AUDIOGRAM

Sonus Manila
Unit 2205 22nd Floor
Jollibee Plaza Condominium Corporation, Emerald
Avenue, Ortigas, Pasig City, Philippines

1
AUDIOGRAM

FREQUENCIES (Hz)
INTENSITIES (dB)

3
SYMBOLS
 Audiogram
• Degree
• Type
• Configuration
• Ear

5
 Audiogram

DEGREE TYPE
Mild sensorineural hearing loss

CONFIGURATION
with a flat configuration

EAR
on the right ear.

6
 DEGREES OF
HEARING LOSS

7
 Degrees of Hearing Loss
0 – 25 dB Normal

26 – 40 dB Mild

41 – 60 dB Moderate

61 – 80 dB Severe

81 dB - above Profound
 PTA AVERAGING -
INTERPRETATION
• Get AC and BC threshold (retest at
1K) and Check for need for Masking
• Get PTA Ave.
• PTA Ave = Ave. of AC @ .5kHz, 1kHz,
and 2 kHz (see interpretation
Degrees of Hearing Loss – WHO)

9
10
PTA = (500 Hz) + (1000 Hz) + (2000 Hz)
= 10 + 5 + 0
= 15 ÷ 3
= 5 (see WHO)
11
 TYPES OF
HEARING LOSS

12
Types of Hearing Loss
 Conductive Hearing Loss
• Structures involved - environment to
the inner ear
• Sound reaches the inner ear with
lower intensity = Sound is reduced in
volume
• May be temporary, but can also be
permanent

14
 NOTE:

YOU CAN ONLY SAY THAT A PATIENT HAS

CONDUCTIVE HEARING LOSS WHEN THERE
IS AN AIR-BONE GAP OF 15 dB or more
15
 Sensorineural Hearing Loss
• Sound arrives at inner ear fails to be
converted into electrical impulses or the
fail to be moved to the nerve
• Reduced in (Newall, 2011):
loudness and clarity are affected
– the sensitivity of the cochlear receptor cells
– in the frequency-resolving ability of the
cochlea
– In the temporal processing ability of the
cochlea
– in the dynamic range of the hearing
mechanism
17
 Sensorineural Hearing Loss
(Newall, 2011)
• Decrease of sound originates from the
inner ear or the nerve
• Speech recognition does not return to
normal at intensity levels sufficient to
overcome the sensitivity loss
• Permanent hearing loss due to
damage to the cochlea/auditory nerve

18
 NOTE:

YOU CAN ONLY SAY THAT A PATIENT HAS

SENSORINEURAL HEARING LOSS WHEN THERE
IS NO OR AN AIR-BONE GAP OF 5-10 dB
19
 Mixed Hearing Loss
• Both conductive and sensorineural
problem
• Sound is reduced due to the impaired
cochlea and the signal is further
attenuated by an outer/ middle ear
problem
• Causes may vary

21
22
CONFIGURATIONS OF
HEARING LOSS

23
Configuration of Hearing Loss
Configuration of Hearing Loss
 FLAT
CONFIGURATION

26
FLAT

Severe sensorineural hearing loss with a flat

configuration on the right ear.
FLAT

Mild conductive hearing loss with a flat

configuration on both ears.
Mild hearing loss with a flat configuration on
the right ear.
FLAT

Normal hearing thresholds with a relatively

flat configuration on both ears.
 SLOPING
CONFIGURATION

32
 SLOPING

Mild hearing loss with a sloping configuration on the right ear/

Mild hearing loss sloping towards the high frequencies on the right ear/
Mild hearing loss gradually sloping towards the high frequencies on the
right ear
 SLOPING

Moderate hearing loss with a sloping configuration on the right ear/

Moderate hearing loss sloping towards the high frequencies on the right ear/
Moderate hearing loss gradually sloping towards the high frequencies on the right ear
 SLOPING

Mild hearing loss with a sloping configuration on the right ear/

Mild hearing loss sloping towards the high frequencies on the right ear/
Mild hearing loss gradually sloping towards the high frequencies on the
right ear
 RISING
CONFIGURATION

38
RISING

Mild hearing loss with a rising configuration on the right ear.

RISING

Moderate hearing loss with a rising configuration on the right ear.

 INVERTED TROUGH/
INVERTED COOKIE-BITE/
INVERTED SAUCER-SHAPED/
TENT-SHAPED
CONFIGURATION

42
INVERTED TROUGH/
INVERTED SAUCER-SHAPED/
INVERTED COOKIE-BITE

Mild hearing loss with an inverted trough configuration on the right ear/
Mild hearing loss with an inverted saucer-shaped configuration on the right ear/
Mild hearing loss with an inverted cookie-bite configuration on the right ear
 Mild hearing loss with an inverted trough configuration on the right ear/
Mild hearing loss with an inverted saucer-shaped configuration on the right ear/
Mild hearing loss with an inverted cookie-bite configuration on the right ear

ALTHOUGH THE DEGREE OF HEARING LOSS WHEN PTA

AVERAGE’S DONE, SHOWED A NORMAL DEGREE,
HOWEVER SUCH CASES WHEN MOST FREQUENCIES
ARE BELOW 25 dB, MILD HEARING LOSS IS
APPROPRIATELY USED
 TROUGH/
COOKIE-BITE/
SAUCER-SHAPED/
CONFIGURATION

46
TROUGH/
SAUCER-SHAPED/
COOKIE-BITE

Mild hearing loss with a trough configuration on the left ear/

Mild hearing loss with a saucer-shaped configuration on the left ear/
Mild hearing loss with a cookie-bite configuration on the left ear
PRECIPITOUSLY FALLING
CONFIGURATION

50
PRECIPITOUSLY FALLING/
STEEPLY FALLING

Mild hearing loss with a precipitous configuration on the right ear/

Mild hearing loss with a precipitously falling configuration on the right ear/
Mild hearing loss with a steeply falling configuration on the right ear
PRECIPITOUSLY FALLING/
STEEPLY FALLING

Mild hearing loss with a precipitous configuration on the right ear/

Mild hearing loss with a precipitously falling configuration on the right ear/
Mild hearing loss with a steeply falling configuration on the right ear
PRECIPITOUSLY FALLING/
STEEPLY FALLING
HIGH FREQUENCY
HEARING LOSS
CONFIGURATION

54
HIGH FREQUENCY
HEARING LOSS

Mild hearing loss with a high frequency hearing loss configuration on both ears.
HIGH FREQUENCY
HEARING LOSS

Mild hearing loss with a high frequency hearing loss configuration on both ears.
 Mild hearing loss with a high frequency hearing loss configuration on both ears.

More or less, it’s the same with precipitously falling, the hearing loss starts around
2000 kHz or 3000 kHz. You can either use this or precipitously falling…. However, if
there is a sudden drop with no rising or reached plateau, precipitously falling is used.
 NOTCH
CONFIGURATION

58
NOTCH

Normal hearing thresholds with a notch at 4kHz on the left ear.

 Normal hearing thresholds with a notch at 4kHz on the left ear.

You may notice with a notch configuration, it is always necessary to state which
frequency the notch is. Also remember that, a notch is only stated when there’s a drop
or 20 dB gap.
NOTCH

Normal hearing thresholds with a notch at 4kHz on the left ear.

 FRAGMENTARY/
CORNER
CONFIGURATION

62
FRAGMENTARY

Profound sensorineural hearing loss with a fragmentary configuration on both ears/

Profound sensorineural hearing loss on both ears.
Profound sensorineural hearing loss with a fragmentary configuration on both ears/
Profound sensorineural hearing loss on both ears.

Fragmentary configuration is rarely

used, most of the time, when
results such as these, the
configuration is not stated.
Profound sensorineural hearing loss with a fragmentary configuration on both ears/
Profound sensorineural hearing loss on both ears.
 UNIDENTIFIED/
UNDETERMINED
CONFIGURATION

67
UNDETERMINED CONFIGURATION

HUH?
UNDETERMINED CONFIGURATION

In cases like this, it is better not to put the

configuration since it doesn’t fit any of the
configuration. Sometimes, malingering
patients have this type of audiogram. It is
best to have a retest to verify the result.
 FINAL WORDS
• If you are unsure of the
configuration, you can drop it and
just have the degree of hearing loss,
type of hearing loss and which ear.
• Some countries/centers use
different names for the
configuration, do not be confused.

70