Accounting for tinnitus in hearing test and client guessing

Hearing Loss
#1

I’ve always wondered how accurate hearing tests are because I just press the button at regular intervals matching the timing of the first (loudest) beeps. If I keep doing this, how accurate is it? I don’t think the beeps are truly random. The timing seems regular enough for me to keep guessing, eg: A A A A A A A A

The audiologist always says just try your best. I have layers and layers of tinnitus - high, low, mid - and I have no idea whether there is a testing beep or whether its the tinnitus. I always hear beeps and other noises. Do audiologists take into account the client perception of pattern/timing with their button pressing?

Does anyone know how random the beeps are?

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#2

I press the button at the first beep I hear, even really quiet.

Don’t wait for timing for the loudest beep? Doesn’t that give you hearing loss that is worse?

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#3

I wouldn’t fake it otherwise the test is useless but I too have been wondering about the role of the tinnitus, which definitely masks some of the sounds.

Once an audiologist said to me that my hearing test looks worse than my hearing abilities because my tinninitus doesn’t let me perform hearing tests well enough.

:person_shrugging:t2:

#4

I don’t think I’ve explained myself very well. I’m never sure whether the noises (beeps) I hear are from the hearing test or from my tinnitus. The tinnitus is at lots of different pitches. When the test beeps are very loud and usually low pitch I can hear them confidently (usually at the start). However particularly when the pitch is higher and the volume gets lower I’m simply guessing. Audiologists have been cranky with me for pressing the button too much (because the tinnitus is always there and at various pitches and volumes) and then the next year when I only pressed the buzzer when I was pretty sure when it was the test beep and not tinnitus I got into trouble for not pressing the button enough - “press when you think there’s a beep!!!” they said. There is always beeps. Always. And at the same pitch as the test or very much the same.

DamonHill - I am not faking it intentionally. I am saying that if the beeps are at regular intervals it is easy and natural for the client to ‘guess’ there is a beep in the same pattern. Which is what I do. Because I hear beeps constantly, most of the testing is a guess. Not my fault if audiologists don’t know what the tinnitus is like.

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#5

I’m not faking it. I hear beeps all the time. Constant. 24/7. Buzzing, whistling, beeping, low pitch drumming, theatre interval donging, sirens, electrical humming, triangle, submarine sonar, popcorn popping, etc, etc. All at the same time. Sometimes in different ears. And at the same pitch or very near the same pitch as most of the testing. A beep from the test is extremely difficult to screen out from the rest of the noises. So most of the time I’m guessing - as I do in real life in non-test circumstances. Is it tinnitus or is the fridge beeping? Is it the dog next door? Is it the pot boiling over? Is someone watching TV downstairs? Is someone calling me? What the hell are they saying? Is it music or is it an ambulance? Is it a phone ringing or the washing machine?
If its louder or lower pitched its a better guess than if its a high pitch at low volume.
I’m saying that I don’t think that a hearing test with regular beeps rather than randomly spaced beeps is going to be a good test for someone with tinnitus because they will naturally press the buzzer in the same pattern as at the start of the test with the louder beeps.

Truly random noises, not just beeps and not graduating in volume and pitch, and definitely not regularly spaced, would be a better representation of what I actually can hear.

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#6

I feel like the tones get imprinted in my ears (if that makes sense) so I don’t know if I’m hearing a new tone or one from before.

My favorite story was going for a hearing test and telling the person that I was going to fail. I don’t think they believed me.

They left me in the sound booth to do the test. I’m clicking away and when they come get me they said the test has been over for five minutes and did you know your hearing is bad.

Duh…

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#7

Wow, I thought the incessant ringing/squealing in my ears was bad until I read this description. I hope you find some relief.

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#8

Hi Damon,

Do you agree with the audiologist? Do you think your hearing ability is not representative of the hearing test and is better than the test shows?

I’ve found out just now with a word recognition test both aided and unaided that my hearing is extremely dependent on lip reading and non-verbal cues like raised eyebrows, etc.

Haven’t masks been fun? Ha ha.

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#9

Yes!! Exactly. Like when you hear an ambulance and then it stays with you all day.

:rofl: That’s hilarious.

So you know!

One trainee audiologist looked astonished when I mentioned how a lot of people think tinnitus isn’t real.

#10

I had to leave my job which was entirely listening-related, so it has eased off quite a bit. I can go 24 hours now without wanting to put my head through a non-safety glass window.

Yeah, the squealing sucks.

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#11

How does faking the results or trying to time the beeps help you.

#12

The better question is how does is a hearing test based on tones valid for somebody who hears tones all the time? In most places a hearing test is required to get any hearing aid. Hearing aids are supposed to improve hearing of speech, not tones.

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#13

Well in my case, hearing aids are used to help hear, anything.

#14

I understand perfectly and it’s exactly how I feel too!

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#15

I don’t know if I agree with my audiologists: for sure both my audiologists have been pleased by my hearing skills (which are bad but still) in the light of my hearing test, that looks much worse.

But, in any case, the fact that certain sounds are masked by tinnitus means that I’m not hearing the sounds anyway, I’m hearing the tinnitus instead of them. So at the end of the day it’s like if don’t hear them no matter what.
Then I don’t known how that translates in real conversation rather than a test based on beeps.

For the records: I haven’t uploaded my hearing test but I completely miss frequencies above 2k but I can hear low tones well and apparently I rely on them a lot to “guess” what’s missing in speech. Hearing aids help me in the way that they can “transfer” higher frequencies into lower ones.

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#16

Legit question, but that’s the audiologist’s job: translating a cold result based on beeps into augmented frequencies (via HAs) that help you understanding speech.

#17

I’m this person. I have a lot of tonal sounds in my ears and I’m motivated to do well in the booth and I just sit there and press the button all the time.

Don’t worry, it doesn’t dramatically impact your test accuracy, it just slows us way down which is why audiologists get cranky. I make all my students test me with a “good luck, I’m the worst!” but they still get accurate results (eventually). And no, the tones aren’t regular, especially not around threshold. The times you press the button in rhythm or when there is no beep don’t count for anything, we just ignore them. Sometimes you can wait someone out and they eventually stop pressing the button, but sometimes they’ll sit there and press the button forever (me). Descending runs also don’t count–it’s not unusual for individuals who don’t have tinnitus to follow the tones down too and come up with an imaginary rhythm and try to predict them. Humans are prediction machines and we can’t help it.

Now, tinnitus and hearing can fluctuate together, certainly. Patients with meniere’s or with auditory migraine will come in with extra loud tinnitus and their hearing will be down, but I expect in those cases it’s the change in hearing that is increasing the tinnitus rather than the change in tinnitus decreasing the hearing. But this hearing change isn’t that common with regular presbycusis + tinnitus.

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#18

Individual level of skill with this varies greatly. Some people are shockingly good at filling in the blanks and are much more successful at a certain level of loss than you would expect. In my experience, I seem to see some relationship to literacy, to musical literacy, and to a work history that requires that sort of speech prediction (e.g. where you are constantly listening to speech in a noisy sound-masking environment, like pilots). But the association is a bit loose.

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#19

Not sure that anyone has mentioned here that the audiologist can change the tone so, for example, it warbles. It doesn’t need to be an exact stable tone to test the threshold. A tone that warbles or beeps quickly or something else similar can help to distinguish it from tinnitus (I have bad tinnitus in one ear and moderate tinnitus in the other so I familiar with what the OP is describing).

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#20

I haven’t seen any mention of using pulsed tones when testing people with tinnitus. It makes it a lot easier for me to discern a tone from my tinnitus.
And if it’s unclear what I mean, it’s like “beep-beep-beep” instead of just a beep.

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