Diagnostics for Adults

diagnostics for adults

Hearing Test

Who should get a hearing exam?
Anyone who feels that he or she is having difficulty hearing or understanding others should get a hearing exam. Oftentimes, family and friends will notice that you are asking them to repeat themselves, or that you turn the volume on the TV too loud. These can be early warning signs of a hearing loss. If you or your loved one exhibits any of the following symptoms, a hearing test is recommended:

  • Asking people to repeat themselves
  • Withdrawing from conversations or social situations
  • Misunderstanding or responding inappropriately to questions
  • Setting the television or radio volume louder than normal
  • Feeling as though other people are mumbling
  • Speaking at a louder volume than normal
  • Ringing in the ears (tinnitus)
  • Seeming forgetful or inattentive
  • Poor speech or language abilities (especially in children). A diagnosis of speech or language disorder from a speech-language pathologist should usually be accompanied by a hearing exam.

If you decide to come to Link for an evaluation, it will help to take note of when and where you have difficulties; as part of our patient-centric approach, we take that information into account to develop individualized treatment plans for each patient. It may also be helpful to bring a friend or family member – someone with whom you regularly communicate – to provide feedback.

What does a hearing exam involve for adults?
A hearing exam is a noninvasive procedure that consists of several behavioral and physiological tests. Depending on your case history, your exam may include some or all of the following tests:

Otoscopic Exam: the audiologist will look in your ears to ensure that the ear canals are clear of earwax, debris, or foreign objects. We observe anatomical markers, check that the eardrum is intact, and look for any visible abnormalities such as infection.

Tympanometry: the audiologist uses a device (a tympanometer) that changes the air pressure in your ear canal while measuring the sound that bounces back from the eardrum. This helps us detect infections, perforations, ossicular disarticulations, and other conditions of the outer and middle ear that may not be visible during the otoscopic exam. For the patient, this test feels as though you are traveling in an elevator for a few seconds.

Middle Ear Reflexes: the audiologist uses the tympanometer to play some loud sounds for a few seconds and stimulate the middle ear reflex. Observing this reflex helps to identify neurological problems that could cause or contribute to hearing problems.

Otoacoustic Emissions (OAEs): the audiologist uses a device to play some sounds in your ear. If the inner ear is functioning correctly, it generates an echo, which is then measured by the device. Observing these echoes helps to identify problems in the inner ear that can cause or contribute to hearing problems.

Puretone Audiometry: the audiologist presents sounds to find the softest sounds that you can hear at different pitches. These scores, called puretone thresholds, are compiled into a graph to illustrate which environmental and speech sounds you are able or unable to hear.

Speech audiometry: the audiologist plays some recorded words through a pair of calibrated headphones and asks you to repeat them. This allows us to observe how well you are able to detect and recognize speech.

Most Comfortable Loudness (MCL)/Uncomfortable Loudness (UCL): the audiologist will play some sounds to find the loudness that is most comfortable for you and the loudest sounds that you can tolerate. These scores give us the dynamic range of your hearing abilities and help ensure that any hearing aids or other amplification devices remain comfortable and audible.

How long does it take to complete a hearing exam?
It typically takes about a half an hour to complete the exam portion of a hearing evaluation. We allow for extra time for counseling before the exam and to go over the results after the exam. Please account for up to an hour and a half for your appointment to ensure that we can address all of your questions and concerns.

If you have any other questions or concerns about scheduling a hearing examination, please feel free to call us at 360-551-4800. If an audiologist is not available to answer your questions, we will call you back as soon as possible.

Hearing Screening for Businesses

If you or your employees are exposed to loud noise at work, you may be subject to OSHA regulations to prevent occupational noise-induced hearing loss. We offer both baseline and annual hearing screenings at a competitive rate and help you maintain records to stay compliant with those regulations.

Industrial hearing screenings are only one part of a comprehensive hearing conservation program. OSHA requires that employers monitor the daily noise exposure levels for employees, use administrative fixes to limit exposure, and provide hearing protection along with instruction to use it properly. We can help with your annual reviews and provide bulk discounts for hearing protection to keep you in compliance with OSHA regulations.

Contact us for additional information and pricing options for you and your employees!

Diagnostic ABR

A diagnostic Auditory Brainstem Response (ABR) is a test that looks at neural responses to sound to determine whether lesions or other abnormalities exist in the ear, along the auditory nerve, or in the brainstem. Some wires are taped to the patient’s scalp and ears and connected to a computer. The computer then records neural responses to sound. For a diagnostic ABR, we look at the timing of the neural response, how it differs between ears, and how long it takes the response to move up the brainstem. This can tell us whether and where a problem exists within the lower central auditory pathway.

Diagnostic ABRs are usually indicated for one or two reasons: (1) to mitigate the need for high-cost and high-stress imaging like MRIs; or (2) when the patient cannot have an MRI or CT scan because of a medical condition or implant.

No preparation is really required for an ABR. You can sleep through the entire procedure. However, we may need to perform a standard hearing test before your ABR to ensure that the ABR produces valid results. Anticipate a 1-2 hour appointment to complete the diagnostic ABR.

Central Auditory Processing

What are Auditory Processing Disorders (APD) and whom do they affect?
Some people have difficulty understanding speech, even though their ears are working normally. When this occurs, it may be because the brain is unable to process the sounds correctly. So a person with APD might respond to the statement “Tell me something about a cat” by saying something inappropriate, like “It’s what you do on a stage.” In that particular instance, the person confused the sequence of letters in the word cat and heard the word act instead. APD may affect anyone, but it is most prominent in children as they are learning to listen to speech. Adults may also be affected by APD that went undiagnosed in their childhood or developed with traumatic brain injury. Since there are different models for diagnosis, and APD symptoms tend to overlap with those of other conditions like ADD/ADHD, it is difficult to tell exactly who may be affected by APD. Dr. Grolley and Dr. Souza both learned to diagnose and treat APD by Dr. Jeananne Ferre, one of the co-developers of the Ferre-Bellis model.

What is the Ferre-Bellis model?
The Ferre-Bellis model aims to not only diagnose APD, but to determine where the problem exists within the brain and what specific processes are deficient, and then prescribe a rehabilitation program based on that information. This is important because the brain doesn’t just hear a word and produce a response; it dissects sound, identifies the individual components, puts it back together, attaches meaning to the sound, cross-references it to other parts of the brain for linguistic and emotional content, generates an appropriate response, then sends that information to the motor cortex to verbalize the response. And all of this happens in just a few milliseconds! When you understand this process, it becomes evident that there are a lot of places where the process can break down. It is for this reason that the Ferre-Bellis model breaks APD into 5 different types (3 primary and 2 secondary) and prescribes a rehabilitation program based on the APD type.


What is tinnitus and who is affected by it?
Tinnitus is a sound that you hear that no one else can hear. It is one of the leading complaints related to the ears and the #1 complaint of returning veterans. The type of sound can vary from person to person – some hear ringing, others hearing buzzing, or wind noise, or static. In most cases (97% or more), the tinnitus is subjective, meaning it cannot be measured by putting a microphone in the ear.

Scientific studies have shown that subjective tinnitus is generated in the brain and not in the ear. It typically occurs with a hearing loss, as the brain is trying to adjust for the decreased ability to perceive sound. Because it cannot hear the sounds that it used to, the brain seeks out the missing sounds. Unable to identify the source of the sound, many people react to it on an emotional level with symptoms including heightened anxiety, depression, and even thoughts of suicide. But there are options for treatment that have been shown to be very effective when properly administered.

What does a tinnitus exam involve?
A tinnitus exam is similar to a standard audiometric exam. In addition to the tests described in the hearing test section, you will be asked to complete a survey about your tinnitus and respond to sounds to try and match the pitch and loudness of your tinnitus. We will avoid loud sounds in this exam, as those sounds may exacerbate your tinnitus. The goal of the evaluation is to determine what your tinnitus sounds like, how it is impacting you, and the best treatment to address the problem.

How long does a tinnitus evaluation take?
Because the tinnitus evaluation requires more tests and counseling than the typical hearing test, we schedule 2 hours for each tinnitus evaluation. Though we may finish the exam in less time, please plan on spending the full 2 hours.