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Audiology Specialties

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Our staff is specially trained and experienced in a wide variety of audiology specialty care areas. 

Choose from these sub-specialties to learn more about available Marshfield Clinic audiology services and providers:

Acoustic reflex testing

Acoustic reflex testing is done in each ear following a tympanometry. Acoustic reflex testing measures the response of a tiny ear muscle that contracts when a loud sound occurs. The loudness level at which the acoustic reflex occurs or the absence of the acoustic reflex gives important diagnostic information.

Acoustic reflex test results give the audiologist valuable information regarding the severity of your hearing loss and its possible cause. It is also a valuable test in detecting problems in the auditory pathway.

Auditory brainstem response testing

An auditory brainstem response test is used to measure hearing when more conventional hearing tests cannot be used. The procedure measures how well a stimulus gets through the auditory system from the outer ear through the brainstem pathway.

The patient wears electrodes, which record appropriate brain wave activity. Brain wave activity is recorded in response to a series of clicks presented to each ear through special earpieces inserted into the ear canals. The audiologist can vary the intensity of the clicks.

Auditory brainstem response testing also can be used for the identification of small tumors on the auditory vestibular nerve, cochlear hydrops (balance problems) and neurological problems. The testing is cost-effective and safe for people with metal implants.

Behavioral observation audiometry

Behavioral observation audiometry assesses hearing acuity using unconditioned responses to sound. A behavioral observation assessment is conducted by a pediatric audiologist specially trained to detect bodily reactions to sound such as body movement, eye widening, eye opening or change in sucking rate.

This procedure is appropriate for children from birth through 7 months of age. The infant is observed for changes in behavior after certain sounds are presented. This screening test provides information about age-appropriateness of an infant's response to sound and can rule out serious hearing loss.

A behavioral observation should be used in conjunction with other supporting tests.

Cochlear implant assessment

We provide a comprehensive adult and children's cochlear implant program. Our audiologists and speech pathologists work together for programming and therapeutic intervention. You are thoroughly evaluated for hearing loss, to determine if you are a candidate for a cochlear implant. Various hearing and speech tests are used to determine how you function with and without hearing aids. Information is provided to you and your family about the cochlear implant process including demonstration of the devices and expectations.

Conditioned play audiometry

Conditioned play audiometry assesses hearing sharpness using conditioned responses to sound by engaging in play-oriented activities. This test is appropriate for children from two to five years of age. The child is conditioned to perform a play activity whenever they hear a sound. Activities might include putting a block in a bucket or placing a peg in a hole. Once the child is conditioned, a threshold hearing level can be determined by decreasing signal intensity. Speech thresholds are typically obtained by having the child identify pictures, objects or body parts.


Electronystagmography (ENG) is a widely used test to evaluate the source of dizziness or unsteadiness. The testing procedure involves attaching electrodes near the eyes in order to record eye movements. Test time is about 90 minutes.

An ENG is generally performed because a physician, after having taken a history and performed a physical examination, needs more information to diagnose a patient’s complaint of dizziness or unsteadiness. The physician uses the information provided by the ENG, along with information from other clinical tests, to make the diagnosis.

Digital Hearing aids and assistive listening devices

We offer digital hearing aid technology to meet your individual needs. Our services include comprehensive hearing aid evaluations, fittings for a wide range of hearing aids and follow-up care for all age groups.

How is a digital hearing aid different from an analog hearing aid?

Digital hearing aids produce a cleaner, clearer and more natural sound quality than analog hearing aids. They have the ability to analyze the incoming sound. Based on these measurements, the digital hearing aid automatically adjusts to help decrease unpleasant background noise.

How will I know what kind of hearing aid I need?

The appropriate style, brand and characteristics of the hearing aid will be determined based upon your hearing loss as well as your personal preferences and specific needs. You may need one hearing aid or you may require two hearing aids. Based on the type of hearing loss, you may want two hearing aids in order to reduce background noise and to clarify sound.

Can I afford a hearing aid?

We offer a trial period for you to decide if a hearing aid is right for you.

Hearing aid cost varies based on the type and size of hearing aid you need. Batteries and out-of-warranty repairs are ongoing costs. Because Medicare and most insurance companies do not cover hearing aids, we offer flexible payment plans to fit your needs.

What can I expect from my hearing aids?

Unlike eyeglasses, hearing aids cannot provide complete correction of the impairment. No hearing aid will restore your hearing to normal or provide a perfect substitute for normal hearing. The benefits from wearing hearings aids will vary from person to person.

What kinds of hearing aids are available?

We offer a wide range of hearing aid brands and styles.

Otoacoustic emissions testing

Otoacoustic emissions tests measure the ability of the cochlea's outer hair cells to respond to sound. Otoacoustic emissions are measured by presenting a series of acoustic stimuli to the ear through a probe. The probe contains a loudspeaker that generates clicks or tones and a microphone that measures the resulting otoacoustic emissions. The presence of the emission is an indication of normal outer hair cell function, often associated with normal hearing.

Otoacoustic emissions testing is typically used for difficult-to-test patients such as infants, young children, and developmentally delayed populations as it is non-invasive and does not require an active response from the patient. Otoacoustic emissions only provide information about the activity of the outer hair cells in the cochlea, and do not assess the status of the auditory pathway. To assess the status of the auditory pathway an auditory brainstem response test is conducted.

Pure tone air and bone conduction testing

Pure tone testing is accomplished by having you listen through headphones, insert earphones or listen through loudspeakers in a sound booth. You are instructed to indicate when tones are heard. The softest level you consistently hear is called a hearing threshold. Threshold results are marked on the audiogram as either an X or an O. This type of testing helps to determine the amount or degree of hearing loss.

Bone conduction testing is accomplished by placing a special bone vibrator type of headphone behind the ear on the mastoid bone. Thresholds are again measured. This method of testing bypasses the middle ear and tests the hearing of the inner ear (cochlea), indicating whether the hearing loss is conductive, mixed or sensorineural.

Speech reception and identification testing

Speech reception and identification testing helps assist your audiologist in predicting how well you might do with hearing aids. The tests use spoken words and sentences rather than pure tones, to assess sensitivity or understanding of speech.

Speech reception testing involves determining the softest level at which speech is understood or heard. Patients are asked to repeat two-syllable words such as baseball, hotdog and cowboy. Patients also are asked to indicate the softest level at which speech is heard, regardless of whether or not what is said is understood.

Speech identification testing evaluates word understanding. A list of one-syllable words is presented at a particular level, usually at the person's most comfortable listening level, and a percentage score is obtained.

Steady state evoked potential testing

Steady state evoked potential testing provides detailed information about a child’s hearing acuity. The test is an objective measure of hearing that requires no participation from the child. It is a new measure that does not have widespread availability.


This test is used to detect disorders of the middle ear. Air pressure in the ear canal is varied to test the condition and movement of the eardrum. Tympanometry is performed after an examination of the ear with an otoscope, to ensure that the path to the eardrum is clear and not perforated. A device is inserted in the ear canal that will change the pressure in the ear, produce a pure tone and measures the eardrum responses to the sound and different pressures.

Visually reinforced audiometry​

This technique is for obtaining responses to sounds from children who are not yet able to report what they hear. The child is presented with a sound. When they respond, he or she is rewarded with something they can see, such as a puppet or an animated toy. The audiologist attempts to condition the child to look for the toy when a sound is heard, providing a method for testing the hearing of small children.