The Békésy test

The Békésy test is an automated method for measuring hearing thresholds, commonly used for audiometric screening and detecting noise-induced hearing loss (NIHL).

This test utilizes pulsed tones that automatically vary in frequency, intensity, and ear based on a pre-set program. Pulsed tones are particularly effective for individuals with tinnitus, as they are often easier to detect in such cases.

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The Békésy test requires a high level of concentration from the patient. During the test, the patient controls the stimulus intensity by pressing a response button when they hear the tone and releasing it when the tone is no longer audible.

When the button is pressed, the intensity level decreases automatically, and when the button is released, the intensity increases. These responses are recorded as a trace on the test screen, and the midpoint of the trace is used to determine the hearing threshold.

How is the Békésy method conducted? 

1. Begin by explaining the procedure to the patient with clear instructions such as:
   
   "You will hear a series of tones. Press the response button as long as you hear a tone, and release it when the tone is no longer audible, regardless of how loud, soft, or which ear you hear the tones in."
    
2. On the audiometer, select the ‘Auto Békésy’ test mode.
3. Allow the patient to familiarize themselves with the test process and the type of tones they will hear. Once the familiarization process is complete, the test will begin automatically.
4. The patient controls the intensity of the sound by pressing the response button when the tone is audible. The audiometer reduces the intensity in steps when the patient presses the button until the tone becomes inaudible and the button is released. The audiometer then increases the intensity automatically until the patient hears the tone again and presses the button.
5. This generates a zigzag trace of peaks and wells (also called ‘excursions’). The mid-point of the excursions is used to calculate the hearing threshold.
6. The test typically starts with the lowest frequencies and progresses to higher frequencies. 

The benefits of using a Békésy test

The Békésy test has advantages as well as disadvantages in comparison to a Hughson Westlake test. A case study by Ventry (1971) found that the major advantage of the Békésy test is its ability to highlight functional hearing loss. Pulsed tones can also be easier to hear for someone with tinnitus, making it a more effective test to perform in these cases.

However, the Békésy test is more demanding than the Hughson Westlake test, requiring a high level of concentration. As a result, it may produce a higher level of inconsistency in some individuals.

Equipment and training

Amplivox offers a comprehensive range of intuitive and accurate audiometry equipment, along with accredited training programs for professionals to gain expertise in the Békésy test and other testing methods.

References and further reading

1. Lentz, J.J. et al. (2017). Audiometric testing with pulsed, steady, and warble tones in listeners with tinnitus and hearing loss, American Journal of Audiology, 26(3), pp. 328–337. https://doi.org/10.1044/2017_aja-17-0009.
2. Burns, W. and Hinchcliffe, R. (1957). Comparison of the auditory threshold as measured by individual pure tone and by békésy audiometry, The Journal of the Acoustical Society of America, 29(12), pp. 1274–1277. https://doi.org/10.1121/1.1908761.
3. Erlandsson, B. et al. (1979). Comparison of the hearing threshold measured by manual Pure-Tone and by Self-Recording (Békésy) audiometry, International Journal of Audiology, 18(5), pp. 414–429. https://doi.org/10.3109/00206097909070067.
4. Ventry, I.M. (1971). Bekesy Audiometry in Functional Hearing loss: a case study, Journal of Speech and Hearing Disorders, 36(1), pp. 125–141. https://doi.org/10.1044/jshd.3601.125.
5. A. Taymour (2018). Békésy Audiometry – Reliability Tested. [online] Available at: https://curtislaw.co.uk/latest-news/b%C3%A9k%C3%A9sy-audiometry-reliability-tested/ (Accessed 3 Jan. 2025).
6. Shojaeemend, H. and Ayatollahi, H. (2018). Automated Audiometry: A review of the implementation and evaluation methods, Healthcare Informatics Research, 24(4), p. 263. https://doi.org/10.4258/hir.2018.24.4.263.

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