Protocol - Audiogram Hearing Test
The National Health and Nutrition Examination Survey (NHANES) 2015-2016 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.
An audiogram should be conducted in a soundproof room or booth to permit accurate hearing threshold measurements. Although the 2015-2016 National Health and Nutrition Examination Survey (NHANES) conducts pure tone audiometry on individuals ages 12–19 years and older than 70 years, previous versions of the NHANES have performed this procedure on children as young as 4 years and adults of all ages.
A downloadable PDF of the full 2015-2016 National Health and Nutrition Examination Survey (NHANES) Audiometry Procedures Manual is available here: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/manuals/2016_Audiometry_Procedures_Manual.pdf.
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, foreign bodies, PE (pressure equalization) tubes, 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 tympanometry 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 (dB).
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:
- 250 hertz,
- 500 hertz,
- 1,000 hertz,
- 2,000 hertz,
- 3,000 hertz*,
- 4,000 hertz,
- 6,000 hertz*,
- 8,000 hertz.
*Test only at 3,000 and 6,000 hertz if there is > 15 dB difference in threshold from octave to octave.
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
National Health and Nutrition Examination Survey (NHANES) Audiometry Protocol
Personnel and Training Required
This 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.
A 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.
|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 ages 12–19 years and adults up to 70 years
The National Health and Nutrition Examination Survey (NHANES) 2015-2016 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|
Process and Review
The Expert Review Panel #7 (ERP 7) reviewed the measures in the Speech and Hearing domain.
Guidance from the ERP includes the following:
- Updated protocol
- New Data Dictionary
Back-compatible: there are changes to the Data Dictionary, previous version of the Data Dictionary and Variable mapping in Toolkit archive (link)
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). (2015–2016). 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.
Hoffman, H. J., Dobie, R. A., Losonczy, K. G., Themann, C. L., & Flamme, G. A. (2017). Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years. JAMA Otolaryngol Head Neck Surg, 143(3), 274-285.
Choi, J. S., Betz, J., Deal, J., Contrera, K. J., Genther, D. J., Chen, D. S., â€¦ Lin, F. R. (2016). A Comparison of Self-Report and Audiometric Measures of Hearing and Their Associations With Functional Outcomes in Older Adults. Journal of aging and health, 28(5), 890-910.
|Variable Name||Variable ID||Variable Description||dbGaP Mapping|
|PX200102060000||Was an automated protocol using a pure tone more||N/A|
|PX200102030200||Do you have a cold or earache?||N/A|
|PX200102040600||Has the ear canal collapsed?||N/A|
|PX200102080200||Which ear was tested first?||N/A|
|PX200102030100||Do you have tubes in either ear?||N/A|
|PX200102070300||Did the examinee record three false positives?||N/A|
|PX200102070100||Was the examinee unable to operate the more||N/A|
|PX200102070200||Was the examinee unable to 'keep up with' more||N/A|
|PX200102050500||Is the examinee seated?||N/A|
|PX200102070400||Was the examinee's threshold over 100 more||N/A|
|PX200102080100||Which headphones were used?||N/A|
|PX200102020100||Do you use hearing aids?||N/A|
|PX200102020200||Have you removed your hearing aids?||N/A|
|PX200102020300||Are you able to remove your hearing aids?||N/A|
|PX200102030400||Do you hear better in one ear or the other?||N/A|
|PX200102080403||What was the threshold (in decibels) at 1000 more||N/A|
|PX200102080404||What was the threshold (in decibels) at 2000 more||N/A|
|PX200102080401||What was the threshold (in decibels) at 250 more||N/A|
|PX200102080601||What was the threshold (in decibels) at 3000 more||N/A|
|PX200102080405||What was the threshold (in decibels) at 4000 more||N/A|
|PX200102080402||What was the threshold (in decibels) at 500 more||N/A|
|PX200102080602||What was the threshold (in decibels) at 6000 more||N/A|
|PX200102080406||What was the threshold (in decibels) at 8000 more||N/A|
|PX200102080500||Was there a difference of more than 15 more||N/A|
|PX200102030300||Have you been exposed to loud noise in the more||N/A|
|PX200102040100||Are there any abnormalities visible in the more||N/A|
|PX200102040200||Is there a presence of excessive ear wax in more||N/A|
|PX200102040300||Is there a presence of foreign bodies in the more||N/A|
|PX200102040400||Is there a presence of PE (pressure more||N/A|
|PX200102040500||Is there a presence of perforation or more||N/A|
|PX200102080300||Was the test performed manually?||N/A|
|PX200102010000||Have you removed anything that might more||N/A|
|PX200102080703||What was the threshold (in decibels) at 1000 more||N/A|
|PX200102080704||What was the threshold (in decibels) at 2000 more||N/A|
|PX200102080701||What was the threshold (in decibels) at 250 more||N/A|
|PX200102080901||What was the threshold (in decibels) at 3000 more||N/A|
|PX200102080705||What was the threshold (in decibels) at 4000 more||N/A|
|PX200102080702||What was the threshold (in decibels) at 500 more||N/A|
|PX200102080902||What was the threshold (in decibels) at 6000 more||N/A|
|PX200102080706||What was the threshold (in decibels) at 8000 more||N/A|
|PX200102080800||Was there a difference of more than 15 more||N/A|
|PX200102050100||Has the size and direction of the ear canal more||N/A|
|PX200102050400||Was a pair of standard headphone or insert more||N/A|
|PX200102050300||Is the resulting tympanogram flat or are the more||N/A|
|PX200102050200||Is an airtight seal achieved after placing more||N/A|
Audiogram Hearing Test
June 4, 2019
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