Protocol - Audiogram Hearing Test
The National Health and Nutrition Examination Survey (NHANES) 2008-2009 audiometry protocol tests the examinee's hearing threshold (in decibels, dB) at 7 frequencies in a soundproof room. Examinees are asked a series of exclusionary questions, undergo an outer-ear examination (otoscopy), and then have the mobility of their eardrum tested (acoustic immittance). Pure tone signals are then presented to each ear through earphones and the intensity of the signals is varied until the level is identified at which the person is just able to hear the sound.
A downloadable PDF of the full 2009–2010 National Health and Nutrition Examination Survey (NHANES) Audiometry Procedures Manual is available here: NHANES Audiometry Procedures Manual
The following is a summary version of the full National Health and Nutrition Examination Survey (NHANES) audiometry protocol. This is not intended to replace the actual protocol.
There are no conditions that would prevent an eligible, consenting examinee from completing the protocol.
Examinees are asked to remove glasses, gum, earrings, or anything else that may interfere with the headphones. Examinees are asked to remove hearing aids. If hearing aids cannot be removed, the examinee skips the audiogram.
Examinees are asked about conditions that affect how the test is conducted or how results are interpreted. These questions include whether the examinee:
- has tubes in either ear
- has a cold or earache
- has been exposed to loud noise in the last 24 hours, and
- hears better in one ear or the other
The technician performs a visual inspection of the outer ear and records any abnormalities of the ear, the presence of excessive ear wax, perforation or inflammation of the ear drum, and whether the ear canal is collapsed.
For each ear, the technician uses the size and direction of the ear canal to properly select the cuff to seal the ear canal. The technician then places the typanometer probe in the examinee's ear, ensures an airtight seal, and performs the test.
The result of the acoustic immittance test is a graph (tympanogram) which is evaluated based on smoothness and symmetry. The test should be repeated once if the tympanogram is flat or if the results are not clear.
The technician ensures that the respondent has removed hearing aids and anything that might interfere with the proper placement of the headphones. The technician fits the standard headphones (or inserts headphones if there are collapsed ear canals) over the examinee's ears and makes sure that the examinee is seated so that he/she can be seen by the examiner during the test.
The pure tone audiometry test is controlled by a computer program.
The technician will control the frequency, stimulus level, and test signals and make a threshold determination under the following circumstances:
- Examinee cannot operate the response switch
- Examinee cannot "keep up with" the automated test
- Examinee records three false positives
- Examinee threshold exceeds 100 decibels
The technician can begin manual testing after the automated protocol has begun, but must complete the test using the manual protocol.
Record the Audiometry Results
The technician records which headphones were used, which ear was tested first, whether the test was performed manually, and the threshold (in decibels) for each ear at the following frequencies:
- 500 hertz
- 1,000 hertz
- 2,000 hertz
- 3,000 hertz
- 4,000 hertz
- 6,000 hertz
- 8,000 hertz
Mild hearing loss
Moderate hearing loss
Moderately severe hearing loss
Severe hearing loss
Profound hearing loss
Please consult the American Speech-Language-Hearing Association and National Institute for Occupational Safety and Health for the most current classification schemes.
Protocol Name from Source:
This section will be completed when reviewed by an Expert Review Panel.
Personnel and Training RequiredThis protocol should be completed by a medical technician capable of performing a visual examination of the outer ear (otoscopy), testing the mobility of the eardrum (acoustic immittance), and performing the audiometry protocol.
Equipment NeedsA complete list of the equipment and supplies needed for audiometry can be found in Appendix A of the National Health and Nutrition Examination Survey Audiometry Procedures Manual [alink[NHANES_audiometry_09.pdf|NHANES Audiometry Procedures Manual]].
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||Yes|
Mode of Administration
Child, Adolescent, Adult, Senior
Adolescents and adults, ages 12-19 years and older than 70 years
The National Health and Nutrition Examination Survey (NHANES) 2008-2009 audiometry protocol is one of the most widely used protocols to measure hearing sensitivity and was selected as the best practice methodology.
|Common Data Elements (CDE)||Hearing Audiogram Hearing Test Assessment Score||3144946||CDE Browser|
|Logical Observation Identifiers Names and Codes (LOINC)||Audiogram hearing test proto||62977-4||LOINC|
Process and Review
This section will be completed when reviewed by an Expert Review Panel.
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). (2009–2010). National Health and Nutrition Examination Survey Audiometry Procedures Manual. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
|Variable Name||Variable ID||Variable Description||Version||dbGaP Mapping|
|PX200101_2000HzRestest_Left_Ear_CNO||PX200101160401||2000 Hz threshold (Left Ear):||N/A|
|PX200101_2000HzRestest_Right_Ear_CNO||PX200101150401||2000 Hz threshold (Right Ear):||N/A|
|PX200101_2000HzRestest_Threshold_Left_Ear||PX200101160400||2000 Hz threshold (Left Ear):||N/A|
|PX200101_2000HzRestest_Threshold_Right_Ear||PX200101150400||2000 Hz threshold (Right Ear):||N/A|
|PX200101_2000Hz_Left_Ear_CNO||PX200101140501||2000 Hz threshold (Left Ear):||N/A|
|PX200101_2000Hz_Right_Ear_CNO||PX200101130501||2000 Hz threshold:||N/A|
|PX200101_2000Hz_Threshold_Left_Ear||PX200101140500||2000 Hz threshold (Left Ear):||N/A|
|PX200101_2000Hz_Threshold_Right_Ear||PX200101130500||2000 Hz threshold:||N/A|
|PX200101_3000HzRestest_Left_Ear_CNO||PX200101160501||3000 Hz threshold (Left Ear):||N/A|
|PX200101_3000HzRestest_Right_Ear_CNO||PX200101150501||3000 Hz threshold (Right Ear):||N/A|
|PX200101_3000HzRestest_Threshold_Left_Ear||PX200101160500||3000 Hz threshold (Left Ear):||N/A|
|PX200101_3000HzRestest_Threshold_Right_Ear||PX200101150500||3000 Hz threshold (Right Ear):||N/A|
|PX200101_3000Hz_Left_Ear_CNO||PX200101140601||3000 Hz threshold (Left Ear):||N/A|
|PX200101_3000Hz_Right_Ear_CNO||PX200101130601||3000 Hz threshold:||N/A|
|PX200101_3000Hz_Threshold_Left_Ear||PX200101140600||3000 Hz threshold (Left Ear):||N/A|
|PX200101_3000Hz_Threshold_Right_Ear||PX200101130600||3000 Hz threshold:||N/A|
|PX200101_4000HzRestest_Left_Ear_CNO||PX200101160601||4000 Hz threshold (Left Ear):||N/A|
|PX200101_4000HzRestest_Right_Ear_CNO||PX200101150601||4000 Hz threshold (Right Ear):||N/A|
|PX200101_4000HzRestest_Threshold_Left_Ear||PX200101160600||4000 Hz threshold (Left Ear):||N/A|
|PX200101_4000HzRestest_Threshold_Right_Ear||PX200101150600||4000 Hz threshold (Right Ear):||N/A|
|PX200101_4000Hz_Left_Ear_CNO||PX200101140701||4000 Hz threshold (Left Ear):||N/A|
|PX200101_4000Hz_Right_Ear_CNO||PX200101130701||4000 Hz threshold:||N/A|
|PX200101_4000Hz_Threshold_Left_Ear||PX200101140700||4000 Hz threshold (Left Ear):||N/A|
|PX200101_4000Hz_Threshold_Right_Ear||PX200101130700||4000 Hz threshold:||N/A|
|PX200101_500HzRestest_Left_Ear_CNO||PX200101160201||500 Hz threshold (Left Ear):||N/A|
|PX200101_500HzRestest_Right_Ear_CNO||PX200101150201||500 Hz threshold (Right Ear):||N/A|
|PX200101_500HzRestest_Threshold_Left_Ear||PX200101160200||500 Hz threshold (Left Ear):||N/A|
|PX200101_500HzRestest_Threshold_Right_Ear||PX200101150200||500 Hz threshold (Right Ear):||N/A|
|PX200101_500Hz_Left_Ear_CNO||PX200101140301||500 Hz threshold (Left Ear):||N/A|
|PX200101_500Hz_Right_Ear_CNO||PX200101130301||500 Hz threshold (Right Ear):||N/A|
|PX200101_500Hz_Threshold_Left_Ear||PX200101140300||500 Hz threshold (Left Ear):||N/A|
|PX200101_500Hz_Threshold_Right_Ear||PX200101130300||500 Hz threshold (Right Ear):||N/A|
|PX200101_6000HzRestest_Left_Ear_CNO||PX200101160701||6000 Hz threshold (Left Ear):||N/A|
|PX200101_6000HzRestest_Right_Ear_CNO||PX200101150701||6000 Hz threshold (Right Ear):||N/A|
|PX200101_6000HzRestest_Threshold_Left_Ear||PX200101160700||6000 Hz threshold (Left Ear):||N/A|
|PX200101_6000HzRestest_Threshold_Right_Ear||PX200101150700||6000 Hz threshold (Right Ear):||N/A|
|PX200101_6000Hz_Left_Ear_CNO||PX200101140801||6000 Hz threshold (Left Ear):||N/A|
|PX200101_6000Hz_Right_Ear_CNO||PX200101130801||6000 Hz threshold:||N/A|
|PX200101_6000Hz_Threshold_Left_Ear||PX200101140800||6000 Hz threshold (Left Ear):||N/A|
|PX200101_6000Hz_Threshold_Right_Ear||PX200101130800||6000 Hz threshold:||N/A|
|PX200101_8000HzRestest_Left_Ear_CNO||PX200101160801||8000 Hz threshold (Left Ear):||N/A|
|PX200101_8000HzRestest_Right_Ear_CNO||PX200101150801||8000 Hz threshold (Right Ear):||N/A|
|PX200101_8000HzRestest_Threshold_Left_Ear||PX200101160800||8000 Hz threshold (Left Ear):||N/A|
|PX200101_8000HzRestest_Threshold_Right_Ear||PX200101150800||8000 Hz threshold (Right Ear):||N/A|
|PX200101_8000Hz_Left_Ear_CNO||PX200101140901||8000 Hz threshold (Left Ear):||N/A|
|PX200101_8000Hz_Right_Ear_CNO||PX200101130901||8000 Hz threshold:||N/A|
|PX200101_8000Hz_Threshold_Left_Ear||PX200101140900||8000 Hz threshold (Left Ear):||N/A|
|PX200101_8000Hz_Threshold_Right_Ear||PX200101130900||8000 Hz threshold:||N/A|
|PX200101_Audiometry_Ear_Could_Not_Obtain||PX200101110000||Could not obtain||N/A|
|PX200101_Audiometry_First_Ear_Tested||PX200101100000||Ear tested first||Variable Mapping|
|PX200101_Audiometry_Headphones_Used_Original_Test||PX200101120000||Headphones used (original test):||N/A|
|PX200101_Audiometry_Left_Ear_Test_Mode||PX200101140000||Test mode left ear||N/A|
|PX200101_Audiometry_Right_Ear_Test_Mode||PX200101130000||Test mode right ear||N/A|
|PX200101_Cold_Sinus_Problem||PX200101030000||Have you had a cold, sinus problem or earache in the last 24 hours?||N/A|
|PX200101_Cold_Sinus_Specify_Cold||PX200101030101||(If yes) Which have you had (check all that apply)? Cold||N/A|
|PX200101_Cold_Sinus_Specify_Dont_Know||PX200101030107||(If yes) Which have you had (check all that apply)? Don't know||N/A|
|PX200101_Cold_Sinus_Specify_Earache_Both||PX200101030105||(If yes) Which have you had (check all that apply)? Earache, both ears||N/A|
|PX200101_Cold_Sinus_Specify_Earache_Left||PX200101030104||(If yes) Which have you had (check all that apply)? Earache, left ear||N/A|
|PX200101_Cold_Sinus_Specify_Earache_Right||PX200101030103||(If yes) Which have you had (check all that apply)? Earache, right ear||N/A|
|PX200101_Cold_Sinus_Specify_Refused||PX200101030106||(If yes) Which have you had (check all that apply)? Refused||N/A|
|PX200101_Cold_Sinus_Specify_Sinus_Problem||PX200101030102||(If yes) Which have you had (check all that apply)? Sinus problem||Variable Mapping|
|PX200101_Ear_Tubes||PX200101020000||Do you now have a tube in your right or left ear [if Yes, indicate affected ear(s)]?||N/A|
|PX200101_First_1000HzRestest_Left_Ear_CNO||PX200101160101||1000 Hz (first) threshold (Left Ear):||N/A|
|PX200101_First_1000HzRestest_Right_Ear_CNO||PX200101150101||1000 Hz (first) threshold (Right Ear):||N/A|
|PX200101_First_1000HzRestest_Threshold_Left_Ear||PX200101160100||1000 Hz (first) threshold (Left Ear):||N/A|
|PX200101_First_1000HzRestest_Threshold_Right_Ear||PX200101150100||1000 Hz (first) threshold (Right Ear):||N/A|
|PX200101_First_1000Hz_Left_Ear_CNO||PX200101140201||1000 Hz (first) threshold (Left Ear):||N/A|
|PX200101_First_1000Hz_Right_Ear_CNO||PX200101130201||1000 Hz (first) threshold (Right Ear):||N/A|
|PX200101_First_1000Hz_Threshold_Left_Ear||PX200101140200||1000 Hz (first) threshold (Left Ear):||N/A|
|PX200101_First_1000Hz_Threshold_Right_Ear||PX200101130200||1000 Hz (first) threshold (Right Ear):||N/A|
|PX200101_Hearing_Aids||PX200101010000||Does the examinee have hearing aids that cannot be removed?||N/A|
|PX200101_Hear_Better_In_One_Ear||PX200101050000||Do you hear better in one ear than the other?||N/A|
|PX200101_Hz_Switched_Manual_Left_Ear||PX200101140100||If mixed, indicate Hz when switched to manual mode (Left Ear)||N/A|
|PX200101_Hz_Switched_Manual_Right_Ear||PX200101130100||If mixed, indicate Hz when switched to manual mode (Right Ear)||N/A|
|PX200101_Left_Ear_Abnormality_Describe||PX200101070100||If answer is "Abnormality, type unknown", enter a comment:||N/A|
|PX200101_Left_Ear_Acoustic_Immittance||PX200101090000||Left ear acoustic Immittance||N/A|
|PX200101_Left_Ear_Acoustic_Immittance_Coded||PX200101090100||Left ear acoustic Immittance||N/A|
|PX200101_Left_Ear_Comment||PX200101070000||Enter a comment to describe the left ear||N/A|
|PX200101_Left_Ear_Tympanogram_ID||PX200101090200||Left ear tympanogram ID:||N/A|
|PX200101_Loud_Noise_Exposure||PX200101040000||Have you been exposed to loud noise or listened to music with headphone in the past 24 hours?||N/A|
|PX200101_Loud_Noise_When||PX200101040100||(If Yes) How many hours ago did the noise or music end?||N/A|
|PX200101_Loud_Noise_When_No_Answer||PX200101040101||(If Yes) How many hours ago did the noise or music end?||N/A|
|PX200101_Right_Ear_Abnormality_Describe||PX200101060100||If answer is "Abnormality, type unknown", enter a comment:||N/A|
|PX200101_Right_Ear_Acoustic_Immittance||PX200101080000||Right ear acoustic Immittance||N/A|
|PX200101_Right_Ear_Acoustic_Immittance_Coded||PX200101080100||Right ear acoustic Immittance||N/A|
|PX200101_Right_Ear_Comment||PX200101060000||Enter a comment to describe the right ear||N/A|
|PX200101_Right_Ear_Tympanogram_ID||PX200101080200||Right ear tympanogram ID:||N/A|
|PX200101_Second_1000HzRestest_Left_Ear_CNO||PX200101160301||1000 Hz (second) threshold (Left Ear):||N/A|
|PX200101_Second_1000HzRestest_Right_Ear_CNO||PX200101150301||1000 Hz (second) threshold (Right Ear):||N/A|
|PX200101_Second_1000HzRestest_Threshold_Left_Ear||PX200101160300||1000 Hz (second) threshold (Left Ear):||N/A|
|PX200101_Second_1000HzRestest_Threshold_Right_Ear||PX200101150300||1000 Hz (second) threshold (Right Ear):||N/A|
|PX200101_Second_1000Hz_Left_Ear_CNO||PX200101140401||1000 Hz (second) threshold (Left Ear):||N/A|
|PX200101_Second_1000Hz_Right_Ear_CNO||PX200101130401||1000 Hz (second) threshold:||N/A|
|PX200101_Second_1000Hz_Threshold_Left_Ear||PX200101140400||1000 Hz (second) threshold (Left Ear):||N/A|
|PX200101_Second_1000Hz_Threshold_Right_Ear||PX200101130400||1000 Hz (second) threshold (Right Ear):||N/A|
Audiogram Hearing Test
October 8, 2010
This measure is a hearing test to assess hearing sensitivity.
This measure is used to evaluate the auditory system of an individual and is capable of identifying hearing problems in any part of the auditory system.
Audiogram, Audiometry, Hearing test, Pure tone audiometry, National Health and Nutrition Examination Survey, NHANES, Speech and Hearing