A Visit to the Audiologist

We all live with earwax. Some more than others, but none of us are immune.

A buildup of excess wax can potentially cause blockage, tinnitus, an infection, or worse: sudden or partial loss of hearing! (Whatever you do, do not Google image search "earwax buildup.") To the average human, a temporary reduction in hearing is an inconvenience. But to the average audiophile, a temporary reduction in hearing could very well mean fatality. (Said in Mortal Kombat fashion.)

Being a proud member of the "some more than others" party, I routinely get my excess wax extracted twice a year by my general practitioner. In between those times, I also use Debrox drops once a month. Aside from being an oddly satisfying sensation, it also helps me guarantee that I'm hearing everything I should be hearing to the best of my ability.

This past Friday, as I was beginning my workday, I decided to take things a step further and not only have my wax extracted, but also take a hearing test. Double the fun! And—why wait? I must do this right now, I thought to myself, in a very matter-of-fact way. When I Google searched "audiologist nyc," the first result was Dr. Andrew Resnick, who also happened to be close by and have a rare last minute opening soon. Destiny calls—even through the wax. Thus began my spontaneous audiology trek through the wild winds and the pouring rain. Oh, how I love New York City in the fall.

Upon entering Dr. Resnick's office, my eyes immediately spotted his Audioengine A2+ speakers sitting atop his desk. I must be in the right place, I thought to myself. He made me feel at ease as he began examining my ears and shoveling out piles of wax—my pride and joy.


After my ears were sufficiently spruced, it was time to begin the hearing tests. I then entered a dark grey cube of foam insulation with a window looking out onto the doctor's desk.

He first conducted a Pure Tone Audiometry (Air Conduction) test. In this test, I was played various frequencies up to 8kHz at various volumes through a pair of Telephonics 296D000-1 headphones, which are apparently the reference standard for the audiometric industry. I was instructed to click a button each time I heard a tone. It was similar to all the annual physicals I took as a child, but more thorough.

Next up was the Speech Reception Threshold test. Dr. Resnick would say a word that I'd hear in my headphones at varying volumes, and I'd repeat it back if it was audible.

Third was the Word Recognition Test. Noise was played constantly in one ear, while a recorded voice would ask me to repeat a single word. This one was kind of fun. I couldn't stop giggling.


The final test was a Pure Tone Test (Bone Conduction). It was similar to the first test, but used bone conduction headphones that emitted vibrations to the inner ear, rather than audible sound. This is used to zoom in further and indicate which part of the ear is responsible for hearing loss. All four tests are used in combination with each other to best examine one's hearing.


The results: I'm not deaf. My hearing is pretty average for a 23 year-old. You'll notice a slight dip around 6kHz, which I am told is normal for people who frequent live music venues. The dip is more prominent in my right ear than my left, which is possibly because of all the times I played saxophone in a big band during college, in which the rhythm section was always to the right. Who knows, really? I'm a little disappointed, because I carry earplugs with me everywhere and wear them religiously, but . . . c'est la vie. Could be worse.

Jana Dagdagan: Does having better overall hearing correlate with having a better ability to hear the detail and quality of music? As in, if someone has hearing loss and requires music to be at a higher volume to be audible, does that affect his/her ability to hear specific sonic characteristics/qualities within the music? Or is hearing loss irrelevant, so long as the music is raised to the necessary volume?

Andrew Resnick, AU.D.: No, in general I wouldn't say that having better overall hearing correlates with a better ability to hear the detail and quality of music, but this is a complex question. Some people with hearing loss, usually when it's a more significant sensorineural (inner ear) hearing loss, experience certain kinds of distortion of sound due to the impairment of the cochlea. This may cause music to sound quite poor, and in some cases even out of tune. So in a case like this, yes, they would have more difficulty to hear and/or appreciate some aspects of music. But it will also depend on their background and experience with music. I've seen musicians with quite severe hearing loss who are still able to perform, and to hear nuances in music. But I've also seen people who have only a "moderate" hearing loss who have lost all ability to enjoy listening to music.

JD: How important is it for the average person to regularly see an audiologist to get their hearing checked? (Not an audio engineer/music professional.)

AR: As a general recommendation, I would say the average person should see an audiologist every 3–5 years after a baseline hearing test that shows normal hearing, and once a year if a hearing test shows a hearing loss.

JD: If a hi-fi reviewer (someone who listens to hi-fidelity audio gear and comments upon its sonic performance) is unable to properly hear a specific frequency (take my lack around 6kHz, for instance) does that compromise their ability to accurately convey how a particular piece of gear sounds? Or does it not matter if there are no further changes to my hearing, because I'm then able to understand a piece of gear relatively to other pieces of gear?

AR: The effect that a hearing loss will have on a reviewer's ability to accurately convey how a particular piece of gear sounds will depend on the extent of the hearing loss, and the level at which they're listening to the gear. If someone (like you) has a 25 or even 40dB deficit at one frequency, this probably won't have an effect, because music will probably be listened to at a level above this. If you're listening at, say, 80dB, then your inability to hear a certain frequency when it's as soft as 30dB won't really matter. On the other hand, if someone can't hear certain frequencies until they're at 70–90dB, which would be a severe hearing loss for those frequencies, then this is more likely to have an impact on how they're perceiving music. It shouldn't matter as much for that person to compare one piece of gear to another, in terms of the relative sound to that person, but it may affect the comparison of what they're hearing to what someone else with normal hearing would hear.

JD: How has being a practicing audiologist affected your daily life and music listening tendencies, if at all?

AR: Being a practicing audiologist has certainly given me a further appreciation for how absolutely incredible the human ear is, and how delicate it is. I am very careful about protecting my ears when I'm exposed to loud music. But there's still a teenage rock guitar player inside of me, and I do appreciate turning it up at times.

* * *

It gives me hope to learn that there is not necessarily a direct correlation—that listening can be more about application and accumulated experience, rather than technical results from a hearing test. (Extreme situations excluded, that is.)

As I exited Dr. Resnick's clinic to return to the Stereophile office, I felt like I had purchased a brand new set of hearing units. No more were the lofty caverns of wax covered by mundane skin flaps. The sounds of the city, the sheer power of raindrops, the elusive singsong voice of wind—what was once dreary background noise, was now the music of the city. It wasn't even only about the basic wax removal. It was about chatting with an experience audiologist and understanding my hearing on a deeper level. A refresh.

I am Daredevil. I hear all.

So there you have it, audiophiles. They say you should "start with the source," but I think a visit to the audiologist could just possibly be the best $150 upgrade to your system yet.

BradleyP's picture

A few months ago, I was on a phone call and when I got off, my ears were ringing and high frequency acuity was way off. I was disturbed. I turned on some music and it sounded awful--distorted, smeared, just wrong. I had to turn it off. The next day, it had improved a little on one side but not the other. Yeah, I was thinking audiophile game over. If I couldn't stand to hear music any longer, that would be tragic to me.

A few days later, my GP sent me to an ENT whose audiologist gave me the same hearing test described here. The problems were obvious on the chart. I was put on oral prednisone in case an inflammatory process was to blame. Over the next few weeks, I got better, and a follow up visit one month out showed major improvement.

Anyway, thank goodness, I am almost back to normal now, and music sounds great again. (I've probably recovered as much as I'm going to.) For all the readers here, pay attention. The audiologist told me very clearly that if EVER faced with sudden hearing loss, get to a doc and get on prednisone IMMEDIATELY. Up to two weeks out can still okay to start the meds, but it's best not to delay at all to increase the chances of a full recovery.

Kal Rubinson's picture

Note how the measurement scales, which are standard for clinical audiometry, have rather gross resolution in amplitude (10dB/div) and frequency (1/octave) and cover a rather limited bandwidth (250Hz to 8KHz) compared to the acoustic and electronic measurements of equipment that are offered here at Stereophile.

If one wishes to get more resolution and additional information about audiometry, see http://www.digital-recordings.com/audiocd/audio.html
I reviewed an early version at:

dalethorn's picture

I got a series of test tones plus a sweep tone from a download, at HDTracks I think. Those are very helpful in understanding how the frequencies sound compared to each other, but there are traps a person can fall into, particularly when the speakers don't reproduce the tones evenly. If a person were to have a dozen different (but high quality) headphones on hand to try the tones with, they could probably net-out the variances between those headphones. Doing the same with a dozen sets of speakers wouldn't be practical for most people.

Anton's picture

If you are so inclined, you can take your headphones online and check even higher frequencies.

My kids 'out hear me' and go to mosquito country, but I can still get 17K.

You 'live music dip' is fascinating, and a great incentive to wear ear protection at shows, too.

Thanks a million for your topic. JA has written about his wax adventures, too!

John Atkinson's picture
Anton wrote:
JA has written about his wax adventures, too!
Back at the beginning of 2007: www.stereophile.com/asweseeit/107awsi/index.html. I have taken better care of my ears' hygiene since then.

John Atkinson
Editor, Stereophile

cgh's picture

John, as you know, one needs to break in earwax. When my ears get full I do the 7th track on Ayre's Irrational, But Efficacious! cd, the 300 second 5Hz - 20kHz test sweep, at about 90dB through headphones, on repeat, for maybe 18 hours. Works like a charm. The wax is fully tuned at this point. I get better high frequency extension, more shimmer in the presence region, and tighter bass.

BradleyP's picture

A little cryo'd lead in your diet helps the wax to shield against RF interference, opening up the soundstage of low impedence IEMs. Models with balanced armature drivers seem to benefit the most.

Anton's picture

Holy cow, 9 years, almost 10.

dalethorn's picture

I've heard that newborns hear up to 20 khz, but that it drops off quite a bit with age. Amazing how many adults in their 30s and 40s can still hear to 17 khz or near that, which makes me wonder...

ken mac's picture

Great report Jana!

As a road drummer in the 80s I regularly bashed with no protection. Until my left ear went silent. Doc used pliers to pull an 8" long green fungus out of my ear; it had wrapped itself around my eardrum. "Your ear protected itself, even though you didn't." Earplugs from that day forward, and today, especially on NYC subways...

es347's picture

..I've found that prior to a listening session, inserting those marshmallow ear plugs for several minutes sort of resets things and seems to improve acuity for listening

Solarophile's picture

Better take it easy Jana on the loud music.

Bilateral 20dB dip around 6kHz is rather significant especially for a young woman. It's of course not just at "one frequency" and it's not necessarily worst at 6kHz either.

Just be careful in any event!

tonykaz's picture

I'm told the Brain Processes and Eq's the tiny voltage coming from it's ears and that the Brain can ( and does ) re-calibrate itself ( a slow but continuous process ).

So, if your Brain is calibrated for the LS3/5a and you have a brief listen to a pair of Magnapans, you'll be listening with LS3/5a Brain Settings, it will take some time for your Brain to re-calibrate to the new Speakers and their room effects.

I think people read reviewers because they don't believe ( trust ) their ears, I've heard it said many times.

Tony in Michigan

Bill Leebens's picture

...the ultrasound techs often said that they thought fetuses could hear the soundwaves during fetal ultrasound exams, as the babies tended to become very wriggly during the process. Given that ultrasound frequencies are above 2 GHz, that seems unlikely. I tended to think that the babies got active because somebody was pressing on the walls of their world.

---Or, maybe in some way they could feel the sound waves. who knows?

Mycophile's picture

Thanks for sharing, Jana. I found this article fascinating.

In response to the comment regarding medical imaging, diagnostic instruments for neonatal ultrasound imaging use frequencies between 1 MHz and 18 MHz. Accordingly, “above 2 GHz” would be off by at least a factor of 100 (for an 18 MHz instrument) if not 2000 (1 MHz instrument).

ScullComm's picture

> I am Daredevil. I hear all.

Jana, you ARE the Daredevil! I love your writing, a strong, engaging experiential narrative. Your time has come!

Anton's picture

I miss you and hope all is well.

Do you still have the ribbon chair?

misterbill17's picture

I'm grateful for ANYTHING informative about hearing loss and it's effects on listening to music. I recently got a pair of hearing aids and have been unable to have them adjusted satisfactorily. They do help when listening to music - I think. But, because they boost certain mid/high frequencies, I'm not sure I'm hearing what was intended. Then there's the problem of eyeglasses bumping up against. I wish I could go to your audiologist, i.e. someone who could communicate with me about music. If I'd known this when younger, I'd have taken more measures to protect my ears. I can remember coming home from concerts and my hearing was veiled for days. Ugh! Thanks, Jana and keep it coming.

Laurence Svirchev's picture

Those negative notches are obnoxious but not the crux of the issue. Continuity over the spectrum is the key part; hearing tests are not the best way to judge the ability of the human nervous system to appreciate music since we don't listen for individual frequencies, but whole sound. The question of harmonics and how the ear parses music and sound is much more interesting. Here is an example. A clarinetist with excellent control of the instrument can hit harmonics above 20kHz. My own hearing takes a dive at 16kHz (I'm 69yo), but I still can feel those high frequencies and the harmonics that go with them. I've (subjectively) tested that by talking with clarinetists post-performance. The young woman sitting next to me only could recognize the sound of the clarinet when her eyes were open. I put the differential to ear training. I asked her to listen to an Ellington track, and she could not identify the difference between the reeds and the trombones (but she loved the overall music). Again, ear training. One of the constant nags by functionally illiterate critics against high-definition recordings is the old saw about 20-20 hearing range. Since they can't hear the difference and proselytize that recordings should stay in the 44-16 range: they can't hear the difference, so no one else should.
I would hope that there could be a followup to this nice article.

Archimago's picture

Sure, what you say has some merit.

1. "Ear training" can of course help with discrimination of sounds such as the lady sitting beside you who cannot differentiate a clarinet blinded or differentiate reeds from trombones. Sonic recognition does take learning after all! Unless one has taken some time to learn what instruments sound like (eg. being part of a band at some point in school for example), it's not unusual to not "know" the timbral or harmonic structure of woods vs. brass vs. strings.

2. But what does this have to do with ultrasonic frequencies beyond 20kHz or high resolution recordings? That's a totally separate issue and one certainly does not need frequencies >20kHz to hear the difference between instruments.

Fair enough if you say and believe you can "feel" those higher frequencies presumably referring to >16kHz. Not that this is all that important what any of us believes, really. But I'm not so sure the scientific literature supports this assertion in experiments controlling bias. And I'm not so sure it's proselytizing as it is about general statements of fact that maybe, just maybe, "high definition recordings" aren't all that necessary in the vast majority of situations and for the vast majority of people.

dalethorn's picture

"just maybe, 'high definition recordings' aren't all that necessary...."

When the customer is willing to spend audiophile prices for gear and recordings, I don't think that "you don't need that much fidelity" is an appropriate sales response. True, we should warn the customer about a possible foolish purchase, where they might not get exactly what they're willing to throw money at, but we should leave it at that rather than telling them that we know better than they do.

dalethorn's picture

Frequencies - yes and no. A frequency adjuster (equalizer, preferably parametric) can help a lot, if the person's hearing damage isn't too severe. The issue of "it's the whole music" is correct, and that's why equalizing can be tricky. You can listen to tones and be sure that a given tone is too loud or too soft, and needs to be adjusted. If the difference is extreme, then yes it does. But once you've adjusted out the extreme cases, then the key is to adjust to a natural sound, with extended listening. Best results are usually obtained late at night, when ambient noise is minimal and the body is very relaxed.

Allen Fant's picture

Great report- Jana.
Life is too short to not be hearing the musical information one should. Happy Listening!

Johnny2Bad's picture

The "normal" human frequency range of 20~20 Khz is our steady-state sensitivity. That does not automatically mean there can be no sensitivity to momentary sound outside that range.

It's useful to remind ourselves that large changes in amplitude can be described as a frequency response, and if some one can hear a steady state 10 Khz that taking into consideration the speed in which that 10Khz note goes from silence to maximum amplitude can be described as a frequency in the ultrasonic range.

There exists in the current literature evidence humans can perceive sound above the normal hearing range. It should also be said that we do not "hear" with our ears alone. We also use other organs to perceive sound, such as our skin.

Our brains do the interpretation from the various sensory inputs that marry the sensitivity of our ears, our bodies to pressure and vibration, and so on. Human sound perception is not limited to the information from just one organ.

There is much we know, and much we don't know about the body and the brain. Without taking a position on ultrasonic perceptibility it must be said that there is no evidence we are limited only to our steady state hearing ability via the one organ.

Audio Help's picture

Glad to see such a quality write up on a Fellow Manhattan Audiologist