A hearing sheet is the common, informal name for an audiogram: the chart your audiologist fills out after a hearing test. It maps how well each ear detects sounds across a range of pitches and volumes, giving a visual snapshot of your hearing ability. If you’ve been handed one after an appointment (or told you’ll receive one), understanding what’s on it takes just a few minutes.
What a Hearing Sheet Actually Shows
The core of any hearing sheet is a graph. The horizontal axis runs from low-pitched sounds on the left (like a bass drum or a dog barking) to high-pitched sounds on the right (like a bird chirping or a whistle). These pitches are measured in Hertz. The vertical axis shows volume in decibels, with quiet sounds at the top and loud sounds at the bottom. Each mark on the graph represents the softest sound you could hear at a given pitch.
Beyond that graph, a full audiological report often includes additional tests: tympanometry (which checks how well your eardrum moves), speech reception threshold testing (the softest level at which you can understand spoken words), and word recognition scoring (how accurately you repeat words at a comfortable volume). Together, these results give a complete picture that goes well beyond a simple “pass or fail.”
Symbols on the Graph
The marks on an audiogram aren’t random. Each symbol tells you which ear was tested and how the sound was delivered. According to standards used by Johns Hopkins Medicine and audiologists worldwide:
- Right ear, air conduction: a circle (O) or triangle
- Left ear, air conduction: an X or a square
- Right ear, bone conduction: a < or [ symbol
- Left ear, bone conduction: a > or ] symbol
Air conduction testing uses headphones or earbuds, so the sound travels through the ear canal, eardrum, and middle ear before reaching the inner ear. Bone conduction testing uses a small vibrating device placed behind the ear, sending sound directly to the inner ear and bypassing the outer and middle ear entirely. The difference between these two results matters a lot for diagnosis.
The Air-Bone Gap
When air conduction results are worse than bone conduction results at the same pitch, that difference is called the air-bone gap. It signals a problem in the outer or middle ear, such as fluid buildup, an eardrum perforation, or a bone-related issue in the middle ear. This type of hearing loss is called conductive hearing loss, and it’s often treatable with medicine or surgery.
If both air and bone conduction scores are equally reduced, the problem is in the inner ear or the hearing nerve. This is sensorineural hearing loss, the most common type in adults, and it’s typically managed with hearing aids or, in more severe cases, cochlear implants. Some people have both types at once, which shows up on the hearing sheet as reduced bone conduction scores with an even larger drop in air conduction scores.
Decibel Ranges and What They Mean
The American Speech-Language-Hearing Association classifies hearing ability by the softest sounds you can detect, measured in decibels (dB):
- Normal: -10 to 15 dB
- Slight loss: 16 to 25 dB
- Mild loss: 26 to 40 dB
- Moderate loss: 41 to 55 dB
- Moderately severe loss: 56 to 70 dB
- Severe loss: 71 to 90 dB
- Profound loss: 91 dB and above
Normal conversation happens at roughly 40 to 60 dB, so someone with mild hearing loss might catch most of what’s said in a quiet room but struggle in a noisy restaurant. Moderate loss makes following conversation difficult even in good conditions without amplification. At the severe and profound levels, even loud speech is hard to detect without a hearing device.
The Speech Banana
If you look at an audiogram, you’ll sometimes see a banana-shaped shaded region drawn across the middle of the graph. This is called the “speech banana,” and it represents the pitch and volume range where most conversational speech sounds fall. Vowels tend to cluster at the lower-pitched, louder end, while consonants like “s,” “f,” and “th” sit at the higher-pitched, quieter end.
This is why many people with high-frequency hearing loss say they can hear people talking but can’t make out the words. The vowels come through fine, but the consonants that distinguish “cat” from “cap” from “cash” are partially or fully missing. If your hearing sheet shows marks that dip below the speech banana at certain pitches, those are the specific speech sounds you’re likely missing.
Common Patterns on a Hearing Sheet
Audiologists don’t just look at individual marks. They look at the overall shape of the curve, because the pattern often points to the cause.
A high-frequency sloping loss, where hearing is normal or near-normal at low pitches and drops off at higher pitches, is the most common pattern. It’s typical of age-related hearing loss and noise-induced damage. A flat loss, where hearing is equally reduced across all pitches, can suggest fluid in the middle ear, genetics, or certain medications. A “cookie-bite” pattern, where the middle frequencies dip lower than the low and high frequencies, is less common and often linked to hereditary causes.
If one ear is significantly worse than the other (called asymmetric hearing loss), that’s something your audiologist will flag, since it can sometimes point to conditions that need further evaluation with imaging.
Speech Understanding Scores
The graph portion of a hearing sheet tells you what you can detect, but detection isn’t the same as understanding. That’s where speech testing comes in. The speech reception threshold (SRT) measures the softest level at which you can correctly repeat simple two-syllable words about half the time. It should line up closely with your pure-tone results; if it doesn’t, it may indicate the test needs to be repeated.
Word recognition testing goes further. You’ll hear a list of single-syllable words at a comfortable volume and repeat them back. Your score is recorded as a percentage. A high score means your inner ear and hearing nerve are processing speech well, even if the volume needs to be turned up. A low score, especially below 50%, suggests that even with amplification, clarity will be limited. Cleveland Clinic guidelines note that patients understanding fewer than 50% of words while wearing hearing aids are candidates for cochlear implant evaluation.
What to Do With Your Results
Your hearing sheet is a medical document you can (and should) keep. Comparing audiograms over time reveals whether your hearing is stable or changing, and how quickly. Even a small shift of 10 to 15 dB at specific frequencies over a few years can signal a trend worth addressing early.
If your results fall in the mild-to-moderate range, hearing aids are the standard next step. Modern devices can be programmed to match the exact shape of your hearing loss, boosting only the frequencies where you need help. For losses in the severe-to-profound range, or when word recognition scores are poor despite amplification, a referral for cochlear implant evaluation is typical. For conductive losses with a clear air-bone gap, medical or surgical treatment may restore hearing without any device at all.
Asking your audiologist for a printed or digital copy of your hearing sheet makes it easy to share with other providers, track changes at future appointments, or simply look up what those symbols mean when you get home.