- The examiner stands at arm's length (~0.6 m) behind the patient (to
prevent lip reading)
- The opposite auditory canal is occluded by the patient or examiner and
the tragus is rubbed in a circular motion (goal; to block hearing from that
- The examiner exhales and whispers a combination of numbers and letters
(example 4-K-2). Whispering at the end of exhalation is to ensure as
quiet and as standardized voice as possible.
- If the patient responds correctly, hearing is considered normal and no
further screening is necessary on that ear.
- If the patient responds incorrectly, then repeat using a different
- If on repeated testing, the patient can answer three out of a possible
six numbers-letters correctly, the patient passes. If they cannot answer
three out of six or more, the patient fails in that ear.
- Repeat the sequence in the opposite ear using different combinations of
numbers and letters. (Note: patients with memory problems may need a
simplified letter/number combination to compensate for their inability to
*Pirozzo S. Whispered voice test for screening for hearing impairment in
adults and children: systematic review. BMJ.
2003 October 25;327(7421):967.
Hearing loss prohibits patients from understanding conversations, contributes to
cognitive decline, and leads to social isolation. This impairment is the third
most chronic impairment among older people. It is also useful to ask the patient
and family if they
have noticed any changes in hearing, to describe any changes and if they have
had any prior treatment.
Patients with no wax occlusion of their ear canal and who failed this test have
a hearing loss that correlates with 30 dB loss. This level of hearing loss has a
significant affect on communication.