How to Read Your Audiogram

The Moment You Get Your Results

There's something unsettling about being handed a graph covered in X's and O's, with your hearing—something you've relied on your entire life—reduced to a series of marks on a grid. Most people look at their first audiogram and think: "I have no idea what I'm looking at."

That's completely normal. Audiograms pack an enormous amount of information into a deceptively simple-looking chart. But once you understand the basics, you'll be able to read your own hearing test results and understand exactly what's happening with your hearing.

Understanding the Basic Structure

An audiogram is essentially a map of your hearing. Like any map, once you understand what you're looking at, it becomes incredibly useful. Let's break down the key elements.

The Two Axes: Frequency and Volume

The horizontal axis (across the top) shows frequency measured in Hertz (Hz). Think of this as pitch—from low sounds like a bass drum on the left (250 Hz) to high sounds like a bird chirping on the right (8000 Hz). The numbers typically go: 250, 500, 1000, 2000, 4000, 8000.

The vertical axis (down the side) shows intensity measured in decibels (dB). This represents how loud a sound needs to be for you to hear it. Here's the counterintuitive part: the numbers start at 0 at the top and go down to 120 at the bottom. The lower the mark on the chart, the louder the sound needed to be for you to hear it.

Frequency (Hz) →
250   500   1K   2K   4K   8K
-10 __________________________ (Better than normal)
 0  __________________________  ← Normal conversation starts here
10  __________________________
20  __________________________ ← Whispering
30  __________________________
40  __________________________ ← Moderate loss begins
50  __________________________
60  __________________________ ← Loud conversation
70  __________________________ ← Severe loss begins
80  __________________________
90  __________________________ ← Shouting
100 __________________________
110 __________________________ ← Profound loss
↓
Volume (dB)
Louder sounds needed →
                

Understanding the Symbols

Those X's and O's aren't random—they tell an important story about each ear separately.

When your audiologist places headphones over your ears and plays beeps at different pitches and volumes, each mark represents the quietest sound you could hear at that specific frequency. The test is repeated with a bone conduction device (placed behind your ear) to determine whether hearing loss is in the inner ear (sensorineural) or the outer/middle ear (conductive).

Degrees of Hearing Loss: What the Numbers Mean

Your hearing is categorized based on where those marks fall on the chart. Here's what audiologists look for:

Common Patterns: What Different Shapes Mean

The configuration of your hearing loss—how the marks connect across frequencies—reveals important information about what's happening and what you'll experience in daily life.

High-Frequency Hearing Loss ("Ski Slope")

This is the most common pattern, especially with age-related hearing loss. Your marks are near the top (good hearing) on the left side of the chart but drop down significantly as you move right.

What you'll experience: Difficulty hearing women's and children's voices, consonant sounds (s, f, th, sh), and the "crispness" of speech. You'll often say "I can hear you talking, but I can't understand what you're saying"—because you're hearing the low-frequency vowels but missing the high-frequency consonants that carry meaning.

Frequency →
250   500   1K   2K   4K   8K
 0   O─────O
20          ╲
40           ╲O
60              ╲
80               ╲O
100                 O
                     ↓
            "Ski slope" pattern
                

Low-Frequency Hearing Loss ("Reverse Slope")

Less common, but important to recognize. Your marks are lower (worse hearing) on the left side and improve as you move right.

What you'll experience: Difficulty hearing men's voices, bass sounds, vowels. You might have trouble hearing the rumble of traffic or deep voices but hear higher-pitched sounds relatively well. This pattern can be genetic or associated with certain medical conditions.

Flat Configuration

Your hearing thresholds are relatively similar across all frequencies—the line connecting your marks is mostly horizontal.

What you'll experience: Consistent difficulty across all sounds. Noise exposure, certain medications, and some medical conditions can cause this pattern. The good news is that hearing aids often work very well for flat losses because they need to amplify all frequencies somewhat equally.

Cookie Bite (Mid-Frequency Loss)

Good hearing at low and high frequencies, but a "dip" in the middle frequencies (500-2000 Hz). When you connect the marks, it looks like someone took a bite out of the middle of the line.

What you'll experience: This pattern is often genetic. You'll have particular difficulty with the core frequencies of speech, making conversations challenging even in quiet environments.

Asymmetric Hearing Loss

Your two ears show significantly different results—one ear has better hearing than the other.

What you'll experience: Difficulty localizing where sounds are coming from, trouble in noisy environments (you rely on having two good ears for this), and you might favor turning one ear toward speakers. Asymmetric loss can sometimes indicate underlying medical issues that need further evaluation.

What Your Results Mean for Daily Life

Here's where the audiogram becomes more than just a medical document—it's a roadmap for understanding your daily experiences and planning next steps.

The Speech Banana

If you look closely at many audiograms, you'll see a banana-shaped region plotted on the chart. This represents where the sounds of normal conversation fall. Different speech sounds occupy different parts of this "banana":

Low-frequency sounds (left side): Vowels like "oo" and "ah," the hum of "m" and "n"

Mid-frequency sounds (middle): Most vowels and some consonants—this is the core of speech understanding

High-frequency sounds (right side): Consonants like "s," "f," "th," "sh"—the sounds that carry the details and clarity of speech

When your hearing thresholds (those X's and O's) fall outside (below) the speech banana, those are the sounds you're likely missing in conversation. This is why two people with the same "degree" of hearing loss can have very different experiences—it depends on which parts of the speech banana they can still access.

Connecting the Dots to Your Experience

Your audiogram explains specific things you've been noticing:

If you have high-frequency loss: That's why restaurants are so exhausting. You're working overtime to fill in the consonants you're missing, using context clues and lip reading to piece together meaning. The background noise masks the few high-frequency sounds you can still hear.

If you have asymmetric loss: That's why you keep asking people to walk on your "good side." That's why you can't tell where your partner's voice is coming from when they call you from another room.

If you have a flat moderate loss: That's why turning up the TV doesn't really help—making everything louder doesn't make speech clearer when you need specific frequencies amplified.

Air Conduction vs. Bone Conduction: What's the Difference?

You'll notice your audiogram has two sets of marks for each ear—one from the regular headphones (air conduction) and one from the bone conduction device placed behind your ear.

Air conduction (X's and O's) shows your overall hearing ability when sound travels the normal route: through your ear canal, vibrating your eardrum and the tiny bones in your middle ear, then reaching your inner ear (cochlea).

Bone conduction (brackets: < and >) bypasses your outer and middle ear entirely, sending vibrations directly to your inner ear through the bones of your skull.

The relationship between these two measurements reveals the type of hearing loss you have:

When they match (or are within 10 dB): Sensorineural hearing loss—the issue is in your inner ear or auditory nerve. This is the most common type and includes age-related hearing loss and noise-induced hearing loss.

When air conduction is worse than bone conduction (a gap between them): Conductive hearing loss—something is blocking or interfering with sound transmission through your outer or middle ear. This might be earwax, fluid, eardrum perforation, or problems with the tiny ear bones. Good news: conductive losses are often medically treatable.

When you have both patterns: Mixed hearing loss—you have both sensorineural and conductive components. For example, age-related inner ear changes plus chronic ear infections.

Your Next Steps: From Results to Action

Understanding your audiogram is the first step. Here's what typically comes next, depending on your results.

If You Have Mild Hearing Loss

You might not need hearing aids right away, but this is the time to protect what you have and monitor for changes. Consider hearing protection in loud environments, have annual hearing tests to track any progression, and start learning about communication strategies that can help in challenging listening situations.

If You Have Moderate or Greater Loss

This is typically when hearing aids become important. Modern hearing aids can be programmed specifically for your audiogram pattern, amplifying exactly the frequencies you're missing while leaving the ones you hear well relatively untouched. Learn more about your care options.

If You Have Severe to Profound Loss

Your audiologist will discuss whether traditional hearing aids will provide enough benefit or whether you might be a candidate for cochlear implants or other advanced technology. This doesn't mean hearing aids won't work—many people with severe loss do well with powerful hearing aids—but it's worth discussing all options.

If You Have Asymmetric or Unusual Patterns

Your audiologist may recommend seeing an ear, nose, and throat (ENT) physician for further evaluation. Certain patterns can indicate medical conditions that should be evaluated beyond just treating the hearing loss itself.

Questions to Ask Your Audiologist

Armed with your understanding of your audiogram, here are some important questions to discuss:

"Which frequencies am I missing, and what sounds does that affect in my daily life?" This helps you understand what specific situations will be challenging.

"Is my hearing loss likely to progress, and how quickly?" Age-related loss typically progresses slowly; other causes might have different timelines.

"What type of hearing loss do I have, and what caused it?" Understanding whether it's sensorineural, conductive, or mixed helps you know what to expect.

"Would hearing aids help me, and what would they actually improve?" Get specific about realistic expectations for your particular audiogram pattern.

"How does my hearing loss in each ear compare, and does that affect my treatment options?" Asymmetric loss sometimes requires different approaches.

"Should I see an ENT physician for any additional evaluation?" Certain patterns or sudden changes warrant medical examination beyond the hearing test.

The Bottom Line

Your audiogram is more than a medical record—it's a detailed explanation of what you've been experiencing. Those X's and O's represent real-world moments: why you miss parts of conversations in restaurants, why phone calls are exhausting, why you keep asking people to repeat themselves.

Understanding your results empowers you to make informed decisions about your hearing health. Whether you're considering hearing aids, exploring other treatment options, or simply learning strategies to communicate more effectively, knowing how to read your audiogram is the foundation.

The good news: modern hearing care is remarkably effective at addressing most patterns of hearing loss. The key is understanding what you're dealing with and taking action before communication difficulties significantly impact your quality of life.