Pure Tone Audiometry


Pure tone audiometry  is the main hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss  and thus providing a basis for diagnosis and management. Pure-tone audiometry is a subjective, behavioural measurement of a hearing threshold, as it relies on patient responses to pure tone stimuli. Therefore, pure-tone audiometry is only used on adults and children old enough to cooperate with the test procedure.Pure-tone audiometry only measures audibility thresholds, rather than other aspects of hearing such as sound localization and speech recognition. However, there are benefits to using pure-tone audiometry over other forms of hearing test, such as click auditory brainstem response (ABR). Pure-tone audiometry provides ear specific thresholds, and uses frequency specific pure tones to give place specific responses, so that the configuration of a hearing loss can be identified. As pure-tone audiometry uses both air and bone conduction audiometry, the type of loss can also be identified via the air-bone gap. 


There are cases where conventional pure-tone audiometry is not an appropriate or effective method of threshold testing. Procedural changes to the conventional test method may be necessary with populations who are unable to cooperate with the test in order to obtain hearing thresholds. Sound field audiometry may be more suitable when patients are unable to wear earphones, as the stimuli are usually presented by loudspeaker. A disadvantage of this method is that although thresholds can be obtained, results are not ear specific. In addition, response to pure tone stimuli may be limited, because in a sound field pure tones create standing waves, which alter sound intensity within the sound field. Therefore, it may be necessary to use other stimuli, such as warble tones in sound field testing.There are variations of conventional audiometry testing that are designed specifically for young children and infants, such as behavioral observation audiometry, visual reinforcement audiometry and play audiometry.

Conventional audiometry tests frequencies between 250 hertz (Hz) and 8 kHz, whereas high frequency audiometry tests in the region of 8 kHz-16 kHz. Some environmental factors, such as ototoxic medication and noise exposure, appear to be more detrimental to high frequency sensitivity than to that of mid or low frequencies. Therefore, high frequency audiometry is an effective method of monitoring losses that are suspected to have been caused by these factors. It is also effective in detecting the auditory sensitivity changes that occur with aging.

Pure-tone audiometry procedural standards

The current International Organization for Standardisation (ISO) standard for pure-tone audiometry is ISO:8253-1, which was first published in 1983. The current American National Standards Institute (ANSI) standard for pure-tone audiometry is ANSI/ASA S3.21-2004, prepared by the Acoustical Society of America.

In the United Kingdom, The British Society of Audiology (BSA) is responsible for publishing the recommended procedure for pure-tone audiometry, as well as many other audiological procedures. The British recommended procedure is based on international standards. Although there are some differences, the BSA-recommended procedures are in accordance with the ISO:8253-1 standard. The BSA-recommended procedures provide a "best practice" test protocol for professionals to follow, increasing validity and allowing standardisation of results across Britain. 

In the United States, the American Speech–Language–Hearing Association (ASHA) published Guidelines for Manual Pure-Tone Threshold Audiometry in 2005.