | Press a button when you hear a beep |
| Impedance audiometry | Eardrum movement, middle ear pressure, fluid, reflexes | All ages | Sit still for a minute or two |
| Speech audiometry | How clearly you understand words | Adults, hearing aid planning | Repeat words you hear |
| Otoacoustic emissions (OAE) | Function of the inner ear’s outer hair cells | Newborns and young children | None, a small probe sits in the ear |
| BERA / ABR | Hearing nerve and brainstem response | Infants, children, unclear results | Rest or sleep with electrodes on the head |
Special tests
Some patients need extra tests such as the Eustachian tube function test, tone decay test or SISI, which help separate inner ear problems from nerve problems. Free field audiometry is used for young children who respond better to sounds from speakers than headphones.
How to prepare
- Avoid loud noise for a day before the test if possible
- Tell the audiologist if one ear has wax, pain or discharge
- For a baby’s BERA, the test works best while the baby sleeps, so time a feed accordingly
After the test
The ENT doctor reads the results with your examination. If a hearing aid is advised, a hearing aid trial lets you try amplification before deciding. Children with hearing loss may also benefit from speech and language therapy.
Frequently asked questions
How long does a hearing test take?
Pure tone and impedance audiometry together usually take 20 to 30 minutes. BERA takes longer.
Is a hearing test painful?
No. None of these tests is painful. You may feel slight pressure during impedance testing.
At what age can hearing be tested?
From birth. OAE and BERA do not need the child to respond, so they work for newborns and infants.
About the author: Dr. Udayakumar, MBBS, MS (ENT), is a consultant ENT surgeon, otologist and vertigo & balance specialist with more than 13 years of experience, founder of Dr. Udaya’s ENT Wellness Centre and SAMANILAI Hearing & Balance Centre, Tambaram, Chennai. Read his profile.
This article is for general information and does not replace a consultation. Last updated: 26 September 2026.
