“The Audiogram – What Does It

Mean?”

Dr. Al Turri, Au.D.

www.fixmyhearing.com

The audiogram…

Despite significant advances in hearing science, the simple audiogram remains an invaluable tool when describing the impact of hearing loss

Represents a picture of how well you hear

The importance of understanding the audiogram (for those with hearing loss)... Track hearing loss over time

Keep all copies of audiograms (with the proper dates) for comparison

Useful for hearing aid adjustments

Unconsciously, audiologists fall into the habit of simplifying & shortening the explanation of the audiogram - perhaps not conveying the pattern & significance of one’s hearing loss

Once completed, the audiogram will tell us:

1. If a hearing loss is present

2. The amount of hearing loss (severity)

3. The configuration or shape of the hearing loss

4. The type of hearing loss (sensorineural, conductive, or mixed)

The horizontal axis of the

audiogram = Frequency or

PITCH

• Measured in units called Hertz (Hz)

• Hertz = cycles per second

Low Pitch High Pitch

The vertical axis of the audiogram = Intensity

or LOUDNESS

• Measured in decibels

(dB)

SOFT

LOUD

The process of obtaining the audiogram…

Inside the sound-treated booth…either insert earphones or headphones are placed in/on your ears. This is how the sounds are presented. This is considered AIR CONDUCTION testing.

The audiologist takes her place outside the booth at the audiometer & gets prepared to present pure tone beeps at several frequencies/pitches to each ear. You have been instructed to respond whenever you hear the beeps…no matter how soft.

The audiologist begins plotting on the audiogram your THRESHOLD for each frequency. This is the softest level at which you barely hear the beep.

O O

O

O

O

O = Right ear

For example: At 4000 Hz, the audiologist had to make the tone 80 dB loud for this patient to just BARELY hear it

Once one ear is completed, the symbols are connected and the other ear begins to be tested

O O

O

O

O

O = Right ear

X = Left ear

O

X

X

X

Once both ears are completed for air conduction, the audiologist is able to determine if a hearing loss is present, the amount of hearing loss, and the configuration or shape of hearing loss

O O

O

O

O

O = Right ear

X = Left ear

O

X

X

X X

X X

The TYPE of hearing loss is not yet able to be determined!

First…is a hearing loss present?? We have to know where the range of

normal hearing lies.

Range of Normal Hearing

OO

O

O

OOX

X

XX

XX

An example of normal hearing in both ears

The audiologist detects a hearing loss but how bad is it??

Degrees of Hearing Loss:

Mild loss: Difficulty with faint speech & speech in “less than ideal” situations

Moderate loss: Frequent difficulty with normal speech (even in “ideal” situations”); repetition is often necessary; listening is a strain

Severe loss: May hear loud voice approximately 1 ft. from ear; may identify environmental sounds; may distinguish vowels of speech

Profound loss: Usually cannot understand amplified speech; hearing is not typically the primary mode of communication

Now what is the shape of the hearing loss??

Typical descriptors are flat, sloping, rising, low-frequency, & high-frequency

We’re not done yet…now it’s time for bone conduction testing to determine the

TYPE of hearing loss… The audiologist will place the bone

conduction oscillator behind one of your ears on the mastoid bone. She will again present the beeps to you in the same manner, this time, however, you are hearing the beeps through vibrations of the skull bones.

O O

O

O

OO

X

X

X X

X X

> >

>

>

Bone conduction testing is typically only performed at the frequencies of 500 Hz – 4000

Hz

Audiologists have to “mask” (or present

sound to the ear not being tested) because

sometimes sounds “crossover” to the opposite ear & we

don’t know which ear is responding! If we

mask, we know which ear is responding.

AC = Air conduction; BC = Bone conduction

Why is it necessary to test both air & bone conduction??

With air conduction testing, the integrity of all 3 parts of our ears (outer, middle, & inner) are being assessed

Insert earphone for air

conduction testing

Why is it necessary to test both air & bone conduction??

With bone conduction testing, the outer & middle ear are bypassed & the inner ear is stimulated directly by the bone conduction vibrations

Examining air conduction vs. bone conduction…

It is necessary to look at the bone conduction thresholds in relation to the air conduction

thresholds…this is how we determine TYPE of

hearing loss & if a pathology may be

present that requires medical attention

>

Examining air conduction vs. bone conduction…

If the bone conduction

thresholds line up with the air conduction

thresholds, the hearing loss

would be considered

SensorineuralSensorineural “Nerve loss”

>

Examining air conduction vs. bone conduction…

If the bone conduction

thresholds fall within the

NORMAL RANGE but air conduction thresholds do not, the hearing loss

would be considered ConductiveConductive

>

Examining air conduction vs. bone conduction…

If the bone conduction

thresholds are better than the air

conduction thresholds (but not normal), the

hearing loss would be

considered MixedMixed

Conductive & Mixed Losses… These type of losses require medical attention

before being fit with hearing aids. Sound is somehow “blocked” or impeded by a

pathology in the outer &/or middle ear. Some causes may include: Middle ear infection Fluid in the middle ear (with no infection) Ruptured eardrum Unhinging of the middle ear bones Stiffening of the middle ear bones (otosclerosis) Tumor in the middle ear space Wax build-up

Let’s practice…

What ear was tested?? Is there a hearing loss present?? If so what is the amount, configuration, and type??

Normal

Let’s practice…

What ear was tested?? Is there a hearing loss present?? If so what is the amount, configuration, and type??

Normal

Let’s practice…

What ear was tested?? Is there a hearing loss present?? If so what is the amount, configuration, and type??

Normal

Let’s practice…

What ear was tested?? Is there a hearing loss present?? If so what is the amount, configuration, and type??

Normal

Let’s practice…

What ear was tested?? Is there a hearing loss present?? If so what is the amount, configuration, and type??

Normal

So I have a moderate sensorineural hearing loss in both ears…what does

that mean??

It helps if you transpose your audiogram onto an “Audiogram of Familiar Sounds”. This will allow you to see the speech sounds & environmental sounds you are missing.

This is a special audiogram that shows where everyday environmental & speech sounds occur (i.e. pitch & loudness)

Audiogram of familiar sounds

Low High Pitch

Soft

Loud

A moderate high-frequency sensorineural hearing loss…A classic example of “hearing

but not understanding”.

NORMAL HEARING

= RIGHT EAR= LEFT EAR

>

> >

>

Hearing but not understanding… Consonants are softer than vowels (higher on

the audiogram) Consonants are higher pitched than vowels

(more to the right on the audiogram)

Where do most people have hearing loss??

The high-pitches!! If a person with hearing loss is able to hear

vowel sounds clearly but misses consonants frequently…they perceive others as MUMBLING!!

Loud Vowels Soft, high-

pitched consonants

Keep in mind… Vowels give power to speech but

consonants give the clarity! Consonants are more important than

vowels in understanding speech but it is the consonants that get drowned out in noisy environments & it is the consonants that individuals with hearing loss have the most difficulty hearing!!

Thank you for your attention!! Any questions?

I will be happy to answer any questions on your personal audiograms.

info@fixmyhearing.com