PTA vs OAE vs BERA: What's the Difference Between These Hearing Tests?
PTA vs OAE vs BERA: What's the Difference Between These Hearing Tests?
If your doctor or audiologist has recommended a hearing test, you may have come across terms like PTA, OAE, and BERA and wondered what they actually mean. These three tests are among the most commonly used hearing evaluations, but each one checks a different part of the hearing pathway and is suited to a different age group or situation. Understanding the difference can help you know what to expect during your visit and why a particular test has been suggested for you or your child.
At VR Speech and Hearing Clinic, we perform all three tests using calibrated, standardised equipment under the guidance of qualified audiologists, including audiologist Vilas Rathod (BASLP). This article breaks down what each test involves, how they differ, and which one might be right for your situation.
What Is PTA (Pure Tone Audiometry)?
Pure Tone Audiometry, commonly known as PTA, is the most widely used hearing test for adults and older children who can actively participate and respond during the test. It measures the softest sound a person can hear at different pitches, or frequencies, ranging from low to high tones.
During a PTA test, the person sits in a quiet room or sound-treated booth and wears headphones. Tones of varying pitch and loudness are played, and the person is asked to respond, usually by pressing a button or raising a hand, whenever they hear a sound. The results are plotted on a chart called an audiogram, which shows the degree and type of hearing loss in each ear, if any is present.
PTA is considered a subjective test because it relies on the person's active response and cooperation. This makes it ideal for adults, teenagers, and children old enough to understand and follow instructions, typically from around five years of age onwards.
What PTA Helps Detect
PTA can identify the degree of hearing loss, ranging from mild to profound, and whether the loss is conductive, sensorineural, or mixed in nature. This information helps audiologists decide whether hearing aids, medical treatment, or further testing is needed.
What Is OAE (Otoacoustic Emissions Test)?
The Otoacoustic Emissions test, or OAE, checks the function of the tiny hair cells inside the cochlea, the inner ear structure responsible for converting sound vibrations into nerve signals. When the cochlea is working normally, it produces faint sound echoes in response to a stimulus sound. The OAE test measures these echoes using a small, soft probe placed in the ear canal.
Unlike PTA, OAE is an objective test, meaning it does not require any active response from the person being tested. This makes it especially useful for newborns, infants, and young children who cannot yet respond to instructions. It is also commonly used for newborn hearing screening programs, often carried out within the first few days after birth.
The test is quick, painless, and can even be performed while the baby is asleep. However, OAE only checks the function of the outer hair cells in the cochlea; it does not assess the hearing nerve or how the brain processes sound, so it is generally used as a screening tool rather than a complete diagnostic test.
What OAE Helps Detect
OAE is highly effective at identifying cochlear-related hearing issues and is often the first step in newborn hearing screening. If the OAE result is not clear or shows a possible issue, further testing such as BERA is usually recommended to confirm the findings.
What Is BERA (Brainstem Evoked Response Audiometry)?
Brainstem Evoked Response Audiometry, or BERA, also known as Auditory Brainstem Response (ABR) testing, evaluates how sound signals travel from the ear through the auditory nerve to the brainstem. Small electrodes are placed on the scalp and earlobes, and clicking sounds or tone bursts are played through headphones or earphones. The electrodes pick up the brain's electrical response to these sounds, which is recorded and analysed as waveforms.
BERA is also an objective test and does not require the person to respond consciously. It is commonly performed on infants, young children, and individuals who cannot cooperate with standard behavioural testing, including those with developmental delays. It is often done while the child is asleep or sedated to keep them still, since movement can interfere with the recording.
Because BERA assesses the auditory nerve and brainstem pathway rather than just the cochlea, it provides more detailed information than OAE and can help estimate the degree of hearing loss even in very young infants.
What BERA Helps Detect
BERA is used to confirm hearing loss detected during OAE screening, diagnose auditory neuropathy, assess hearing nerve function, and estimate hearing thresholds in infants and children who cannot undergo PTA. It is considered one of the more thorough diagnostic tools available for early hearing evaluation.
Key Differences Between PTA, OAE, and BERA
Each of these three tests plays a distinct role in hearing evaluation, and audiologists often use them together for a complete picture rather than relying on just one.
PTA requires active participation and gives a detailed, ear-specific measurement of hearing across different pitches, making it the standard test for older children and adults. OAE is a quick screening test that checks cochlear hair cell function without requiring any response, making it ideal for newborns and infants. BERA goes a step further by evaluating the auditory nerve and brainstem pathway, offering diagnostic-level detail for infants, young children, or anyone unable to complete a behavioural hearing test.
In terms of age groups, OAE and BERA are typically used for newborns and infants as part of universal newborn hearing screening programs, while PTA becomes possible once a child is old enough to reliably respond to sounds, usually from around four to five years of age. Adults of any age can undergo PTA as their primary hearing assessment, while BERA may also be recommended for adults in specific diagnostic situations, such as suspected auditory neuropathy or when assessing the auditory nerve pathway more closely.
In terms of what they measure, PTA measures hearing thresholds based on a person's actual perception of sound, OAE measures the cochlea's physical response to sound, and BERA measures the electrical response of the auditory nerve and brainstem to sound stimuli.
Which Test Should You Choose?
The right test depends on age, ability to cooperate, and the reason for testing.
For newborns, OAE is usually the first screening step, often done within the first few days of life. If results are inconclusive or suggest a possible hearing concern, BERA is typically recommended to confirm the diagnosis. For toddlers and young children who are not yet able to respond reliably to sound cues, BERA may be advised, especially if there are concerns about speech or language delay. For older children and adults, PTA is generally the primary test, often supplemented with other tests such as speech audiometry or tympanometry for a fuller picture of ear health.
It is common for audiologists to combine these tests. For example, a child who fails a newborn OAE screening will usually be referred for a diagnostic BERA test to confirm whether hearing loss is present and to what degree, before intervention such as hearing aids is considered.
Why Early and Accurate Hearing Testing Matters
Hearing plays a crucial role in speech and language development, especially in the first few years of life. Undetected hearing loss in infants and young children can delay speech development, affect learning, and impact social and emotional growth. This is why newborn hearing screening using OAE, followed by confirmatory BERA testing when needed, is so widely recommended by paediatricians and ENT specialists.
For adults, regular hearing checks using PTA can catch gradual hearing loss early, whether it is age-related, noise-induced, or linked to another underlying condition. Early detection allows for timely intervention, whether that means hearing aids, medical treatment, or lifestyle changes to protect remaining hearing.
Hearing Tests at VR Speech and Hearing Clinic
VR Speech and Hearing Clinic offers PTA, OAE, and BERA testing across its branches in Chhatrapati Sambhajinagar (Aurangabad), Ahmednagar, Pune, Nashik, Beed, and Jalna. Tests are conducted using calibrated audiometric equipment under the supervision of trained audiologists, including Vilas Rathod (BASLP), ensuring accurate results whether you are getting a newborn screened or evaluating your own hearing health.
The clinic's headquarters is located on the Second Floor, Vasantrao Naik Chowk, N-3, CIDCO, Opposite Hotel Deepali Executive, Chhatrapati Sambhajinagar, Maharashtra, 431003.
If a hearing test has been recommended for you or a family member, understanding which test is being done, and why, can make the process far less confusing and help you feel more prepared for the appointment.
Frequently Asked Questions
1. Is PTA test painful?
No, PTA is completely painless. It simply involves listening to sounds through headphones and responding when you hear them.
2. At what age can a baby undergo OAE testing?
OAE testing can be done within the first few days after birth and is a standard part of newborn hearing screening programs.
3. Does BERA require sedation?
BERA is often done while the baby or child is asleep, since staying still helps get accurate readings. In some cases, especially with older, uncooperative children, mild sedation may be used under medical supervision.
4. If a newborn fails the OAE screening, does that mean they have hearing loss?
Not necessarily. A failed OAE screening can happen due to factors like fluid in the ear canal or background noise. It simply means further testing, usually BERA, is needed to confirm the result.
5. Can adults undergo BERA testing?
Yes, BERA can be done on adults in specific cases, such as suspected auditory neuropathy or to evaluate the auditory nerve pathway in more detail.
6. How long does each test take?
PTA usually takes around 15 to 30 minutes. OAE takes just a few minutes per ear. BERA can take between 45 minutes to over an hour, depending on the child's cooperation and sleep state.
7. Which test is best for detecting hearing loss in toddlers?
For toddlers who cannot reliably respond to behavioural testing, BERA is generally recommended for an accurate diagnosis.
8. Where can I get PTA, OAE, or BERA tests done near me?
VR Speech and Hearing Clinic offers all three tests at its branches in Chhatrapati Sambhajinagar (Aurangabad), Ahmednagar, Pune, Nashik, Beed, and Jalna.
