Whisper Test Hearing Decibel Level
The whisper test is designed to detect hearing loss at approximately 25-30 dB hearing level (HL), which corresponds to the threshold for soft speech and represents clinically significant hearing impairment that may benefit from intervention. 1
Clinical Performance Characteristics
The whisper test performed at 2 feet (approximately 60 cm) demonstrates robust diagnostic accuracy for detecting hearing impairment:
- Sensitivity of 86-100% for identifying hearing loss at the 25-30 dB threshold, depending on the specific audiometric definition used 2, 3
- Specificity of 84-90%, meaning it effectively rules out hearing loss when the test is passed 2, 3
- Positive likelihood ratio of 3.0-5.1, indicating moderate ability to confirm hearing loss when the test is failed 1
- Negative likelihood ratio of 0.03-0.52, demonstrating excellent ability to rule out hearing loss when the test is passed 1
Clinical Context and Interpretation
The 25-30 dB threshold is clinically meaningful because:
- This level represents the transition from normal hearing (0-20 dB) to soft speech range (21-40 dB), where communication difficulties begin to emerge 1
- The average hearing loss from otitis media with effusion in children is 28 dB HL, making the whisper test particularly relevant for detecting this common condition 1
- Children with hearing levels between 15-30 dB demonstrate significantly poorer cognitive, language, and reading skills compared to those with better hearing, emphasizing the clinical importance of this threshold 1
Comparison to Other Screening Methods
The U.S. Preventive Services Task Force found that the whisper test performs comparably to more complex screening methods:
- Nearly as accurate as detailed questionnaires (HHIE-S) and handheld audiometers for detecting hearing loss at the 25-30 dB threshold 1
- More practical than finger rub or watch tick tests, which showed higher positive likelihood ratios but were evaluated in limited studies with wide confidence intervals 1
- Simpler to perform than single-question screening while maintaining similar diagnostic accuracy 1
Important Clinical Caveats
When using the whisper test, be aware that:
- The test should be performed at a standardized distance of 2 feet (60 cm) to maintain consistency with the validated threshold 1, 2, 3
- Free-field voice testing was concordant between independent observers in 88% of all ears and 100% of ears able to hear a whispered voice, demonstrating excellent inter-rater reliability 3
- A failed whisper test requires formal audiometric evaluation to quantify the degree and type of hearing loss, as the whisper test cannot distinguish between conductive, sensorineural, or mixed hearing loss 1
- The test has a predictive value of 92% for hearing impairment likely to benefit from hearing aid provision, making it clinically useful for identifying patients who need intervention 3