How to Read an Audiogram

The two axes of an audiogram

The horizontal axis shows frequency in hertz, abbreviated Hz. Low-pitched sounds appear on the left and high-pitched sounds appear on the right. A typical clinical audiogram includes frequencies such as 250, 500, 1000, 2000, 4000, and 8000 Hz. Many speech cues extend across this range. Vowels tend to carry more low-frequency energy, while consonants such as s, f, and th contain important high-frequency information.

The vertical axis shows decibels hearing level, written dB HL. Softer test levels are near the top. Louder test levels are farther down. This upside-down layout means that marks lower on the page represent sounds that had to be made louder before you responded.

Zero dB HL does not mean the absence of sound. It is a standardized reference based on average hearing sensitivity at each test frequency. A threshold is the softest level at which a person responds reliably during the test.

Common symbols for the right and left ears

The key printed on your own report controls how its symbols should be read. Common clinical conventions: unmasked right ear air conduction uses O (often red); unmasked left ear air conduction uses X (often blue); masked air conduction uses a triangle (right) or square (left); unmasked bone conduction uses < (right) or > (left); masked bone conduction uses [ (right) or ] (left); sound field uses S or another keyed symbol.

A downward arrow attached to a symbol generally means there was no response at the loudest level tested. Color helps, but the symbol shape is important because printed copies may be black and white.

How to read the graph step by step

1. Find the legend. Confirm which symbols represent each ear, test method, masking condition, and any no-response result.

2. Trace one ear at a time. Follow the right ear across the frequencies, then repeat with the left ear. Avoid averaging the two ears together in your head.

3. Read each threshold. Match a symbol to its frequency on the horizontal axis and its dB HL value on the vertical axis. A mark at 2000 Hz and 40 dB HL means the tone had to reach about that hearing level before the response was recorded.

4. Describe the degree by frequency. Hearing may fall in one range at low pitches and another at high pitches, so a single label may not describe the entire audiogram.

5. Look at the configuration. Note whether the line is flat, slopes downward toward high frequencies, rises, has a notch, or dips in the middle.

6. Compare the ears. Similar lines suggest symmetric thresholds. Clear differences at one or more frequencies may need professional interpretation and follow-up.

7. Compare air and bone conduction. The relationship between these thresholds helps the audiologist describe the type of hearing loss.

8. Review speech results. Speech reception and word recognition add information that pure tone thresholds alone cannot provide.

What the degree labels mean

Clinicians may use slightly different classification systems, and pediatric criteria are often more conservative. A commonly cited adult framework: −10 to 15 dB HL is the typical range; 16–25 dB HL is slight; 26–40 dB HL is mild; 41–55 dB HL is moderate; 56–70 dB HL is moderately severe; 71–90 dB HL is severe; 91 dB HL or greater is profound.

These labels describe audibility thresholds. They do not predict exactly how well a person understands speech, especially in background noise.

Air conduction and bone conduction

Air conduction testing sends sound through earphones or insert receivers. The sound travels through the ear canal and middle ear before reaching the inner ear. Bone conduction testing uses a small oscillator placed behind the ear or on the forehead. It bypasses much of the outer and middle ear and stimulates the inner ear through vibration.

The difference between air and bone thresholds is called an air-bone gap. Audiologists judge whether a gap is clinically meaningful by considering its size, the tested frequencies, masking, and measurement reliability.

Conductive pattern: bone conduction is within the expected range while air conduction is poorer, creating an air-bone gap. Sensorineural pattern: air and bone thresholds are both reduced and are generally similar, without a meaningful air-bone gap. Mixed pattern: bone thresholds are reduced, and air thresholds are poorer still, producing both an inner ear component and an air-bone gap.

These patterns describe where a problem may be affecting the hearing pathway. The audiogram alone does not identify a specific disease or cause.

Why masking may appear on the report

When one ear hears much better than the other, a loud tone presented to the poorer ear may cross through the skull and be detected by the better ear. Masking places controlled noise in the non-test ear so the audiologist can measure the intended ear more accurately. Masked thresholds use different symbols. Masking is a normal test technique and does not mean the hearing loss is more severe.

Common audiogram shapes

Audiologists often describe the overall configuration because two people with the same average threshold can have different hearing across pitches.

Flat: thresholds are relatively similar across the tested frequencies. Sloping: thresholds are better in the low frequencies and poorer in the high frequencies. Rising: thresholds are poorer in the low frequencies and better in the high frequencies. Notched: a limited frequency region is poorer than the frequencies around it. Mid-frequency dip: thresholds are poorer in the middle frequencies than at the low and high ends.

A shape can suggest questions for further evaluation, but it is not a diagnosis. Similar shapes can occur for different reasons, and the audiologist must interpret the pattern with the rest of the examination.

How speech test results fit in

The speech reception threshold (SRT) estimates the lowest level at which you can repeat familiar two-syllable words. Audiologists compare the SRT with the pure tone results as a cross-check on test consistency.

Word recognition testing measures how many words you repeat correctly at a selected presentation level, usually in quiet. The score is reported as a percentage. Its meaning depends on the word list, presentation level, test setup, language, and other clinical factors. A percentage should not be interpreted without those details.

Some people hear tones or words well in quiet but struggle in restaurants, meetings, or group conversations. Speech-in-noise testing can measure this difficulty more directly. It is not always printed on a standard audiogram, so ask whether it was included.

What an audiogram cannot tell you by itself

The audiogram alone cannot tell you the exact cause of a hearing change, how you will function in every real-world listening situation, whether a particular hearing aid or other treatment is right for you, how the eardrum and middle ear are functioning unless other tests such as tympanometry are included, or whether the result explains tinnitus, dizziness, sound sensitivity, or listening fatigue.

A comprehensive hearing evaluation may also include otoscopy, tympanometry, acoustic reflexes, otoacoustic emissions, speech testing, and other measures selected for your history and symptoms.

Questions to ask about your audiogram

Are my results similar in both ears? Which frequencies are affected, and how might that relate to speech understanding? Is there an air-bone gap or another pattern that needs follow-up? How reliable and consistent were my responses? What do my speech reception and word recognition results mean in context? Would speech-in-noise testing add useful information? Should I repeat the test, monitor a change, or seek medical evaluation?

When hearing changes need prompt care

Seek urgent medical evaluation for hearing that drops suddenly over hours or a few days, especially in one ear. Sudden sensorineural hearing loss can be treated as a medical emergency, and delaying assessment may reduce treatment options. Prompt care is also important for hearing changes accompanied by new neurologic symptoms, severe dizziness, ear injury, drainage, or significant pain.

The bottom line

Start with the axes, read each ear separately, and remember that lower marks mean louder sounds were needed. Then compare air and bone conduction and review the speech measures. The audiogram describes hearing sensitivity; your audiologist connects those results to symptoms, communication goals, and the rest of the evaluation.

If you want help understanding the next step, request local hearing help through Audiology.md or search for a hearing care provider near you. An online hearing screening can be educational, but it is not a diagnosis and does not replace a comprehensive evaluation.

Explore pure-tone audiometry to learn how the thresholds are measured, or read What Is a Hearing Evaluation? for an overview of the full appointment.