What is an Audiogram and How to Read It

It’s easier than you might think.

Getting your hearing tested is an important part of your overall physical and mental well-being. If you’ve gotten a hearing test recently or are about to, you may have heard about an “audiogram,” a graphic representation of hearing loss and what’s contributing to it.

Whether you’re experiencing changes in your hearing or are simply curious about the process, understanding how to read an audiogram can help you make sense of your hearing health.

In this article, we’ll explore the basics of this hearing tool and guidance on how to read audiogram results.

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What is an Audiogram?

It is a graph that represents hearing test results. It shows how well you can hear different frequencies (pitches) and intensities (volumes) of sound. Hearing care providers commonly use this graph to identify your degree and type of hearing loss.

How This Hearing Test Works

This hearing test involves using transducers and specialized equipment. Here’s a breakdown of the main components, including transducers, and steps in the testing process:

In this case, transducers convert electrical energy into sound and deliver the sound to different parts of the patient’s ear. For an audiogram, there are two types of transducers used:

Headphones or Insert Earphones. These are placed on or in the patient’s ear to deliver sounds. Insert earphones are typically used for air-conduction testing because they provide a good seal in the ear canal, reducing the chances of sound leakage and creating a more accurate assessment.
Bone Oscillator. Used for bone-conduction testing, these are placed on the mastoid bone (behind the ear or on the forehead). They send sound directly to the inner ear by vibrating the skull, bypassing the outer and middle ear.

Using both methods helps differentiate between conductive and sensorineural hearing loss. Now let’s look at how these two transducers are used for air-conduction and bone-conduction tests:

Pure Tone Air-Conduction (AC) Test: The hearing care provider places headphones or inserts earphones on the patient, who will then hear a series of tones at different frequencies. For each frequency, the sound intensity is gradually increased from faint to louder, and the patient signals when they can hear the tone.
Bone-Conduction (BC) Testing: Once the bone oscillator has been placed the hearing care provider will play tones at various frequencies, and the patient will indicate when they can hear each tone.

This information is plotted on the audiogram. The horizontal axis (x-axis) of the audiogram shows different sound frequencies. It can be helpful to think of the frequency axis (the horizontal x-axis) like a piano; as you move left to right, the sounds go up in pitch.

Meanwhile the vertical axis (vertical y-axis) shows sound intensity or loudness.

From there, you and your hearing health care provider can read the results to understand what’s contributing to your hearing loss.

The Key Components of an Audiogram

Learning how to read an audiogram starts with understanding its different key components:

Frequencies (Pitch)

Frequencies, measured in hertz (Hz), are shown on the horizontal (x-axis) and range from 125 Hz all the way up to 8,000 Hz. Everyday sounds vary across this frequency range. For instance, bass notes like a truck engine are low-frequency sounds, while birds chirping are high-frequency sounds.

Intensity (Loudness)

Intensity, which is measured in decibels (dB), is shown on the vertical (y-axis). It ranges from very soft sounds at the top (-10 dB HL) to very loud sounds at the bottom (120 dB HL). To put it in context, regular conversation occurs around 60 dB HL.

Audiogram Symbols

Audiogram symbols, made with an X and an O are used to indicate hearing thresholds for each ear. “O” is marked in red and represents the right ear, and “X,” marked in blue, represents the left. Normal hearing appears at low intensity levels at the top of the graph, hearing loss occurs at higher intensity levels, lower on the graph.

How to Read an Audiogram

Reading an audiogram can offer a lot of insights, including the type, degree, and configuration of hearing loss. To that end, here are a couple pieces of information you can get from your audiogram results:

1. Look at the Threshold Levels

Hearing threshold levels are the lowest volumes that you can hear a sound at each frequency. Hearing is generally considered “normal” if the marks fall within the range of -10 dB to 20 dB. When the marks fall above this range, it may indicate hearing loss.

2. Identify the Type of Hearing Loss

This test helps determine if there’s an issue in the outer or middle ear by comparing air- and bone-conduction thresholds. Here’s what we can learn from the results:

Conductive Hearing Loss. When hearing loss is due to issues in the middle or outer ear, it typically shows up as a gap between air and bone conduction thresholds.
Sensorineural Hearing Loss. This is caused by damage to the inner ear or auditory nerve. Sensorineural hearing loss can be any configuration, but it is indicated by a small gap between air conduction and bone conduction thresholds. That’s because with this type of hearing loss, both air and bone conduction thresholds are similarly affected.
Mixed Hearing Loss. If you have a combination of conductive and sensorineural hearing loss, the audiogram will show both conductive and sensorineural loss patterns.

3. Determine the Degree of Hearing Loss

Hearing loss is categorized by its severity:

Mild (20-40 dB) = Difficulty hearing soft sounds.
Moderate (41-55 dB) = Difficulty hearing regular conversation.
Severe (71-90 dB) = Trouble hearing loud sounds, including conversations.
Profound (91 dB+) = Minimal to no hearing without amplification.

Identifying the type and degree of hearing loss charted on the audiogram is difficult to interpret if you’re not a professional hearing care provider. But your provider should walk through your results with you so you understand your specific type and degree of hearing loss.

Learn more about the degrees of hearing loss.

4. Look for Patterns

Audiograms can reveal insightful patterns into your hearing ability. As one example, high-frequency hearing loss, which can affect the ability to understand speech, often looks like a sloping line from left to right.

What to Do If Your Audiogram Shows Hearing Loss

During your appointment, don’t hesitate to ask your hearing care provider questions so you understand your hearing health. Hearing loss is common and treatable, and your provider should walk you through your options including hearing aids, assistive devices, and lifestyle adjustments.

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