How to read your audiogram: a plain-English guide

Your audiogram is a graph of the softest sounds you heard at each pitch during your hearing test ^[5]. Pitch runs from low on the left to high on the right. Loudness runs from soft at the top to loud at the bottom, so the lower your marks sit, the louder a sound had to be before you heard it, and the more hearing loss you have ^[3]. O marks your right ear and X your left ^[3].

To read it, check three things: how low the marks fall (degree), whether the earphone and bone marks line up (type), and the overall shape. This guide walks through each, then reads a sample audiogram step by step.

The two axes

Across the bottom or top: pitch (frequency). Measured in hertz (Hz), from low pitches on the left to high pitches on the right. Most charts mark 250, 500, 1,000, 2,000, 4,000 and 8,000 Hz ^[3]. ASHA's standard format runs from 125 to 8,000 Hz ^[2].

Down the side: loudness (hearing level). Measured in decibels hearing level (dB HL), starting near 0 at the top and running to 120 at the bottom ^[2][3]. A mark at 10 dB means you heard a very soft tone. A mark at 70 dB means the tone had to be much louder.

ASHA's format sets the grid so one octave across equals 20 dB down, which keeps charts from different clinics looking alike ^[2].

What the symbols mean

Symbol	Ear	What it shows
O, often red	Right	Earphone (air conduction) result [3]
X, often blue	Left	Earphone (air conduction) result [3]
<	Right	Bone conduction result [3]
>	Left	Bone conduction result [3]
[	Right	Bone conduction with masking noise in the other ear [2]
]	Left	Bone conduction with masking noise in the other ear [2]
Small arrow angled down from a symbol	Either	No response at the loudest level tested [2]
S	Neither ear specifically	A result from loudspeakers (sound field) that can't be assigned to one ear [2]

"Masking" means the tester played steady noise into your other ear so it couldn't pick up the test sound and skew the result. Some charts use a small caret (^) for bone results that aren't tied to one ear ^[2]. ASHA's guidelines say color coding isn't required ^[2], so always check the key printed on your chart.

Degree of hearing loss

Find where your marks fall on ASHA's scale, which is adapted from a classic 1981 classification ^[1]:

Degree of hearing loss	Threshold range (dB HL)
Normal	-10 to 15
Slight	16 to 25
Mild	26 to 40
Moderate	41 to 55
Moderately severe	56 to 70
Severe	71 to 90
Profound	91 and above

Clinics don't all agree on where "normal" ends. Some use 20 or 25 dB HL as the cutoff instead of 15 ^[4], and UCSF's patient guide counts -10 to 25 as normal ^[3]. So a mark at 20 dB may be called "slight" on one report and "normal" on another.

Many reports also give a pure-tone average (PTA): the average of your thresholds at 500, 1,000 and 2,000 Hz ^[3]. It's a useful single number, but it can hide a steep loss at higher pitches. UCSF's guide puts it plainly: the shape of your audiogram matters as much as the average ^[3].

Type of loss: compare the earphone and bone marks

Earphone (air) testing sends sound through the whole ear. Bone testing sends vibrations straight to the inner ear and skips the outer and middle ear ^[5]. Comparing the two tells you where the problem sits ^[3]:

• The marks match, and both are below normal: sensorineural loss, an inner-ear or nerve issue.
• Earphone marks are worse than bone marks (a gap): conductive loss, a blockage in the outer or middle ear.
• Bone marks are below normal and there's also a gap: mixed loss.

The type changes what happens next. Conductive loss may be treatable, for example by removing wax, draining fluid or surgery. Sensorineural loss usually can't be cured, but hearing aids, implants and assistive devices can help ^[6].

Shape, and the speech banana

The shape of your hearing loss on the chart is called its configuration ^[4]. Two common patterns ^[3]:

• Ski slope: near-normal hearing at low pitches that drops off at high pitches.
• Cookie bite: a dip in the middle pitches with better hearing at both ends.

Also compare your O and X lines. Similar lines mean a symmetrical loss. A clear difference between ears is worth asking about: the AAO-HNS tinnitus guideline lists uneven hearing between the ears among the findings that justify imaging in people with tinnitus ^[7].

Many audiograms shade a banana-shaped region, nicknamed the speech banana, showing where the sounds of normal conversation fall. Marks below that region point to speech sounds you may be missing in conversation ^[3].

Worked example: reading a sample audiogram

The numbers below are a hypothetical sample made up for teaching, not a real patient. Each number is the softest level, in dB HL, heard at that pitch.

Pitch (Hz)	250	500	1,000	2,000	4,000	8,000
Right ear (O)	10	15	20	35	55	65
Left ear (X)	10	15	25	40	60	70

In this sample, the bone conduction marks (< and >) sit on top of the O and X marks at every pitch tested.

Reading it step by step, using ASHA's ranges ^[1]:

1. Low pitches (250 and 500 Hz): 10 to 15 dB in both ears. Normal.
2. 1,000 Hz: 20 dB right and 25 dB left. Slight loss, or normal at clinics that use a 25 dB cutoff ^[4].
3. 2,000 Hz: 35 dB right and 40 dB left. Mild.
4. 4,000 Hz: 55 dB right (moderate) and 60 dB left (moderately severe).
5. 8,000 Hz: 65 and 70 dB. Moderately severe in both ears.
6. Pure-tone average: right ear (15 + 20 + 35) ÷ 3 = about 23 dB, slight; left ear (15 + 25 + 40) ÷ 3 = about 27 dB, mild.
7. Type: bone marks match air marks, so the loss is sensorineural ^[3].
8. Shape: a ski slope, dropping at high pitches ^[3].
9. Symmetry: the ears are within 5 dB of each other at every pitch, so the loss is symmetrical.
10. Speech banana: the high-pitch marks fall below the shaded zone, so some conversational sounds are likely being missed ^[3].

Plain-English summary: a high-pitch sensorineural hearing loss in both ears, ranging from mild to moderately severe. The averages alone (slight and mild) understate what this person is missing at high pitches, which is why the shape matters as much as the average ^[3].

If your own audiogram shows a loss in this range, our guide to OTC hearing aids explains who they're designed for and when to see a professional instead.

Questions to ask about your audiogram

• What is the degree of loss in each ear, and at which pitches?
• Is it sensorineural, conductive or mixed?
• What are my pure-tone average and word recognition scores? ASHA lists word recognition testing, the percentage of words you repeat correctly, as a standard part of a full evaluation ^[1].
• Is anything here a reason to see an ENT?
• Can I have a copy to keep for comparison next time?

Unfamiliar terms on your report? Our hearing glossary defines them in plain English. To see where these numbers come from, read what happens at a hearing test. To get tested or retested, find an audiologist near you.