Elderly patients can be screened for significant hearing impairment by a simple free field voice test using 4 different levels in the loudness of the examiner's voice.


Test methodology:

(1) The examiner stands behind the patient to remove the possibility of lip reading.

(2) The examiner then occludes the non-tested ear by gently occluding that ear's external auditory canal.

(3) The examiner asks the patient to repeat a set of 3 random numbers spoken by the examiner under different testing conditions.


4 sets of testing conditions are performed:

(1) conversational voice at 6 inches

(2) conversational voice at 2 feet

(3) whispering voice at 6 inches

(4) whispering voice at 2 feet


Passing level - either:

(1) The patient is able to repeat all 3 numbers correctly, OR

(2) The patient is able to successfully repeat more than 50% over three triplet sets of numbers.


Failure to pass at each level of voice testing was considered a positive evidence for some degree of hearing impairment.

• The inability to hear a whispered voice at 2 feet was successful in identifying those patients likely to benefit from a hearing aid.

Validity in detection of significant hearing impairment



positive predictive value

failure to hear a whispered voice at 2 feet




failure to hear a whispered voice at 6 inches




failure to hear a conversational voice at 2 feet






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