More Than a Line Graph: The Power of Audiograms

 

An audiogram maps your hearing health. This painless test measures how well you hear different pitches. A hearing professional conducts the test, assessing your ability to detect sounds from soft to loud.

 

The results guide interventions to improve or preserve hearing function to prevent the risks of untreated hearing loss. They provide a clear picture of your hearing abilities, helping professionals determine the best treatment options.

 

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Understanding the Graph

 

An audiogram may seem complex, but understanding its components reveals valuable insights about your hearing health.

 

The Axes

 

  • Frequency (X-Axis): The horizontal axis represents sound pitch, measured in Hertz (Hz). It ranges from 125 Hz (low sounds like thunder) to 8000 Hz (high sounds like crickets chirping).

 

  • Intensity (Y-Axis): The vertical axis represents sound loudness, measured in decibels (dB). It typically ranges from -10 dB (very soft sounds) to 110 dB (loud sounds).

An image of an audiogram from Alpha One Now that shows hearing loss at higher frequencies.

The Lines

 

The lines on the audiogram are not random; they indicate your hearing thresholds at different frequencies.

 

  • Hearing Threshold: This is the softest sound you can consistently hear at a specific pitch. The lower the dB value on the Y-axis, the better your hearing for that frequency.

 

  • Interpreting the Lines: Imagine the lines on the audiogram as your personal “hearing islands.” Ideally, these lines stay within the normal hearing range, usually shown by a shaded area.

 

  • Shifts in the Lines: If lines dip below the normal hearing range, it suggests hearing loss at those pitches. The severity depends on how far below the normal range the line falls.

 

Additional Components

 

Air Conduction vs. Bone Conduction: An audiogram may show two lines: one for air conduction testing (the standard method) and another for bone conduction testing (differentiating conductive vs. sensorineural hearing loss).

 

Common Measures:

 

  • Threshold: The lowest sound level is heard 50% of the time.
  • Speech Reception Threshold (SRT): The softest intensity at which you can repeat bisyllabic words 50% of the time.
  • Word Recognition Score: The percentage of words correctly identified at threshold.
  • Speech Discrimination: The percentage of single-syllable words identified at suprathreshold levels (usually 30 dB above SRT).
  • Acoustic Reflex: Muscle contraction in the middle ear in response to high-intensity sounds.
  • Tympanometry: Assesses ear canal volume and eardrum mobility with air pressure.
    • Types of Tympanometry Results
      • Type A: Normal.
      • Type B (Flat): Limited mobility due to fluid or eardrum damage.
      • Type C: Negative pressure from retraction.

 

Patients often ask about their “percentage of hearing loss.” There is no evidence-based formula to convert the dB scale to a meaningful percentage of hearing loss. However, a formula exists to calculate disability percentage for pension eligibility.

 

Understanding these components helps you know what the audiogram reveals about your hearing health. Your audiologist will interpret the audiogram, other tests, and your medical history for a comprehensive assessment.

 

Beyond the Numbers: What Does Your Audiogram Reveal?

 

An audiogram reveals more than just numbers and lines. It provides a detailed picture of your hearing health, showing how well you hear sounds at various pitches.

 

Normal Hearing vs. Hearing Loss

 

The  Zone: The area on the audiogram represents the normal hearing range. Ideally, your hearing thresholds should fall within this zone, indicating you can hear sounds from soft whispers (around 20 dB) to comfortably loud sounds (around 40 dB) across various pitches.

A volume control shows 70dB.

Degrees of Hearing Loss:

 

  • Mild Hearing Loss: Lines dip slightly below the normal range (20-40 dB). This can make faint sounds or soft speech hard to hear, especially in noisy environments.
  • Moderate Hearing Loss: Lines dip further (40-60 dB). Following conversations, especially in groups or with background noise, becomes challenging.
  • Severe Hearing Loss: Lines fall significantly below the normal range (60-90 dB). Speech may sound muffled, and understanding conversation is tough.
  • Profound Hearing Loss: Lines fall well below the normal range across most frequencies (90+ dB). Significant hearing impairment is present, often requiring visual cues or assistive devices.

 

Types of Hearing Loss

 

An audiogram also indicates the type of hearing loss:

 

  • Conductive Hearing Loss: This occurs when sound waves struggle to reach the inner ear due to issues in the outer or middle ear (e.g., earwax buildup, infections). The audiogram may show a flat dip across all frequencies, with worse air conduction thresholds than bone conduction thresholds.

 

  • Sensorineural Hearing Loss: Involves damage to the inner ear or auditory nerve, affecting sound signal processing. The audiogram might show a variable dip across different frequencies with similar air and bone conduction thresholds.

 

Hearing Loss Configuration

 

Hearing loss configuration refers to the pattern of loss across frequencies:

 

  • High-Frequency Hearing Loss: Good hearing at lower pitches and poor hearing at higher pitches.
  • Bilateral vs. Unilateral: Affects both ears or just one.
  • Symmetrical vs. Asymmetrical: Similar in both ears or varies in degree/configuration.
  • Progressive vs. Sudden: Steady decline in hearing or rapid loss without warning.
  • Fluctuating vs. Stable: Changes over time or remains the same.

 

A qualified audiologist will interpret your audiogram, other tests, and your medical history to provide a specific diagnosis and explore appropriate treatment options. Understanding these aspects helps you grasp the complete picture of your hearing health.

 

A Deeper Dive: Conductive vs. Sensorineural Hearing Loss on Audiograms

 

While an audiogram offers clues, it doesn’t provide a definitive diagnosis. It helps identify the type of hearing loss you might have.

 

Conductive Hearing Loss

 

Understanding the Problem: Conductive hearing loss occurs when sound waves struggle to travel through the outer or middle ear due to obstructions or malfunctions. Causes include earwax buildup, infections, eardrum perforation, or issues with the ossicles (tiny bones in the middle ear).

 

Impact on Hearing: All sounds become quieter, but the quality remains unaffected. Sound waves don’t efficiently reach the inner ear.

 

Audiogram Indicators:

 

Air-Bone Gap: An audiogram shows air conduction (standard test) and bone conduction (direct vibrations to the inner ear). In conductive hearing loss, air conduction thresholds are worse than bone conduction thresholds, creating a visible gap between the two lines.

Flat Dip in Lines: Hearing thresholds appear relatively flat across most frequencies, affecting all sounds evenly.

 

Treatment Options:

 

  • Earwax removal
  • Medication for ear infections
  • Surgery to repair a perforated eardrum or ossicular problems

 

Sensorineural Hearing Loss

 

Inner Ear Issues: Sensorineural hearing loss involves damage to the hair cells or auditory nerve in the inner ear, which is responsible for converting sound waves into electrical signals for the brain. Causes include age, noise exposure, genetics, or certain medications.

 

Hearing Effects: Both loudness and clarity of sounds are affected. Sounds may seem muffled or distorted, and understanding speech, especially in noisy environments, is difficult.

 

Audiogram Indicators:

 

Variable Dips: Hearing thresholds dip variably across different frequencies. Some frequencies are more affected than others, depending on the damage location in the inner ear.

Similar Air and Bone Conduction: Air and bone conduction thresholds are similar since the issue lies within the inner ear itself.

 

Treatment Options:

 

  • Hearing Aids: These devices amplify sound waves, making them easier to hear.
  • Cochlear Implants: For severe cases, cochlear implants bypass damaged hair cells and directly stimulate the auditory nerve.

 

An audiogram is a valuable tool for initial assessment, but further tests and your medical history help audiologists provide a definitive diagnosis and recommend the best treatment plan for your hearing loss.

A man gets a hearing test at a hearing center.

What is the Cost of an Audiogram Test?

 

An audiogram is a vital tool in understanding your hearing health. It clearly shows your ability to hear sounds at different pitches and volumes. But what about the cost?

 

Cost of an Audiogram Test

 

The price of an audiogram varies by location, facility, and type. However, many hearing centers, like American Hearing + Audiology, offer free initial hearing evaluations, including an essential audiogram. Some insurance plans may also cover the cost, partially or entirely, so check with your provider.

 

Learn more about understanding hearing aid insurance.

 

Importance of Follow-Up

 

Getting an audiogram is only the first step. Discussing the results with your hearing care provider is essential. They help you understand what the audiogram means for your hearing health. They can discuss potential treatment options and guide you on the next steps to improve your hearing, if necessary. Ongoing care from a hearing provider is crucial for monitoring your hearing over time, adjusting treatment plans as needed, and providing support and guidance.

 

Investing in a comprehensive hearing evaluation with a qualified hearing care provider is an investment in your overall well-being. Contact American Hearing + Audiology for your initial hearing evaluation today.