Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Testing must be safe and timely
An urgent hearing-loss history takes priority over a routine test appointment, and pressure testing is unsuitable in some painful, discharging or recently operated ears.
Action: Use the urgent ENT pathway for recent unexplained sudden loss. Before tympanometry, examine the ear and check for discharge, an acutely red bulging drum, recent surgery and other contraindications; defer an unsafe procedure and obtain appropriate clinical advice.
Synopsis
Read an audiogram and tympanometric report systematically, understand threshold and masking methods, and recognise procedural contraindications and findings that change referral or rehabilitation.
Pure-tone audiometry measures frequency-specific behavioural hearing thresholds; tympanometry measures the mechanical response of the ear to changing pressure.
Interpret air and bone thresholds with masking and reliability information before assigning a conductive, sensorineural or mixed mechanism.
BSA threshold testing uses a 10 dB decrease after a response and 5 dB ascending steps to establish a reproducible threshold.
Key red flags
Do not defer assessment of a recent unexplained sudden loss while waiting for routine pure-tone audiometry.
Investigation priorities
01
Preparation and otoscopyFirst step
Establish whether the chosen test is appropriate and identify factors that could invalidate it.
Management branches
Reading a completed audiogramCheck validity before classifying the loss
A chart is available for a patient with hearing difficulty.
Confirm patient, side, test date, units, transducers and reliability notes; identify masked results and any no-response symbols.
Compare air with bone by frequency, then compare ears, looking for a gap, raised sensory thresholds and asymmetry rather than relying on an average alone.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.