The first examination is a physical examination of the ear. Using an instrument with a light at the end, called an auriscope or otoscope, they will look for anything that is not normal, including:

• Discharge (fluids coming out of the ear)
• A bulging ear drum (indicating that there is fluid inside the inner ear)
• A perforated ear drum (with a hole in it)
• An object that might be blocking the ear

Methods for testing hearing

• Whispering or using a ticking watch
 One ear at a time will be blocked and the nurse or doctor will test hearing with sounds of varying volumes. In the whispering test, the patient might have to repeat the whispered words out loud.

• Tuning fork
A tuning fork is a Y-shaped metallic object which, when tapped, produces sound waves at a fixed pitch. The tuning fork is made to vibrate and is then held at each side of the head. It can be used to test how well sounds are heard that are transmitted through air vibrations and through the bone behind the ear (mastoid bone).

Tuning fork

• Audiometry 
In this test the patient is given earphones that are attached to a machine. Sounds of different volumes are played through the earphones, and the patient has to indicate whether the sounds are heard. This can involve raising a hand or pressing a button.

• Bone oscillator
This is another test that measures how well a patient can hear sounds sent through the bone, instead of the air. This uses an instrument called a bone oscillator placed against the bone behind your ear.

Sometimes further hearing tests are needed, to help doctors work out why your hearing is impaired. These include:

• Tympanometry
This test is used to check how well the moving parts of the middle ear are working. A small earpiece is held in the ear canal. A pump causes pressure in the ear to change and the earpiece measures the change by checking the sound that is reflected by the eardrum.

• Auditory brainstem response test (ABR) 
Tiny electrical sensors are placed on the scalp and each ear lobe. Earphones are put over the ears and quiet clicking noises are played to each ear. The sensors measure the response of different parts of the brain to the noises.

• Otoacoustic emissions test (OAE)
OAE tests are most often used in people who are difficult to test, such as newborn babies and people who are pretending to be deaf. In this test, a probe is gently put into the ear canal. It has a speaker that plays soft clicking noises, and a microphone that records the noises the ear makes in response. A machine records the responses, and shows if the inner ear is working properly.

References:

NHS Direct Online Health Encyclopedia

National Deaf Children's Society