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Department of Communication Sciences & Disorders

Pure Tone Hearing Screenings

Est. 12/29/08


Purpose: to identify individuals who may have hearing difficulties and refer them for further assessment and follow-up as appropriate.

Description: The client listens to a series of pure tones and indicates when they hear a tone by either raising their hand or pressing a button.

Selecting Clients for Screening

Clients appropriate for screening:

Clients with a chronological and cognitive age of 3 years or older are appropriate for screening IF

  1. Consent is obtained (screening is voluntary)
  2. Client has no diagnosed hearing impairment
  3. Client’s hearing has not been screened or tested within the last year


Clients who are not appropriate to screen:

  1. Clients with a chronological and cognitive age of birth to 2:11 years (children ages birth to 2:11 years should be screened by an audiologist).
  2. Clients with a diagnosed hearing impairment
  3. Clients with behavioral issues which may make screening unreliable or unsafe.
  4. Clients who have regular follow-up with an audiologist; request copies of the audiology reports for the clinic records.  Have the client sign a Release of Information form.
  5. Clients who do not give consent

Refer for a full audiologic assessement IF they have no record of hearing status in the past year AND:

  1. the client does not pass a second screener and/or has concerns about their hearing
  2. has a previously existing hearing impairment
  3. the client’s chronological and/or cognitive age is under three years
  4. the client is unable to participate in a convention screening (e.g., a child does not keep headphones on,  does not understand they need to indicate when they hear the presented tone, does not give consent for a screener)

Request that  a copy of the assessment records be sent to the clinic.  Have the client complete a Release of Information form.


Refer for medical assessment if client:

  1. Complains of pain or discomfort in ears
  2. Presents with drainage emitting from ears

Request that  a copy of the assessment records be sent to the clinic.  Have the client complete a Release of Information form.


Checks Prior to Screening:

Intern Competency: Interns must pass a competency check before screening hearing.

Setting:  Quiet room free from visual distractions

Equipment: Portable pure tone audiometer, towelette for sanitizing equipment after screening.  Equipment is calibrated at least annually to meet ANSI specifications (American National Standards Institute, 1996 ). 

Complete Mechanical Check and Biological Check on Equipment before any screener.


Mechanical Check

Before using the audiometer, plug in the device and check the mechanical function:

  1. Power: make sure there is power to the audiometer
  2. Jacks: be sure jacks are pushed fully into ports
  3. Earphone cushions:  should be clean, pliable, free from tears.
  4. Headband tension: there should be sufficient tension so the headphones rest snugly on ears.
  5. Tone On/Off: tone should emit when tone on is pressed.  Select a steady tone for screening hearing (no pulse).
  6. Headphone cords:  cords should be firmly attached to headset, with no frays or wires.
  7. Pitch change: change the frequency and listen for the corresponding change in pitch.  There should be no static.
  8. Cross talk: when the tone is presented into one phone, there should be not sound crossing to the other phone.


Biological Check

To ensure the audiometer is working, a biological check of equipment should be completed prior to any screener.

  1. The Screener should put on the headphones
  2. Check for tones at 500, 1000, 2000, 4000 Hz in the right ear and then in the left ear.  The Screener may ask a partner to help complete the biological check.
  3. If certain tones are not present, the equipment should be reported to the clinic office and taken out of service.


Screening Procedure
(based on instructions from ISD 709 Audiologist Linda Kalweit, 2008)

Place Equipment

  1. Set selector switch to the right ear
  2. Set HL dial to 40 dB HL.
  3. Set frequency dial to 1000 Hz
  4. Seat the client so they cannot see the front of the audiometer and they cannot see your face, but you can see their hands.
  5. Remove glasses, large earrings, hairbands, etc.
  6. Instruct the client to raise their hand when they hear a tone
  7. Place hair behind ears.
  8. Place earphones on the client’s head, red phone on right ear and blue phone on left ear.  Make sure the client’s ear canal opening is in the center of the earphone diagphragm.


Give Practice Tone

  1. Present the 1000 Hz 40 dB HL tone for 1-2 seconds in the right ear. 
    1. If the client responds to the tone in the right earà proceed with screening.
    2. If the client does not respond to the tone in the right ear, turn the tone to the left ear and repeat. 
    3. If the client responds to the tone in the left ear,continue with screening. 
    4. If the client does not respond to the tone in the left ear or the right earà try instructing in a different way, readjust the headphones and repeat the Practice tone.
    5. If the practice tone trial does not yield a response on the second attempt, discontinue screening and either refer to an audiologist or schedule a repeat screening within a month as appropriate.


Successful Practice Toneà Proceed with Screening

For each ear, screen 500 Hz at 25 dB HL; screen 1000 Hz, 2000 Hz, and 4000 Hz at 20 dB HL
For each tone, mark + for “pass” and – for “no pass”.

  1. Turn dial down to 20 dB HL.
  2. Present tones at 1000, 2000, and 4000 Hz
  3. Turn selector switch to the opposite ear.
  4. Present tones at 1000, 2000, and 4000 Hz
  5. Set the HL dial at 25 dB HL
  6. Turn frequency to 500 Hz
  7. Present tone in one ear, and then switch and present to the other ear.


Scoring Results and making recommendations for the first screening:

  1. If the client misses ONE or more of the eight tone responses, Mark NO PASS.  Recommend and complete a repeat screening within a month. 
  2. If the client responds to all the tonesà Mark PASS.   Recommend a repeat screening on an annual basis, or to consult an audiologist or physician if they have concerns about their hearing at any time.


Second Screening:

Procedures are the same as the first screening.  If the client does not pass, recommend the client have a full audiological assessment.


Per Guidelines for Audiologic Screening, American Speech-Language-Hearing Association ( November 1996), hearing screening should include education  on the process of hearing screening, the likelihood of hearing impairments, and follow-up services available.  




  • Complete the hearing screening record in PEN and place it in the client chart.  Documentation should include client identifying information, date of screener, results of screener (PASS or NO PASS) and recommendations.  Record should be signed by intern and by the supervising Clinic Instructor. 
  • Document completion of a hearing screening on the Client Service Summary record in the chart. 

Disapproved Procedures:
The following are not acceptable practices for hearing screeners at the Robert F. Pierce Speech-Language Hearing Clinic :

  • speech stimuli in lieu of pure tone audiometric stimuli;
  • noncalibrated signals (e.g., noisemakers, whisper);
  • group screening procedures
  • Avoid play audiometry or visual reinforcement audiometry (VRA).  If a child is not responding to basic pure tone screening, discontinue the screener and refer for a full audiologic assessment.


Suggestions for More Accurate Screening Results

  1. Seat the client so they are not facing you.  It is easy for a client to pick up on visual cues related to the presentation of the signal.
  2. Tuck the client’s hair behind their ears.  Remove their glasses, headbands, large earrings.
  3. Clients should not chew gum during the screening.
  4. Earphone placement is crucial.  The headband should be placed directly over the top of the head.  The diaphragms are aimed directly at the opening into the ear canal.  Practice placing and removing earphones before you screen a person.
  5. Watch for chronic hand raisers.  If someone is raising their hand too much, they probably do not understand the task.  They should be reinstructed.
  6. Avoid presenting the tone in a consistent manner.  Stagger the length of the time between successive tone presentations, so the client cannot establish a rhythm.
  7. For children, be very matter-of-fact about putting the earphones on.  Don’t ask their permission.
  8. Do NOT ask the client, “Did you hear that?”  But if you do…
    1. You cannot count the client’s “yes” response as one of the eight responses because you have prompted the client to respond and you really cannot be sure if the client heard the “beep”.
    2. If the client does say “yes” they heard it, remind them to raise their hand when they hear a beep.
    3. IF the client says “no” to your question, attempt a practice 40 dB HL at 2000 Hz and 4000 Hz.  Make sure you mark down on the hearing screening sheet any interesting comments about the client’s response.  These comments can be helpful for the professionals that work with the client in the future, including the audiologist.
  9. It is OKAY to NOT PASS a client.  The idea is to screen for any possible problems, not to diagnose the problem.
  10. Place the client so they cannot watch you, but you still can watch them and see their hands.



 Guidelines for Audiologic Screening, American Speech-Language-Hearing Association

( November 1996)



CSD current
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