What Happens at a Hearing Evaluation in Portland: A Patient’s Guide to Northwest Hearing

Deciding to get your hearing checked is the easy part. Most people put it off for months or years before making the call. Once you do schedule, the next question is usually the same: what is actually going to happen when I get there?

A hearing evaluation at Northwest Hearing, NWPC’s audiology branch, is not a pass-fail test. It is a comprehensive assessment that gives your audiologist a detailed picture of how your hearing works across different frequencies and situations. Understanding what the appointment involves helps you prepare, know what to expect, and make sense of your results when you leave. Northwest Hearing serves patients throughout SE Portland and Clackamas County. If you are ready to schedule, call our scheduling team at (503) 659-4988 to request a new patient appointment.

Key Takeaways

Here is a brief overview of what follows:

• A hearing evaluation is a comprehensive diagnostic appointment. It measures how well you hear tones at different frequencies, how clearly you understand speech, and how your middle ear is functioning.
• The appointment typically runs 60 to 90 minutes. Your audiologist takes a thorough history before any testing begins, which is an important part of the evaluation.
• Results are explained at the same appointment. You will not leave wondering what your audiogram means. Your audiologist walks through the findings with you and discusses next steps.
• You do not need to have significant hearing loss to benefit from an evaluation. A baseline evaluation gives you a reference point for future comparisons, even if your hearing is currently within normal range.
• Northwest Hearing shares records with your NWPC primary care provider. Your audiologist’s findings go directly into the shared electronic health record, keeping your primary care team informed without extra coordination on your end.

Ready to schedule? Call (503) 659-4988 to make an appointment.

Before the Testing Begins: Your Hearing History

Your audiologist starts the appointment by taking a detailed history. This part of the evaluation matters as much as the testing itself. The information you provide shapes how your audiologist interprets your results and what they recommend.

You can expect questions about when you first noticed changes in your hearing, what situations give you the most difficulty, and if the problem affects one ear or both. Your audiologist will also ask about noise exposure history, including occupational noise, recreational noise such as concerts or shooting sports, and any use of hearing protection. Tinnitus, that ringing, buzzing, or hissing sound some people experience, is discussed here as well, since it frequently accompanies hearing changes.

Your medical history is relevant too. Certain medications, including some antibiotics, chemotherapy drugs, and loop diuretics, can affect hearing. A history of ear infections, ear surgeries, head injuries, or vertigo all provide useful context. Family history of hearing loss is worth mentioning, as genetics play a role in age-related hearing loss for many people.

Come prepared with a list of your current medications, and if possible, bring a family member or close friend. A second person often notices hearing difficulties that the patient has adapted to without realizing it, and their perspective can add useful detail to the history.

The Physical Examination

After the history, your audiologist examines your ear canals and eardrums using an otoscope, a small instrument with a light. This step identifies any visible issues that might affect your hearing or the testing results.

Earwax buildup is one of the most common findings. Significant cerumen impaction can block the ear canal enough to cause measurable hearing loss on its own. If your audiologist identifies impaction, they may address it before proceeding with testing or refer you to your primary care provider for removal, depending on the degree.

The examination also checks for signs of infection, structural abnormalities, fluid behind the eardrum, or perforations that might explain your symptoms. These findings influence which tests are most appropriate and how your results should be interpreted.

Pure Tone Audiometry

Pure tone audiometry is the core of the hearing evaluation. You sit in a sound-treated booth or room and wear headphones. Your audiologist plays tones at different frequencies and varying volume levels. Each time you hear a tone, you indicate it by pressing a button or raising your hand.

The test measures the softest sound you can hear at each frequency, establishing your hearing threshold at that pitch. Frequencies tested typically range from 250 Hz, which represents low-pitched sounds, to 8000 Hz, which represents high-pitched sounds. The range most critical for understanding speech falls between 500 Hz and 4000 Hz.

Your audiologist also tests bone conduction, placing a small vibrator behind your ear or on your forehead. Bone conduction bypasses the outer and middle ear and stimulates the inner ear directly. Comparing air conduction and bone conduction thresholds tells your audiologist where in the auditory system the hearing loss originates. A gap between the two suggests a conductive component, meaning something in the outer or middle ear is affecting transmission. When the two thresholds match, the loss is sensorineural, originating in the inner ear or auditory nerve.

Speech Audiometry

Pure tone testing measures your ability to detect sounds. Speech audiometry measures your ability to understand them. These are related but distinct, and patients sometimes score differently than expected on one relative to the other.

The speech recognition threshold test establishes the softest level at which you can correctly repeat back simple two-syllable words half the time. This threshold should closely match your pure tone average and serves as a cross-check of your audiogram results.

Word recognition testing evaluates how clearly you understand speech when it is loud enough to hear comfortably. Your audiologist presents a list of single-syllable words at a comfortable listening level, and you repeat each one back. Your score reflects the percentage you identify correctly. A high score with normal or near-normal pure tone thresholds may indicate that amplification would help you significantly. A lower score at a comfortable volume suggests that clarity, not just loudness, is part of the picture, which affects hearing aid selection and expectations.

Tympanometry and Acoustic Reflex Testing

Tympanometry assesses middle ear function by measuring how your eardrum responds to changes in air pressure. A small probe seals the ear canal and varies the pressure while measuring eardrum movement. This test is painless and takes only a few seconds per ear.

Normal tympanometry results indicate that the eardrum moves freely and the middle ear pressure is appropriate. Abnormal results may suggest fluid behind the eardrum, a stiff or scarred eardrum, a perforation, or problems with the small bones of the middle ear. These findings help your audiologist determine the nature of any hearing loss and guide treatment recommendations.

Acoustic reflex testing measures the response of the stapedius muscle in the middle ear to loud sounds. This reflex normally causes a slight stiffening of the middle ear system. Absent or abnormal reflexes provide additional diagnostic information about the location and nature of hearing loss and can occasionally indicate neurological involvement that warrants further evaluation.

Understanding Your Audiogram

At the end of testing, your audiologist reviews your results with you using the audiogram, a graph that plots your hearing thresholds across frequencies. Hearing levels are measured in decibels of hearing level, or dB HL. Normal hearing falls within zero to 25 dB HL across the tested frequencies.

Mild hearing loss sits between 26 and 40 dB HL. Moderate hearing loss falls between 41 and 55 dB HL. Moderately severe ranges from 56 to 70 dB HL. Severe hearing loss covers 71 to 90 dB HL, and profound hearing loss refers to thresholds above 90 dB HL.

The pattern of loss across frequencies tells its own story. Age-related hearing loss typically shows a high-frequency pattern, with thresholds dropping more steeply in the upper frequencies where consonant sounds like “s,” “f,” and “th” live. Noise-induced hearing loss often shows a characteristic notch around 4000 Hz. Conductive losses tend to affect all frequencies more evenly.

Your audiologist explains what your specific audiogram means for your daily listening experience, not just as numbers on a chart.

What Happens After Your Evaluation

Your audiologist discusses your results and recommends next steps based on the full picture of your evaluation. For patients with hearing loss that affects daily function, hearing aid evaluation and fitting may be the appropriate next step. For others, the recommendation might be monitoring with a follow-up evaluation in one to two years. For patients whose results suggest a medical issue, such as asymmetric hearing loss, sudden hearing changes, or abnormal acoustic reflex findings, your audiologist coordinates with your primary care provider or recommends a referral to an ear, nose, and throat physician.

Because Northwest Hearing operates within the Northwest Primary Care network, your evaluation results go directly into the shared electronic health record. Your primary care provider has access to your audiologist’s findings and recommendations without you needing to carry paperwork between offices or make separate calls to coordinate care.

You can reach our scheduling team by calling (503) 659-4988 or visit the Northwest Hearing page to learn more.

Frequently Asked Questions

How long does a hearing evaluation take?

A comprehensive hearing evaluation at Northwest Hearing typically runs 60 to 90 minutes. The history and physical examination take a meaningful portion of that time. Plan to arrive a few minutes early to complete any intake paperwork so your appointment starts on time.

Do I need a referral for a hearing evaluation?

Oregon law allows direct access to audiological services without a physician referral for diagnostic evaluations. However, some insurance plans require a referral for coverage. It is worth calling your insurance provider before your appointment to confirm your benefits. If you are an NWPC primary care patient, your provider can place a referral directly when one is needed.

What should I do to prepare for my hearing evaluation?

Come with a list of your current medications, your medical history including any ear surgeries or significant ear infections, and a sense of the listening situations where you struggle most. If a family member has commented on your hearing, bringing them along can be helpful. Avoid exposure to loud noise in the 16 hours before your appointment, as temporary threshold shifts from recent noise exposure can affect your results.

What is the difference between a hearing screening and a hearing evaluation?

A hearing screening is a brief pass-fail check, often conducted in a primary care office or at a health fair, that identifies people who may need further evaluation. A hearing evaluation is a comprehensive diagnostic assessment that measures specific thresholds across frequencies, evaluates speech understanding, and assesses middle ear function. Screenings identify who should be seen. Evaluations determine what is actually happening with their hearing.

Will my insurance cover a hearing evaluation?

Most major commercial insurance plans and Medicare cover diagnostic hearing evaluations when medically indicated. Coverage for hearing aids varies significantly and is handled separately from the diagnostic evaluation. Our team can verify your benefits before your appointment so you know what to expect. If you have questions about coverage, call (503) 659-4988 before scheduling.