An audiogram is a graph that maps your hearing ability across different pitches and volumes. It’s the primary tool audiologists and doctors use to measure how well you hear, identify what type of hearing loss you have, and determine what’s causing it. If you’ve been referred for a hearing test, the audiogram is the result you’ll walk away with.
What an Audiogram Actually Shows
An audiogram plots the quietest sounds you can hear at eight different pitches, ranging from 125 Hz (a deep hum) up to 8,000 Hz (a high-pitched whistle). The horizontal axis represents pitch, moving from low on the left to high on the right. The vertical axis represents volume in decibels, with soft sounds at the top and loud sounds at the bottom. This inverted scale means that the further down your results fall on the graph, the louder a sound needs to be before you can hear it.
Each ear is tested and charted separately. On the graph, circles or triangles mark results for the right ear, while X’s or squares mark the left. You’ll also see a second set of symbols for bone conduction testing: brackets or angle symbols that show how sound travels through the bones of your skull directly to the inner ear, bypassing the ear canal and eardrum entirely. The relationship between these two sets of results is what reveals the type of hearing loss you have.
How It Identifies Three Types of Hearing Loss
The core diagnostic value of an audiogram comes from comparing air conduction results (what you hear through headphones) with bone conduction results (what you hear through a vibrating device placed behind your ear). When both results show hearing loss at the same level, the problem is in the inner ear or the hearing nerve. This is called sensorineural hearing loss, and it’s the most common type, often caused by aging or noise exposure.
When bone conduction results are normal but air conduction results are worse, there’s a gap between the two lines on the graph. This “air-bone gap” signals conductive hearing loss, meaning something is blocking or dampening sound before it reaches the inner ear. Fluid behind the eardrum, earwax buildup, or a problem with the tiny bones in the middle ear can all produce this pattern. When both types appear together, it’s called mixed hearing loss.
Grading the Severity of Hearing Loss
The American Speech-Language-Hearing Association classifies hearing loss into specific ranges based on the decibel levels recorded on your audiogram:
- Normal: -10 to 15 dB
- Slight: 16 to 25 dB
- Mild: 26 to 40 dB
- Moderate: 41 to 55 dB
- Moderately severe: 56 to 70 dB
- Severe: 71 to 90 dB
- Profound: 91 dB and above
These categories matter because they directly shape treatment decisions. Someone with mild loss might benefit from simple strategies like better positioning during conversations, while moderate to severe loss typically calls for hearing aids. Profound loss may warrant cochlear implant evaluation. Your audiogram doesn’t just confirm that you have trouble hearing; it quantifies exactly how much trouble, at which pitches, and in which ears.
Spotting Patterns That Point to Specific Conditions
Certain conditions leave recognizable signatures on an audiogram. Noise-induced hearing loss, for example, typically produces a sharp dip at 4,000 Hz, sometimes called a “noise notch,” with hearing recovering somewhat at higher frequencies. This pattern is distinctive enough that an audiologist can often identify noise damage just by looking at the graph.
Otosclerosis, a condition where abnormal bone growth stiffens one of the tiny bones in the middle ear, tends to produce a characteristic dip in bone conduction around 2,000 Hz. This feature, known as the Carhart notch, has historically been considered a hallmark of the condition, though it can occasionally appear with other disorders. Conditions involving structural problems in the inner ear often show a gap between air and bone conduction that’s most pronounced at lower frequencies, below 1,000 Hz, because low-frequency sound energy is more easily disrupted by these defects.
These patterns help clinicians decide whether additional testing, imaging, or referrals are needed. The audiogram often serves as the first step in a diagnostic chain rather than the final answer.
Why Speech Understanding Matters on the Graph
If you look at an audiogram with common speech sounds plotted on it, they cluster in a banana-shaped zone roughly between 250 and 6,000 Hz, at volumes between about 20 and 50 dB. Audiologists call this the “speech banana.” Where your hearing thresholds fall relative to this zone tells you which speech sounds you’re likely missing.
Someone whose thresholds dip below the speech banana at high frequencies, for instance, will struggle to hear consonant sounds like “s,” “f,” and “th,” which carry much of the clarity in spoken language. They might hear that someone is talking but find the words muddy or unclear. A child whose thresholds fall below the speech banana at multiple frequencies faces a real risk of delayed language development, which is why pediatric audiologists pay especially close attention to this zone. Understanding which sounds fall above or below your threshold line makes the audiogram far more meaningful than a simple pass/fail test.
How the Test Works
A standard hearing test takes place in a soundproof booth. You’ll sit down, and the audiologist will place headphones or small foam inserts in your ears, then step into an adjacent room where they control the equipment and watch you through a window. Tones are played one at a time, starting at a pitch and volume you can easily hear. You press a button, raise your hand, or say “yes” each time you hear a sound.
The audiologist then uses a bracketing technique: lowering the volume by 10 dB each time you respond, raising it by 5 dB each time you don’t, zeroing in on the quietest level you can detect at least half the time. Testing typically starts at 1,000 Hz, moves up through the higher pitches, then circles back to recheck 1,000 Hz for consistency before testing the lower frequencies. The whole process is repeated for bone conduction using a small vibrating device placed on the bone behind your ear. A complete test usually takes 20 to 30 minutes.
Testing Children
Standard audiometry requires a person to sit still, pay attention, and respond consistently, which is a tall order for young children. Audiologists use several adapted techniques depending on the child’s age. For toddlers as young as two, conditioned play audiometry turns the test into a game: the child drops a block in a bucket or completes a puzzle piece each time they hear a tone. For infants, visual reinforcement audiometry pairs the sound with an animated toy or light, training the baby to look toward the sound source. These methods typically require two audiologists, one in the booth to keep the child engaged and one operating the equipment.
Children who can’t tolerate headphones are tested using speakers placed at specific angles in the booth, though this approach measures hearing from both ears together rather than each one individually.
Programming Hearing Aids
If your audiogram shows you’re a candidate for hearing aids, the same graph becomes the blueprint for programming them. Hearing aids don’t simply make everything louder. They’re set to boost specific frequencies by specific amounts based on your individual audiogram. Where your hearing is near normal, the aid applies little or no amplification. Where your loss is greatest, it applies more.
Two widely used prescription formulas take slightly different approaches to this. One prioritizes amplifying only the frequencies that are genuinely useful for understanding speech, deliberately leaving out frequencies where the hearing loss is too severe for amplification to help. The other takes a broader approach, attempting to restore audibility across as wide a range of frequencies as possible on the assumption that any additional sound information could be beneficial. Both start with your audiogram as the foundational input, and both factor in loudness comfort so that amplified sounds don’t become painfully loud. Your audiologist may fine-tune settings after the initial fitting based on your real-world experience, but the audiogram is always the starting point.