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LSTN Editorial Team · Editorially overseen by Dan McCoy
You got an audiogram. The audiologist may have walked you through it, but results can be hard to hold onto after you leave the room. Here's a plain-English guide to reading yours: the two axes, what the symbols mean, and where spoken language falls on the chart.
The horizontal axis (X) represents frequency, from low-pitched sounds on the left to high-pitched sounds on the right. Frequencies are measured in Hertz (Hz). The standard audiogram runs from 250 Hz (a low bass note) to 8,000 Hz (the high-pitched /s/ sound in speech). The speech range spans roughly 250-6,000 Hz.
The vertical axis (Y) represents hearing level: how loud a sound must be before you can detect it. It's measured in dBHL (decibels Hearing Level). The scale runs from 0 dBHL (the softest sound a typical young adult can detect) downward to 120 dBHL (profound loss). Counterintuitively, worse hearing appears lower on the page.
Normal hearing is typically defined as 25 dBHL or better at all tested frequencies. If all your thresholds fall in the top quarter of the chart, your hearing is within normal limits.
The letter O plotted in red represents the right ear's air conduction thresholds. The letter X plotted in blue represents the left ear. Each symbol is placed at the point where the frequency (horizontal position) meets the softest volume you could detect that frequency (vertical position).
'Air conduction' means the tone was delivered through headphones: sound traveling through the air in the ear canal, through the middle ear, and into the cochlea. This is the standard hearing pathway. Audiologists also measure 'bone conduction' using a vibrating device placed behind the ear, which bypasses the outer and middle ear and stimulates the cochlea directly.
Comparing air and bone conduction thresholds is how audiologists determine the type of hearing loss. If air conduction thresholds are poor but bone conduction is normal, the problem is in the outer or middle ear (conductive loss). If both are equally poor, the problem is in the cochlea or auditory nerve (sensorineural). If both are poor but air is worse, it's a mixed loss.
A sloping (ski-slope) configuration (normal thresholds at low frequencies, declining at high frequencies) is the most common pattern in both age-related and noise-induced hearing loss. This is why speech clarity is affected disproportionately: vowels (low-frequency) come through, consonants (high-frequency) don't.
A notch at 4,000 Hz (good thresholds above and below with a dip specifically at 4 kHz) is the hallmark of noise-induced hearing loss. It reflects damage in the cochlear region most vulnerable to acoustic trauma.
A flat configuration (roughly equal thresholds across all frequencies) is less common and has different causes, including some genetic forms of hearing loss, Meniere's disease, and certain types of conductive loss. A rising configuration (worse at low frequencies) can indicate Meniere's disease or endolymphatic hydrops.
Normal (0-25 dBHL): you detect soft sounds comfortably, including whispered speech. Mild (26-40 dBHL): you miss soft speech and consonants in noise. Most people with mild loss don't know they have it. Moderate (41-55 dBHL): conversational speech at normal volume is difficult in many situations; hearing aids are typically recommended.
Moderate-severe (56–70 dBHL): difficulty even with amplification in challenging environments. Severe (71–90 dBHL): highly dependent on technology. Profound (91+ dBHL): very limited hearing even with powerful amplification; cochlear implant candidacy is often evaluated.
These categories are guides, not rigid predictions. A person with moderate-severe loss who has worn well-fitted hearing aids for years may function better in conversation than someone with mild loss who is newly diagnosed and has no accommodating strategies yet.
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