Speech audiometry
A usually not painful hearing test that measures how well you can hear and understand spoken words, not just detect sounds, to add to the picture from a standard hearing test.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Speech audiometry measures how well you understand spoken words, not just whether you can detect sound — it complements a standard hearing test.
- It is usually not painful and non-invasive, and usually takes only 10 to 20 minutes as part of a hearing appointment.
- The result helps with hearing-aid fitting and understanding your hearing, but it is read alongside your other tests, not on its own.
- Scores can be affected by concentration, language and accent, so they are interpreted in context, not as a fixed measure of intelligence or effort.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Shows how well you understand speech, not just detect sound
Sudden hearing loss needs urgent assessment, not a routine booked test.
You listen and repeat words at different volumes. It is comfortable, though it takes concentration.
A plain-English explanation of your scores and what they mean for everyday listening.
You listen and repeat words at different volumes. It is comfortable, though it takes concentration.
There are no after-effects. You can return to normal activities and drive as usual.
The result is usually explained on the day, alongside your audiogram and any middle-ear tests.
If hearing aids or further tests are recommended, these are arranged and the speech result helps guide them.
What is speech audiometry?
Speech audiometry is a usually not painful hearing test that measures how well you can hear and understand spoken words, rather than just detect tones. A standard hearing test (pure tone audiometry) shows the quietest sounds you can hear, but it does not fully capture how clearly you make out speech. Speech audiometry adds that missing piece.
During the test you listen to words or sentences, usually through headphones, at different volumes and repeat back what you hear. The audiologist scores how many you get right. Two common measures are the speech reception threshold (the quietest level at which you can correctly repeat words) and the word recognition score (the percentage of words you get right at a comfortable listening level).
The test provides information; it does not treat anything. It helps show how hearing loss affects your understanding of speech, can support fitting and checking hearing aids, and can help tell apart different types of hearing problem. A result guides what to do next and is read alongside your other hearing tests, rather than giving a diagnosis on its own.
It is worth knowing the test depends on you being able to hear and repeat the words, so it can be affected by tiredness, concentration, language, accent or how the words are presented.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Pure tone audiometry vs speech audiometry
| Pure tone test | Speech audiometry | |
|---|---|---|
| What it measures | Quietest tones you hear | How well you understand words |
| What you do | Press a button to beeps | Repeat words or sentences |
| Main use | Type and degree of loss | Clarity of speech, aid fitting |
| Result | Audiogram | Threshold and/or % score |
The two tests are complementary. A standard hearing test shows what you can detect; speech audiometry shows how well you understand. They are read together.
Preparing for your test
- Keep your ears free of anything blocking them; tell the team if you think you have a lot of earwax, as it can affect the test.
- Bring your glasses if you need them, and your hearing aids if you already wear them.
- Try to attend when you are rested, as tiredness and concentration affect speech scores.
- Mention if English is not your first language, or if you have a strong accent or a speech difficulty, so the test can be chosen and interpreted fairly.
- Let the team know about any recent ear infection, cold or ear surgery.
- Bring a list of your symptoms and any previous hearing results to compare.
What happens
You sit in a quiet room and usually wear headphones. The audiologist plays recorded or spoken words or sentences at different volumes, one ear at a time, and asks you to repeat what you hear. You are encouraged to have a guess even if you are not sure.
The audiologist scores how many words you repeat correctly at each level. From this they work out measures such as your speech reception threshold and word recognition score. The test is comfortable and usually takes 10 to 20 minutes, often within a longer hearing appointment.
Results are typically explained on the day, alongside your audiogram and any middle-ear tests, to build a fuller picture of your hearing.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Sudden hearing loss needs urgent assessment, not a routine booked test.
- The test is the wrong choice if you cannot hear or repeat words at all because of very severe loss, when other tests are used instead.
- It is not a substitute for a standard hearing test or middle-ear tests; it adds to them.
- It cannot, on its own, diagnose the cause of hearing loss.
Delay or rearrange if…
- You have a heavy cold, ear infection or a lot of earwax that could affect the result.
- You are very tired or unwell on the day, which can affect concentration and scores.
- You have had recent ear surgery and have been advised to wait.
- There is a sudden change in your hearing that needs urgent review first.
Alternatives to discuss
- Pure tone audiometry alone for a basic measure of hearing.
- Speech-in-noise testing if difficulty in noisy places is the main concern.
- Objective tests (such as those used in children or when cooperation is limited) where repeating words is not possible.
- Watchful waiting and a hearing-aid trial in selected situations.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Shows how well you understand speech, not just detect sound
- Adds useful detail to a standard hearing test
- Helps decide on, fit and check hearing aids
- Can help tell apart different types of hearing problem
- Cross-checks the reliability of your other hearing results
- Gives a baseline to compare against in future
Risks & complications
- Mild tiredness from concentrating during the test
- Frustration if words are hard to make out, which is understandable
- A score affected by language, accent or how the words are presented
- Sometimes needing to repeat the test if results are inconsistent
- A result that does not match how you feel you hear day to day
- Difficulty completing the test if hearing loss is very severe
- Needing additional tests to explain an unexpected result
- Test results being unreliable because of a problem with cooperation, language or equipment
Speech audiometry is usually not painful and carries essentially no physical risk. The main limitation is that the score depends on you hearing and repeating words, so it can be affected by tiredness, concentration, language and accent, and is not a measure of intelligence. A result is interpreted alongside your other hearing tests. Ask what your score means for everyday listening and for any hearing-aid decision.
Published figures to discuss
Speech audiometry is a non-invasive test, so complication rates are not meaningful. What matters is reliability: scores depend on hearing, attention, language and accent, and can vary between sessions. There are no robust adverse-event rates to quote, so none are given here. The result is interpreted alongside your other hearing tests and your own experience.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical harm from speech audiometry | None expected | The test involves listening and repeating words at controlled levels. | Guide sourcesClinical context |
| Result affected by language, attention or cognition | Recognised limitation | Speech scores can reflect more than hearing, including vocabulary, fatigue and memory. | Guide sourcesClinical context |
| Quiet-room score does not predict noisy real life | Common mismatch | People can score well in quiet but struggle in restaurants, meetings or classrooms. | Guide sourcesClinical context |
| Unexpectedly poor speech score | Needs interpretation | Very poor or asymmetric scores may prompt checking hearing-aid settings or looking for retrocochlear pathology. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from speech audiometry. You can carry on with your day straight away. What matters afterwards is how the result is explained alongside your other hearing tests.
- Feeling a little tired after concentrating
- No physical after-effects
- Having the result explained alongside your other hearing tests
- Sometimes being asked to repeat part of the test for reliability
Aftercare
- Ask what your speech reception threshold and word recognition score mean in plain terms.
- Discuss how the result fits with your everyday listening difficulties.
- If hearing aids are suggested, ask how the speech result guides the choice and settings.
- Keep a copy of your results so future tests can be compared.
- Mention if the result does not match how you feel you hear, so it can be reviewed.
- Attend any follow-up or hearing-aid fitting that is arranged.
- Ears free of blockage, with earwax mentioned if present
- Glasses and existing hearing aids brought along
- Note made of language, accent or speech factors
- List of symptoms and previous hearing results
- Questions written down about the result and hearing aids
- Follow-up or fitting appointment noted if arranged
⚠ Get urgent help if…
- Sudden hearing loss, especially in one ear — this should be assessed urgently, separately from a routine test
- New ringing in one ear with hearing loss, which should be reviewed promptly
- Hearing loss with dizziness, facial weakness or severe headache — seek prompt medical advice
- Ear pain, discharge or a feeling of fullness that is getting worse
- A sudden, marked change in how well you understand speech
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a clear measure of how well you understand speech, which adds to the picture from your standard hearing test. A high word recognition score suggests speech is reasonably clear once it is loud enough; a lower score suggests clarity is affected even when sound is audible, which is useful when planning hearing aids.
Results have limits. The score depends on you hearing and repeating words, so language, accent, concentration and fatigue all matter, and it is not a fixed or perfect measure. It does not, by itself, diagnose the cause of hearing loss. Your audiologist interprets it alongside your audiogram, middle-ear tests and your own experience of listening.
Your speech understanding can change as your hearing changes, so the result reflects how things are now. If your hearing or your ability to follow conversations changes, the test may be repeated. It is also commonly repeated to help fit or fine-tune hearing aids.
Related tests, treatments or support
Speech audiometry is usually done alongside pure tone audiometry and middle-ear tests such as tympanometry, as part of a full hearing assessment. Where difficulty in noisy places is the main concern, speech-in-noise testing may be added, and the results together guide hearing-aid choices or further investigation.
Follow-up & long-term care
The result is usually explained on the day, as part of your overall hearing assessment. If hearing aids are recommended, the speech result helps guide the fitting and is sometimes repeated to check benefit. Further tests or referral are arranged if anything is unclear or unexpected.
Repeat, follow-on and what comes next
- The test may be repeated if results are inconsistent or affected by tiredness or a cold.
- It is commonly repeated to help fit or check hearing aids.
- A score that does not match everyday listening may prompt a speech-in-noise test or further assessment.
- Results can change as hearing changes, so testing may be repeated over time.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A plain-English explanation of your scores and what they mean for everyday listening.
- Clear links between the result and any hearing-aid recommendation.
- A written record so future tests can be compared.
- A route to further testing or referral if the result is unclear or unexpected.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether it is part of a fuller hearing assessment or a standalone test
- The audiologist's time and equipment
- Whether testing is done in quiet, in noise, or both
- Whether results are linked to hearing-aid fitting
- Any follow-up appointment to discuss results
- Further tests if results are unclear
- Which tests are included in the appointment
- The audiologist's and facility fees
- Whether a written report and results discussion are included
- Whether hearing-aid assessment is included or separate
- Any follow-up appointment cost
- What happens, and what it costs, if more tests are needed
On the NHS? Speech audiometry is available on the NHS as part of an audiology assessment when clinically indicated; private testing may be used for speed, convenience or choice of provider.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Treating the score as a fixed or exact measure rather than one that varies with conditions.
- Not allowing for language, accent or speech difficulties when interpreting the result.
- Implying the test diagnoses the cause of hearing loss on its own.
- Not explaining how the result will or will not change hearing-aid decisions.
Marketing red flags
- Promising a single score will fully explain your hearing difficulties.
- Using the test to push a particular hearing aid without explaining the result.
- Suggesting a perfect score means your hearing is normal in all situations.
- Not mentioning the limits of testing in quiet versus real-world noise.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What do my speech reception threshold and word recognition score mean for me?
- How does this result fit with my everyday difficulty understanding speech?
- Does the result change whether, or which, hearing aids would help?
- Could language, accent or tiredness have affected my score today?
- Would a speech-in-noise test add anything for my situation?
- What happens if the result is unclear or does not match my hearing?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does the test hurt?
What is the difference between this and a normal hearing test?
What is a word recognition score?
What if my first language is not English?
Why does my score not match how I hear in real life?
Is it available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Hearing tests British Society of Audiology — Recommended procedures British Academy of Audiology RNID — What happens in an audiology appointment Speech audiometry — StatPearls (NCBI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Hearing and balance assessment · Speech-in-noise testing · Tympanometry · Acoustic reflex testing · Age-related hearing loss assessment