What This Article Covers
This guide helps you understand the audiogram you received from your audiologist or hearing care provider. We'll walk through what the graph shows, how to read the results, and most importantly—what it all means for your daily life.
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 down the mark on the chart, the louder the sound needed to be for you to hear it.
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.
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:
| Degree of Loss | Decibel Range | What This Means |
|---|---|---|
| Normal | -10 to 25 dB | You can hear very soft sounds. No difficulty in quiet or noisy environments. |
| Mild | 26 to 40 dB | Difficulty hearing soft speech, especially in noise. You might miss parts of conversations. |
| Moderate | 41 to 55 dB | Difficulty hearing normal conversation. You likely need hearing aids. |
| Moderately Severe | 56 to 70 dB | Very difficult to hear normal conversation. Powerful hearing aids needed. |
| Severe | 71 to 90 dB | Can only hear very loud sounds. Hearing aids or cochlear implants recommended. |
| Profound | 91+ dB | Extremely limited hearing. Cochlear implants or assistive technology typically needed. |
Important Note About Averages
Audiologists typically calculate your "pure tone average" (PTA) by averaging the thresholds at 500, 1000, and 2000 Hz. This single number gives a quick snapshot but doesn't tell the whole story. The shape of your audiogram matters just as much as the average.
Common Patterns: What Different Shapes Mean
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, and consonant sounds (s, f, th, sh). 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.
Low-Frequency Hearing Loss ("Reverse Slope")
Less common. Your marks are lower (worse hearing) on the left side and improve as you move right. You may have trouble hearing bass sounds or the rumble of traffic, but hear higher-pitched sounds well.
Flat Configuration
Your hearing thresholds are relatively similar across all frequencies. This can be caused by noise exposure or certain medications. Hearing aids often work very well for flat losses because they amplify all frequencies equally.
Cookie Bite (Mid-Frequency Loss)
Good hearing at low and high frequencies, but a "dip" in the middle frequencies. This pattern is often genetic and causes particular difficulty with the core frequencies of speech.
When Asymmetry Matters
If your audiogram shows a significant difference between your two ears (more than 15 dB difference), your audiologist will likely recommend additional testing. Sudden asymmetric hearing loss can indicate conditions requiring medical attention and is considered a medical emergency.
What Your Results Mean for Daily Life
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.
When your hearing thresholds fall below the speech banana, those are the sounds you're likely missing in conversation. This explains why two people with the same "degree" of hearing loss can have very different experiences—it depends on which parts of speech they can still access.
Air Conduction vs. Bone Conduction
Air conduction shows your overall hearing ability when sound travels the normal route through your ear canal. Bone conduction bypasses your outer and middle ear, sending vibrations directly to your inner ear.
Comparing these reveals the type of loss:
- Match: Sensorineural loss (inner ear issue).
- Gap (Air worse than Bone): Conductive loss (blockage in outer/middle ear).
- Both: Mixed hearing loss.
The Bottom Line
Your audiogram is a visual summary of how softly you can hear different pitches in each ear. The position and pattern of those Xs and Os tell your audiologist not just “how bad” your hearing loss is, but which sounds are hardest for you and how that affects conversation.
The degree of loss (mild, moderate, severe, etc.) is only part of the story. The shape of your audiogram and whether air and bone conduction match or differ help your team figure out the likely cause and the best treatment options.
You don’t have to decode the chart alone. Bring your questions to your audiologist, and use this guide alongside your results so you can make informed decisions about hearing aids, cochlear implants, or other next steps.
Next Steps: Use Your Results to Plan Care
Now that you understand your audiogram, you can start connecting it to real-world decisions—like when to try hearing aids, how to choose technology, and what kind of follow-up care you might need.