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Types of Hearing Tests

Pure Tone Audiometry (Hearing Test)

A hearing test also known as pure tone audiometry measures the quietest sounds you can hear in sound-proof conditions.

Its purpose is to verify the degree and type of any hearing loss. Prior to any hearing test we will complete a medical questionnaire and undertake otoscopic examination of the ears.

During the hearing test you will be required to wear headphones or ear inserts and press a small button in response to a variety of tones at various levels of frequency and intensity.

A full detailed report of a clients’ hearing can be provided to explain the hearing test results. We can also discuss the appropriateness of hearing aids or further diagnostic investigations can also be recommended.

Pure tone audiometry is adaptable to suit young children and learning disabled adults.

Obscure Auditory Dysfunction Test

Lee James is the sole provider of ‘obscure auditory dysfunction’ (OAD) testing in the region (and one of very few private practitioners nationwide).

The OAD package is devised to determine whether you have a measurable disability when listening in background noise, compared to the average listener with normal hearing. Our trusted Hearing Therapist is on hand to counsel about coping and management tactics.

Threshold Equalizing Noise Test

Within the cochlea (organ of hearing) of a hearing-impaired individual, there can exist an area of total non-functionality. This is known as a ‘dead region’. Since amplification of sound falling within the boundaries of a dead region has frequently proven of minimum or even negative benefit, the implications for hearing aid fitting are great.

Diagnosis of dead regions is not easily done from the hearing test. Instead, James Hearing specialists can utilise the ‘threshold equalizing noise’ (TEN) test to identify dead regions, thus amending amplification strategy to avoid a deleterious effect on performance.

Listening and Communication Enhancement (LACE)

Many people will deny they have a hearing problem for years before being persuaded to act. During this period, the individual deliberately socializes less and so like an unexercised muscle their listening skills diminish. Hearing aids make the most of your capabilities at ear level, however this is wasted unless at brain level you are able to tolerate and process the stimulus. Even the very best technology can be thwarted in challenging scenarios if the wearer is a poor listener. Equally, a normally hearing individual can underperform due to their lack of communication strategies. The Listening and Communication Enhancement (LACE) program is an interactive computer-friendly aural training scheme offered by James Hearing specialists, proven to enhance performance by up to 40%. Those who have undergone LACE acclimatised to their hearing aids quicker and were more satisfied long-term. Quite simply, LACE can give you back what you thought was lost forever.

Vestibular System Assessment

Following referral from your medical specialist, we will perform an array of tests able to locate and measure any weaknesses of the inner ear balance system.

Your balance can be affected by a disorder of the inner ear causing unsteadiness or vertigo. A spinning or swaying sensation may result. Untreated, this is a potentially disabling condition. Our dedicated vestibular suite, the only one of its kind in Oxfordshire, allows us to perform a battery of tests that document the full nature of your symptoms – the first step to recovery.

Videonystagmography (VNG) and Calorics

Cameras mounted into a pair of googles will record your eye movements for a classic sign of dizziness known as nystagmus as you track an animated dot on a light bar.  Each ear is then stimulated by a small amount of running water to induce a response, the magnitude of which is used to isolate the balance organ at fault.

ICS Head Impulse Testing (HIT)

The head impulse test (HIT) provides quick, clear-cut ear specific assessment of the vestibulo-ocular reflex response to stimuli in the high-frequency range, the natural range of head movements. ICS Impulse from Otometrics is the world’s first HIT device to combine gold-standard accuracy with unrivaled patient comfort, enabling you to perform head impulse testing with inarguable results.

The clinician stands before the patient, holding the patient’s head in his hands, and the patient, who is looking straight at the clinician, is asked to keep staring at the earth-fixed target (the clinician’s nose).  If the clinician now turns the patient’s head abruptly and unpredictably to the left or right, through a small angle (only 10-20 degrees – not a large angle), that head turn is what we call the head impulse. If the patient has a functioning vestibulo-ocular response they will be able to maintain gaze on the target because the vestibulo-ocular response drives the eyes to rotate to exactly compensate for head rotation and so maintain fixation.

However if the patient’s vestibulo-ocular response is inadequate then their eyes will be taken off target during the head rotation, because their eyes will not rotate at the correct speed to exactly compensate for head rotation. So an inadequate VOR means that the eyes go with the head during the passive unpredictable head turn and will be taken off target by the head turn, so that at the end of the head turn the patient must make a corrective saccade back to the clinician’s nose.  To the clinician watching the patient’s eyes, this saccade is usually very clear, and we have termed it an overt saccade. It is the tell¬tale sign of inadequate semicircular canal function on the side to which the head was rotated.  So an overt saccade after a leftwards head rotation means the left semicircular canal has a deficit. If there is any doubt, the clinician just repeats the head impulses until they are satisfied.

Vestibular Evoked Myogenic Potentials (VEMPs)

Vemps are widely accepted as a ‘gold standard’ indicator of certain balance disorders.  James Hearing specialists are equipped to provide VEMP testing in addition to the routine vestibular battery.


Cortical Evoked Response Audiometry (CERA)

A CERA or Cortical Evoked Response Audiometry is an objective hearing test, that records the signals from the auditory cortex (part of the brain that recognises sound) that have been generated in response to sounds introduced to the ears.

The test gives information about the level of sound needed to produce a signal and confirms the status of the auditory cortex.This is valuable information that we can not obtain from a normal hearing test.

The CERA appointment takes approximately two hours to complete and you’ll be asked to bring a book so you or your child can be as relaxed as possible during the test.  It involves placing electrodes behind the ears and on your head and these are then connected to the computer. A series of tones at various loudness levels are then produced to help us analyse the responses.


We perform CERA tests for ENT Consultants, Solicitors and Medico-Legal agencies.

To find out imore, please email