An audiogram is a graph that maps your hearing ability across different pitches and volumes. Once you understand the two axes and a few symbols, you can look at your own results and immediately see which sounds you hear well, which ones you’re missing, and whether the pattern points to a specific type of hearing loss.
What the Graph Shows
An audiogram has two axes. The horizontal axis (left to right) represents frequency, measured in Hertz (Hz). This is pitch. Low-pitched sounds like a rumbling engine sit on the left side, and high-pitched sounds like a bird chirping sit on the right. Standard audiograms test frequencies between 250 Hz and 8,000 Hz, which covers the range most important for understanding speech and everyday sounds.
The vertical axis (top to bottom) represents intensity, measured in decibels (dB). This is volume. Here’s the part that trips people up: the top of the graph is quiet (0 dB), and the bottom is loud (up to 110 dB). So the farther down a mark appears on the graph, the louder a sound had to be before you could hear it at that pitch. A mark near the top means you heard a very soft sound. A mark near the bottom means the sound had to be cranked up significantly before you detected it.
Symbols for Each Ear
Your audiogram will have separate marks for each ear. The standard convention uses an “O” (often in red) for the right ear and an “X” (often in blue) for the left ear. These represent air conduction, meaning sound traveled through your ear canal the way it normally does in everyday life. The marks are connected by lines so you can see the shape of your hearing across all the pitches tested.
You may also see brackets or angle symbols on your audiogram. These represent bone conduction, where a small vibrating device was placed behind your ear to send sound directly through the skull to the inner ear, bypassing the ear canal and eardrum entirely. Bone conduction results matter because comparing them to air conduction results reveals where the problem is located, which is covered in the next section.
Three Types of Hearing Loss
The relationship between your air conduction results (the O’s and X’s) and your bone conduction results tells your audiologist which type of hearing loss you have. There are three possibilities.
Sensorineural hearing loss means the inner ear or the nerve pathway to the brain is damaged. On the audiogram, both air and bone conduction thresholds are elevated (shifted downward on the graph), and they sit close together with no significant gap between them. This is the most common type, often caused by aging, noise exposure, or genetics. It’s typically permanent.
Conductive hearing loss means something is blocking or reducing sound before it reaches the inner ear. Think of earwax buildup, fluid behind the eardrum, or a problem with the tiny bones in the middle ear. On the audiogram, bone conduction results look normal (near the top), but air conduction results are worse (shifted downward). That gap between the two lines is called the air-bone gap, and it’s the hallmark of conductive loss. This type is often treatable with medication or surgery.
Mixed hearing loss combines both. The bone conduction thresholds are elevated (indicating some inner ear damage), and the air conduction thresholds are even worse, creating an air-bone gap on top of the sensorineural component.
How Severity Is Classified
The decibel level where you first detect a sound at each pitch is your hearing threshold. The American Speech-Language-Hearing Association (ASHA) classifies hearing loss into categories based on these thresholds:
- Normal: up 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
Your hearing loss may not fall into the same category across all frequencies. It’s common to have normal hearing in the low pitches and moderate loss in the high pitches, for example. That’s why the shape of the audiogram matters as much as any single number.
One summary number you’ll often see on your report is the pure tone average, or PTA. This is the average of your thresholds at 500, 1,000, and 2,000 Hz, the three frequencies most important for understanding speech in quiet environments. Some clinicians also include 3,000 Hz in the calculation, which gives a better estimate of how well you’ll hear speech in noisy settings. The PTA gives a quick snapshot, but it can mask significant hearing loss at frequencies outside those three or four.
Common Audiogram Shapes
The pattern your thresholds form across frequencies often hints at the cause of hearing loss. Audiologists look at these shapes as a starting point for diagnosis.
A sloping (ski-slope) pattern shows normal or near-normal hearing in the low frequencies that drops off steeply in the high frequencies. This is the most common shape. Age-related hearing loss typically follows a gentle slope, while noise-induced hearing loss from loud music, machinery, or firearms tends to produce a steeper drop. People with this pattern often say they can hear that someone is talking but can’t make out the words clearly, because consonant sounds like “s,” “f,” and “th” are high-pitched and fall in the range where their hearing is weakest.
A rising pattern is the opposite: worse hearing in the low frequencies with better hearing in the highs. This is less common and often linked to a genetic component. People with rising loss may struggle with lower-pitched vowel sounds while catching higher-pitched consonants just fine.
A notch pattern shows a sharp dip at one specific frequency (commonly around 4,000 Hz) with better hearing on either side. This is the classic signature of noise-induced hearing loss and often appears before a person notices any difficulty in conversation.
A cookie-bite (U-shaped) pattern shows hearing loss worst in the mid-frequencies with better hearing in both the lows and highs. The name comes from the shape it creates on the graph, which looks like someone took a bite out of the middle. This pattern is relatively rare and often has a genetic origin.
A flat pattern shows roughly equal hearing loss across all frequencies. This can result from a variety of causes and doesn’t point to one specific condition the way a notch or cookie-bite does.
The Speech Banana
Many audiograms include an overlay called the “speech banana,” a banana-shaped region on the graph where the sounds of normal conversational speech fall. Individual speech sounds are plotted within this area based on their typical pitch and volume. Low-pitched sounds like “m” and “j” sit on the left side, while high-pitched sounds like “s” and “th” sit on the right.
This overlay is one of the most practical tools on the audiogram. If your hearing thresholds fall above (better than) the speech banana, you can hear those speech sounds at normal conversational volume. If your thresholds cut through the banana or drop below it, the speech sounds in that region will be difficult or impossible to hear without amplification. For example, if your threshold at 250 Hz is 60 dB, the audiogram suggests you’d hear a dog barking at that pitch but would miss softer speech sounds like “m” or “j” at normal speaking volume.
This is why two people with the same overall degree of hearing loss can have very different experiences in conversation. Someone whose loss is concentrated in the high frequencies may miss “s” and “f” sounds but hear vowels perfectly, making speech sound muffled rather than quiet. Someone with a flat loss across all frequencies may hear speech as uniformly too soft.
Putting It All Together
When you look at your audiogram, start with the big picture. Check where your thresholds fall relative to the 25 dB line, which marks the boundary of normal hearing. Note whether the pattern is flat, sloping, or notched. Compare both ears to see if the loss is symmetric or if one ear is significantly worse. If bone conduction results are included, look for a gap between those marks and your air conduction marks to identify whether the loss is conductive, sensorineural, or mixed.
Then look at the speech banana. The frequencies between roughly 500 and 4,000 Hz carry most of the information in speech. If your thresholds are below the speech banana in that range, you’re likely finding conversations difficult, especially in background noise. Your PTA number will give you a single-number summary, but always look at the full shape of the graph. A PTA of 30 dB could mean a flat mild loss across all frequencies or normal low-frequency hearing with a moderate high-frequency drop, and those two situations feel very different in daily life.