Dr.

ASM

Audiogram

Pure tone audiometry

Pure-tone audiometry is a behavioral test used to measure hearing sensitivity

Audiometer

An audiometer is an electronic device which produces pure tones, the intensity of which can be increased or
decreased in 5 dB steps
Usually air conduction thresholds are measured for tones of 125, 250, 500, 1000, 2000 and 4000 and 8000 Hz
and bone conduction thresholds for 250, 500, 1000 and 2000 and 4000 Hz
It contains a noise generator unit, which is used for masking

Technique of pure tone audiometry

The test should be carried out in a soundproofed room

The audiometer is an instrument that generates pure tone signals ranging from 125 to 12.000 Hz (12 kHz) at
variable intensities
The signal is presented to the patient through:
a) Earphones for testing air conduction (AC) through the external and middle ear, or
b) Small vibrator applied to the mastoid process for testing bone conduction (BC) through the inner ear
The tester gradually increases the intensity of stimulus (pure tone) till it is heard by the subject, or the tester
may present a stimulus that is easily heard and then slowly decreases the intensity until the subject no longer
hears the tone
The process is repeated several times and the intensity at which the subject hears the sound (tone) for 50% of
the time, is taken as the threshold of hearing at that frequency
When difference between the two ears is 40 dB or above in air conduction thresholds, the better ear is masked
to avoid getting a shadow curve from the non-test better ear
Similarly, masking is essential in all bone conduction studies
Masking is done by employing narrow-band noise to the non-test ear

Pure-tone thresholds (PTTs) indicate the softest sound audible to an individual at least 50% of the time

Audiogram

The audiogram is a graph showing the hearing sensitivity for air and bone conducted sounds
The two main components that are graphed are frequency and intensity
The frequency or pitch of the tone in Hertz (Hz) is represented along the horizontal axis
The intensity or loudness of the tone in decibels (dB) is represented along the vertical axis
Pitch or frequency
Each vertical line from left to right represents a pitch or frequency, in Hertz (Hz)
The graph starts with the lowest pitches on the left side and moves to the very highest frequencies tested
on the right side
Loudness or intensity
Each horizontal line from top to bottom represents loudness or intensity in units of decibels (dB)
Lines at the top of the chart (-10 dB and 0 dB) represent soft sounds
Lines at the bottom of the chart represent very loud sounds
The softest intensity tested is typically 0 dB and the loudest is 110 dB
Zero (0) dB does not mean that there is no sound at all. Rather, it is the softest sound that a person with
"normal" hearing ability would be able to detect at least 50% of the time

Dr. ASM

Audiogram

Symbols on audiogram

There are different styles of audiograms, but most use a standard set of symbols for representing items on the
chart. However, you must review the key that accompanies each audiogram to verify that it uses the symbols
you are familiar with
Red circle represents air conduction for the Right ear
Blue X represents air conduction for the left ear
Red triangle represents air conduction for the Right ear (when masking noise is used)
Blue square represents air conduction for the left ear (when masking noise is used)
Red < represents bone conduction for the Right ear
Blue > represents bone conduction for the left ear
Red [ represents bone conduction for the Right ear (when masking noise is used)
Blue ] represents bone conduction for the left ear (when masking noise is used)
A represents childs hearing with hearing Aids
C represents childs hearing with Cochlear implant
S used when testing is performed through the speakers or in the soundfield

An easy way to remember which symbols are right vs. left is to imagine the child is facing you <O>. Their right ear
will be on your left, so you use the symbol < and vice versa
Once you have memorized the X and O for left and right, it may help you to remember the symbols if you think that
the triangle fits within the circle, and that an X fits in a box
The patient cannot be sedated or under anesthesia for pure tone audiometry

Common audiogram/audiologic assessment abbreviations

CNT Could not test

DNT Did not test
HA Hearing aid
HAE Hearing aid evaluation
NR No response
SNHL Sensorineural hearing loss
WNL Within normal limits
AU Both sides (ears)
AS Left
AD Right
VT Vibrotactile response
RTC Return to clinic
PRN As needed
BC Bone conduction
AC Air conduction
PTA Pure-tone average
UCL Uncomfortable loudness level
MCL Most comfortable loudness level
HFA High frequency average
HL Hearing level
SPL Sound pressure level
SRT Speech reception threshold
SAT Speech awareness threshold

Dr. ASM

Audiogram

Audiogram interpretation
A. Identify the degree of hearing loss
Normal hearing 0-25 dB
Mild hearing loss 26-40 dB
Moderate hearing loss 41-55 dB
Moderate-severe hearing loss 56-70 dB
Severe hearing loss 71-90 dB
Profound hearing loss > 90 dB
B. Identify the frequency of hearing loss low-frequency or high-frequency hearing loss
C. Identify the type of hearing loss
Normally both air and bone conduction curves superimpose on the graph showing no HL at 0-20 dB
Conductive hearing loss
Conductive HL occurs due to malfunction of the external or middle ear. The cochlea is not affected
Therefore, conductive hearing loss shows:
a) Air-conduction thresholds are poorer than normal by at least 10 dB
b) Bone-conduction thresholds are normal
Sensorineural hearing loss
In this type of hearing loss the defect lies in the cochlea and neural pathways
Therefore, thresholds for bone conducted sounds are the same as thresholds for air conducted sounds
of the same frequency, and both show equal losses
Mixed hearing loss
The hearing loss affects both air and bone conduction, but the hearing loss for air conduction is more
than the loss by bone conduction

Summary

When the bone-conduction thresholds are normal (0-25 dB) and the air-conduction thresholds are higher than
25 dB conductive hearing loss
When both bone-conduction thresholds and air-conduction thresholds are higher than 25 dB, and the air-bone
(A-B) gab is < 10 dB sensorineural hearing loss
When both bone-conduction thresholds and air-conduction thresholds are higher than 25 dB, and the air-bone
(A-B) gab is > 10 dB mixed hearing loss

Dr. ASM

Audiogram

Normal hearing audiogram

Mild conductive hearing loss

Sensorineural hearing loss

Mixed hearing loss

Bilateral sensorineural hearing loss