Protocol - Audiogram Hearing Test

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This section will be completed when reviewed by an Expert Review Panel.


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The National Health and Nutrition Examination Survey (NHANES) 2008-2009 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.


A downloadable PDF of the full 2009–2010 National Health and Nutrition Examination Survey (NHANES) Audiometry Procedures Manual is available here: [alink[NHANES_audiometry_09.pdf|NHANES Audiometry Procedures Manual]]

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.

Eligibility Criteria

There are no conditions that would prevent an eligible, consenting examinee from completing the protocol.

Preliminary Activities

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.

Pre-Exam Questionnaire

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, perforation or inflammation of the ear drum, and whether the ear canal is collapsed.

Acoustic Immittance

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 typanometer 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.

Automated Protocol

The pure tone audiometry test is controlled by a computer program.

Manual Protocol

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

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:

  • 500 hertz
  • 1,000 hertz
  • 2,000 hertz
  • 3,000 hertz
  • 4,000 hertz
  • 6,000 hertz
  • 8,000 hertz

Scoring Instructions:

0–25 dB

Normal hearing

26–40 dB

Mild hearing loss

41–55 dB

Moderate hearing loss

56–70 dB

Moderately severe hearing loss

71–90 dB

Severe hearing loss

91+ dB

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.

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.

Equipment Needs

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 [alink[NHANES_audiometry_09.pdf|NHANES Audiometry Procedures Manual]].


Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualYes
Major equipmentYes
Specialized requirements for biospecimen collectionNo
Specialized trainingYes

Mode of Administration

Health Professional

Life Stage:

Child, Adolescent, Adult, Senior

Specific Instructions:

An audiogram should be conducted in a soundproof room or booth to permit accurate hearing threshold measurements. Although the 2009-2010 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 National Health and Nutrition Examination Survey have performed this procedure on children as young as 4 years and adults of all ages.
Research Domain Information

Release Date:

October 8, 2010


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.

Selection Rationale

The National Health and Nutrition Examination Survey (NHANES) 2008-2009 audiometry protocol is one of the most widely used protocols to measure hearing sensitivity and was selected as the best practice methodology.


English, Spanish


Common Data Elements (CDE)Hearing Audiogram Hearing Test Assessment Score3144946CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Audiogram hearing test proto62977-4LOINC

Process and Review

This section will be completed when reviewed by an Expert Review Panel.


Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). (2009–2010). 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.

General References


Protocol ID:



Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX200101_Hearing_AidsPX200101010000Does the examinee have hearing aids that cannot be removed?4N/A
PX200101_Ear_TubesPX200101020000Do you now have a tube in your right or left ear [if Yes, indicate affected ear(s)]?4N/A
PX200101_Cold_Sinus_ProblemPX200101030000Have you had a cold, sinus problem or earache in the last 24 hours?4N/A
PX200101_Cold_Sinus_Specify_ColdPX200101030101(If yes) Which have you had (check all that apply)? Cold4N/A
PX200101_Cold_Sinus_Specify_Sinus_ProblemPX200101030102(If yes) Which have you had (check all that apply)? Sinus problem4N/A
PX200101_Cold_Sinus_Specify_Earache_RightPX200101030103(If yes) Which have you had (check all that apply)? Earache, right ear4N/A
PX200101_Cold_Sinus_Specify_Earache_LeftPX200101030104(If yes) Which have you had (check all that apply)? Earache, left ear4N/A
PX200101_Cold_Sinus_Specify_Earache_BothPX200101030105(If yes) Which have you had (check all that apply)? Earache, both ears4N/A
PX200101_Cold_Sinus_Specify_RefusedPX200101030106(If yes) Which have you had (check all that apply)? Refused4N/A
PX200101_Cold_Sinus_Specify_Dont_KnowPX200101030107(If yes) Which have you had (check all that apply)? Don't know4N/A
PX200101_Loud_Noise_ExposurePX200101040000Have you been exposed to loud noise or listened to music with headphone in the past 24 hours?4N/A
PX200101_Loud_Noise_WhenPX200101040100(If Yes) How many hours ago did the noise or music end?4N/A
PX200101_Loud_Noise_When_No_AnswerPX200101040101(If Yes) How many hours ago did the noise or music end?4N/A
PX200101_Hear_Better_In_One_EarPX200101050000Do you hear better in one ear than the other?4N/A
PX200101_Right_Ear_CommentPX200101060000Enter a comment to describe the right ear4N/A
PX200101_Right_Ear_Abnormality_DescribePX200101060100If answer is "Abnormality, type unknown", enter a comment:4N/A
PX200101_Left_Ear_CommentPX200101070000Enter a comment to describe the left ear4N/A
PX200101_Left_Ear_Abnormality_DescribePX200101070100If answer is "Abnormality, type unknown", enter a comment:4N/A
PX200101_Right_Ear_Acoustic_ImmittancePX200101080000Right ear acoustic Immittance4N/A
PX200101_Right_Ear_Acoustic_Immittance_CodedPX200101080100Right ear acoustic Immittance4N/A
PX200101_Right_Ear_Tympanogram_IDPX200101080200Right ear tympanogram ID:4N/A
PX200101_Left_Ear_Acoustic_ImmittancePX200101090000Left ear acoustic Immittance4N/A
PX200101_Left_Ear_Acoustic_Immittance_CodedPX200101090100Left ear acoustic Immittance4N/A
PX200101_Left_Ear_Tympanogram_IDPX200101090200Left ear tympanogram ID:4N/A
PX200101_Audiometry_First_Ear_TestedPX200101100000Ear tested first4N/A
PX200101_Audiometry_Ear_Could_Not_ObtainPX200101110000Could not obtain4N/A
PX200101_Audiometry_Headphones_Used_Original_TestPX200101120000Headphones used (original test):4N/A
PX200101_Audiometry_Right_Ear_Test_ModePX200101130000Test mode right ear4N/A
PX200101_Hz_Switched_Manual_Right_EarPX200101130100If mixed, indicate Hz when switched to manual mode (Right Ear)4N/A
PX200101_First_1000Hz_Threshold_Right_EarPX2001011302001000 Hz (first) threshold (Right Ear):4N/A
PX200101_First_1000Hz_Right_Ear_CNOPX2001011302011000 Hz (first) threshold (Right Ear):4N/A
PX200101_500Hz_Threshold_Right_EarPX200101130300500 Hz threshold (Right Ear):4N/A
PX200101_500Hz_Right_Ear_CNOPX200101130301500 Hz threshold (Right Ear):4N/A
PX200101_Second_1000Hz_Threshold_Right_EarPX2001011304001000 Hz (second) threshold (Right Ear):4N/A
PX200101_Second_1000Hz_Right_Ear_CNOPX2001011304011000 Hz (second) threshold:4N/A
PX200101_2000Hz_Threshold_Right_EarPX2001011305002000 Hz threshold:4N/A
PX200101_2000Hz_Right_Ear_CNOPX2001011305012000 Hz threshold:4N/A
PX200101_3000Hz_Threshold_Right_EarPX2001011306003000 Hz threshold:4N/A
PX200101_3000Hz_Right_Ear_CNOPX2001011306013000 Hz threshold:4N/A
PX200101_4000Hz_Threshold_Right_EarPX2001011307004000 Hz threshold:4N/A
PX200101_4000Hz_Right_Ear_CNOPX2001011307014000 Hz threshold:4N/A
PX200101_6000Hz_Threshold_Right_EarPX2001011308006000 Hz threshold:4N/A
PX200101_6000Hz_Right_Ear_CNOPX2001011308016000 Hz threshold:4N/A
PX200101_8000Hz_Threshold_Right_EarPX2001011309008000 Hz threshold:4N/A
PX200101_8000Hz_Right_Ear_CNOPX2001011309018000 Hz threshold:4N/A
PX200101_Audiometry_Left_Ear_Test_ModePX200101140000Test mode left ear4N/A
PX200101_Hz_Switched_Manual_Left_EarPX200101140100If mixed, indicate Hz when switched to manual mode (Left Ear)4N/A
PX200101_First_1000Hz_Threshold_Left_EarPX2001011402001000 Hz (first) threshold (Left Ear):4N/A
PX200101_First_1000Hz_Left_Ear_CNOPX2001011402011000 Hz (first) threshold (Left Ear):4N/A
PX200101_500Hz_Threshold_Left_EarPX200101140300500 Hz threshold (Left Ear):4N/A
PX200101_500Hz_Left_Ear_CNOPX200101140301500 Hz threshold (Left Ear):4N/A
PX200101_Second_1000Hz_Threshold_Left_EarPX2001011404001000 Hz (second) threshold (Left Ear):4N/A
PX200101_Second_1000Hz_Left_Ear_CNOPX2001011404011000 Hz (second) threshold (Left Ear):4N/A
PX200101_2000Hz_Threshold_Left_EarPX2001011405002000 Hz threshold (Left Ear):4N/A
PX200101_2000Hz_Left_Ear_CNOPX2001011405012000 Hz threshold (Left Ear):4N/A
PX200101_3000Hz_Threshold_Left_EarPX2001011406003000 Hz threshold (Left Ear):4N/A
PX200101_3000Hz_Left_Ear_CNOPX2001011406013000 Hz threshold (Left Ear):4N/A
PX200101_4000Hz_Threshold_Left_EarPX2001011407004000 Hz threshold (Left Ear):4N/A
PX200101_4000Hz_Left_Ear_CNOPX2001011407014000 Hz threshold (Left Ear):4N/A
PX200101_6000Hz_Threshold_Left_EarPX2001011408006000 Hz threshold (Left Ear):4N/A
PX200101_6000Hz_Left_Ear_CNOPX2001011408016000 Hz threshold (Left Ear):4N/A
PX200101_8000Hz_Threshold_Left_EarPX2001011409008000 Hz threshold (Left Ear):4N/A
PX200101_8000Hz_Left_Ear_CNOPX2001011409018000 Hz threshold (Left Ear):4N/A
PX200101_First_1000HzRestest_Threshold_Right_EarPX2001011501001000 Hz (first) threshold (Right Ear):4N/A
PX200101_First_1000HzRestest_Right_Ear_CNOPX2001011501011000 Hz (first) threshold (Right Ear):4N/A
PX200101_500HzRestest_Threshold_Right_EarPX200101150200500 Hz threshold (Right Ear):4N/A
PX200101_500HzRestest_Right_Ear_CNOPX200101150201500 Hz threshold (Right Ear):4N/A
PX200101_Second_1000HzRestest_Threshold_Right_EarPX2001011503001000 Hz (second) threshold (Right Ear):4N/A
PX200101_Second_1000HzRestest_Right_Ear_CNOPX2001011503011000 Hz (second) threshold (Right Ear):4N/A
PX200101_2000HzRestest_Threshold_Right_EarPX2001011504002000 Hz threshold (Right Ear):4N/A
PX200101_2000HzRestest_Right_Ear_CNOPX2001011504012000 Hz threshold (Right Ear):4N/A
PX200101_3000HzRestest_Threshold_Right_EarPX2001011505003000 Hz threshold (Right Ear):4N/A
PX200101_3000HzRestest_Right_Ear_CNOPX2001011505013000 Hz threshold (Right Ear):4N/A
PX200101_4000HzRestest_Threshold_Right_EarPX2001011506004000 Hz threshold (Right Ear):4N/A
PX200101_8000HzRestest_Threshold_Right_EarPX2001011508008000 Hz threshold (Right Ear):4N/A
PX200101_8000HzRestest_Right_Ear_CNOPX2001011508018000 Hz threshold (Right Ear):4N/A
PX200101_First_1000HzRestest_Threshold_Left_EarPX2001011601001000 Hz (first) threshold (Left Ear):4N/A
PX200101_First_1000HzRestest_Left_Ear_CNOPX2001011601011000 Hz (first) threshold (Left Ear):4N/A
PX200101_500HzRestest_Threshold_Left_EarPX200101160200500 Hz threshold (Left Ear):4N/A
PX200101_500HzRestest_Left_Ear_CNOPX200101160201500 Hz threshold (Left Ear):4N/A
PX200101_Second_1000HzRestest_Threshold_Left_EarPX2001011603001000 Hz (second) threshold (Left Ear):4N/A
PX200101_Second_1000HzRestest_Left_Ear_CNOPX2001011603011000 Hz (second) threshold (Left Ear):4N/A
PX200101_2000HzRestest_Threshold_Left_EarPX2001011604002000 Hz threshold (Left Ear):4N/A
PX200101_2000HzRestest_Left_Ear_CNOPX2001011604012000 Hz threshold (Left Ear):4N/A
PX200101_3000HzRestest_Threshold_Left_EarPX2001011605003000 Hz threshold (Left Ear):4N/A
PX200101_3000HzRestest_Left_Ear_CNOPX2001011605013000 Hz threshold (Left Ear):4N/A
PX200101_4000HzRestest_Threshold_Left_EarPX2001011606004000 Hz threshold (Left Ear):4N/A
PX200101_4000HzRestest_Left_Ear_CNOPX2001011606014000 Hz threshold (Left Ear):4N/A
PX200101_6000HzRestest_Threshold_Left_EarPX2001011607006000 Hz threshold (Left Ear):4N/A
PX200101_4000HzRestest_Right_Ear_CNOPX2001011506014000 Hz threshold (Right Ear):4N/A
PX200101_6000HzRestest_Threshold_Right_EarPX2001011507006000 Hz threshold (Right Ear):4N/A
PX200101_6000HzRestest_Right_Ear_CNOPX2001011507016000 Hz threshold (Right Ear):4N/A
PX200101_6000HzRestest_Left_Ear_CNOPX2001011607016000 Hz threshold (Left Ear):4N/A
PX200101_8000HzRestest_Threshold_Left_EarPX2001011608008000 Hz threshold (Left Ear):4N/A
PX200101_8000HzRestest_Left_Ear_CNOPX2001011608018000 Hz threshold (Left Ear):4N/A