Reading An Audiogram
November 16, 2021

Reading An Audiogram

A pair of hearing aids sitting on top of a graph

Many health-related measurements are familiar to people, like perfect vision being represented as 20/20. However, how is healthy hearing quantified? Presented with the results of a hearing test, most people have no idea how to interpret what the graph—called an audiogram—reveals. 


An audiogram may initially look like indecipherable lines and symbols on a graph, but learning how to interpret it gives you a much better understanding of your hearing. Your audiologist uses it to determine recommendations for addressing your hearing loss, so knowing how to read your audiogram means even better communication between you and your audiologist in mapping a treatment plan for you. 


The goal of a diagnostic hearing evaluation

The goal of audiometric testing is to measure a person’s hearing ability across a range of frequencies, or pitches. Each ear is measured independently since hearing ability is not always the same in both ears. During a hearing evaluation, the audiologist will use headphones or earphones through which you listen for sounds, including beeps at various frequencies and recorded words. As you respond by depressing a handheld button when you hear beeps or by repeating back understood words, your hearing thresholds are plotted. A hearing threshold is the softest sound you can detect about 50% of the time. 


Understanding frequency and loudness

Look at the sample audiogram below. The horizontal axis (x) represents frequency, or pitch, from lowest to highest and is measured in hertz (Hz). Typically, the lowest frequency tested during a hearing diagnostic is 250 Hz; the highest is 8000 Hz. When you look at the x-axis that measures frequency, moving from left to right shows the frequency going from deep-sounding pitch to high pitched, much like the keys on a piano. Most human speech ranges from 250 to 6000 Hz. Vowel sounds (A, E, I, O, and U) are among the lowest frequencies and are responsible for loudness of speech. Consonants like S, F, SH, CH, H, TH, T and K sounds are among the highest frequencies and create clarity of speech. This is why hearing loss affects a person’s ability to understand words and conversations. If, for instance, a person has hearing loss that affects high frequency sounds, a word like “feet” begins to sound like “ee” as the letters F and T become indiscernible. Oftentimes, hearing loss occurs in the high frequencies first, which is why people often comment on hearing but not understanding. So, if you have been blaming your family of mumbling, it actually may be hearing loss.

The vertical axis (y) represents the intensity, or loudness, of sound and is measured in decibels (dB). A rifle being fired is a loud noise or a very high decibel sound. Rustling leaves are soft sounds or very low decibel.. Although the top left of the chart is labeled -10 dB or 0 dB, that does not indicate the absence of sound. A zero decibel reading actually represents the softest level of sound that the average person with normal hearing will hear, for any given frequency.


Understanding symbols on the graph

Several different symbols are used to indicate hearing thresholds on an audiogram, which create a quantitative “picture” of your hearing ability or loss. Testing with earphones or headphones is called air conduction testing because the sound must travel through the air of the ear canal to reach the inner ear. The organs of the inner ear then transmit the sound to the auditory nerve and on to the brain where sound is interpreted and assigned meaning. A red “O” denotes air conduction results for the right ear on an audiogram. The results for the left ear are marked with a blue “X." Bone conduction testing is completed by placing a device behind the ear on the mastoid bone. Sound is transmitted through the vibration of the mastoid bone, and results are marked on the audiogram with a “greater than (>) symbol” for the left ear and a “lesser than (<)” symbol for the right ear. Refer to the audiogram below for a visual reference of an audiogram.


Air and bone conduction and speech testing allow an audiologist to more precisely interpret and diagnose hearing loss. Each symbol (X or O, < or >) on the chart represents your threshold for a given frequency and, when plotted, represents overall hearing ability. In the sample audiogram, the individual's thresholds from 250 Hz through 8000 Hz denote hearing below normal in both ears. A person with this degree of hearing loss will struggle when there is background noise, with softer speech and when there are no visual cues and may complain that people mumble. This person would benefit greatly from hearing aids. 


If audiogram symbols are essentially overlapping, hearing loss is considered symmetrical, or the same in both ears, like the sample audiogram shows. If the symbols do not overlap, your hearing loss is asymmetrical, meaning your ears have differing degrees of hearing loss. Your hearing loss also may show a pattern of loss that is generally flat or that is sloping or rising where some pitches are worse than others. Connecting the air conduction symbols makes the pattern obvious.


What is considered healthy hearing on an audiogram?

Take a look at the audiogram again. As a general rule, healthy hearing is represented in the blue shaded area above the 20 dB line that crosses the graph from left to right.* Any symbols below that shaded area, however, indicate hearing loss at those frequencies. Noteworthy is that hearing can be damaged by things like ear infections; medications; common household items like lawnmowers; noisy work environments; or a family history of hearing loss. (Find a list of common items that can cause hearing damage at johnsonaudiology.com/audiogram.)


Ultimately, when diagnosing and treating, your audiologist considers your audiogram, which represents quantitative measures, along with your perception of your overall listening challenges. Input from family members about communication difficulties also can be beneficial. Today’s sophisticated hearing aid technology is programmed to increase the sounds within the specific frequencies of your hearing loss. Thus, hearing aids are a great solution for restoring the sounds a person is missing, and early identification and treatment are keys to success.


A snapshot in time

Your audiogram is a snapshot in time of your hearing. It is a prescription for treating your hearing loss and a baseline for you and your audiologist. To monitor any changes in your hearing over time, routine testing is necessary. Knowing how to interpret your audiogram is a valuable skill, empowering you to make informed decisions. The information in this article is a basic interpretation of an audiogram. Audiograms can be more complex depending on the nature of the hearing loss or underlying medical issues.


*Some exceptions exist, such as when the person has very mild hearing loss but has tinnitus, or ringing in their ears.



A graph showing the frequency / pitch of a sound
By Jan Hollingsworth June 4, 2025
Like anything new in life, adjusting to hearing aids can take time and perseverance to achieve the best results. Yet many people are too quick to give up, not allowing the brain the chance to relearn how to hear or not giving themselves the opportunity to become accustomed to the use and maintenance of their devices. “We meet so many people who wait—who convince themselves their hearing is not ‘bad enough’ or that they can just get by. But untreated hearing loss quietly steals moments, connection, and joy. At Johnson Audiology, we understand the fear, the frustration, and the doubt. That is why we offer more than hearing aids—we offer compassion, answers, and a partner you can trust. You don’t have to do this alone. Let us help you hear your life again,” says Dr. Megan Johnson, audiologist and owner of Johnson Audiology. “Hearing aids should never be an experience where a person is fit with devices and then they never see their hearing care provider again. To ensure patient success, Johnson Audiology seeks to be a lifelong partner on a person’s journey to healthy hearing, someone who is there at every turn,” says Dr. Megan Johnson, audiologist and owner of Johnson Audiology. What are the most common reasons why people give up on hearing aids and why is it important to stick with it? Reasons why people might give up on hearing aids An adjustment period It is your brain that hears, not your ears. The ears transmit sound to the brain where it is interpreted. Dr. Johnson explains, “When a person’s brain has not been stimulated by sound because of hearing loss and then sound is restored with hearing aids, it can take some getting used to. For some people, it takes more than one appointment to get them up to full sound prescription, stair stepping up gradually to let the brain adjust. The brain’s capacity to do this is called neural plasticity .” Research by the University of Colorado Boulder’s Hearing Epidemiology and Research Diagnostic Laboratory has revealed that what the brain can experience impacts within weeks rather than years when hearing loss reaches a certain level. Dr. Johnson says, “The brain’s temporal lobe is where much of hearing and sound interpretation happens. Electroencephalogram (EEG), which is a medical test that measures the electrical activity of the brain, shows that in the presence of hearing loss, the brain will recruit areas assigned to other tasks—like vision—to compensate. The trouble is that this extra cognitive load can tax those areas. However, after treatment with hearing aids, brain recruitment is shown to reverse, partially or fully.” The adjustment period for hearing aids tends to be more seamless for those who have not been without sound for years and years. Dr. Johnson says, “I always encourage people to get their hearing checked when they first notice they are struggling. Sooner is always better.” An investment in quality of life People often make an investment in their health and well-being—for example, purchasing glasses, getting a knee replacement, straightening their teeth—and yet many relegate hearing to the backburner because of cost. Dr. Johnson says, “I’ve seen many patients struggle with hearing aids after buying inferior products in an attempt to save money. Without the guidance of a hearing care provider, even the best device can quickly become ineffective and frustrating.” Dr. Johnson encourages making hearing a priority and budgeting for your hearing health. Perceived benefits and ease of use Getting in the routine of putting hearing aids in each day and being diligent about regular cleaning and maintenance might be a challenge that some face and which deters them from being successful with their aids. “At Johnson Audiology, we offer a plan for regular in-office cleaning and maintenance, easing the task of upkeep for patients. Plus, our offices have dedicated walk-in hours that do not require an appointment. We are here to answer questions, make hearing aid adjustments, and much more as we seek to help people safeguard their investment in hearing technology and make the process easy and convenient.” Family attitudes and support When it comes to hearing aids, having a support system can be crucial to success. “In my 20 years as an audiologist, I have seen the immense benefits when a person’s family members show patience and support during the adjustment period with new hearing aids,” said Dr. Johnson. What about patients who do not have that familial encouragement? Dr. Johnson says, “We are your support system. That’s where our caring and professional audiologists, audiology assistants, and patient care coordinators can lend a helping hand. Success with hearing aids is our goal for every patient, so we promise to be there every step of the way.” Why is healthy hearing so important Hearing loss is a family affair The positive impact of treating hearing loss is often manifested most significantly through improved relationships with family and friends. Hearing loss leads to miscommunication. It can also cause mounting frustration as family members must constantly repeat every sentence. Dr. Johnson comments, “Living with the TV blaring can put a strain on others living in the same household. Untreated hearing loss can quietly tear at the fabric of your relationships. When words go unheard and conversations fade, love and connection start to suffer, and that pain is felt by all involved.” Healthy hearing can help the brain stay sharp and pliable For many years, researchers at Johns Hopkins University have been studying the relationship between hearing loss and dementia. While there is still much left to discover, increasingly scientists recognize healthy hearing as a key factor in maintaining a healthy brain and potentially decelerating the risk of dementia, like Alzheimer’s disease. Dr. Johnson says, “It seems logical that when certain areas of the brain are not stimulated by sound, they atrophy. In fact, research suggests an actual reduction in the physical size of the brain, especially in areas where sound processing and memory take place.” She goes on to say that “while there are many risk factors that individuals cannot control about the effects of aging on the brain, hearing is definitely one that can and should be addressed.” Healthy hearing keeps a person engaged in life Humans are social beings. Since hearing loss can impair effective communication, it is not difficult to understand how it also could lead to social isolation, which can cause increased anxiety and depression. “Conversely, addressing hearing loss can keep a person engaged in life and connected to family and friends,” Dr. Johnson says. Falls and other health risks The ears have two main functions. Hearing is one that most of us learn as youngsters, but the ears also play a major role in helping a person maintain their balance and knowing where their body is in space. “The fluid, or endolymph, in the ear’s semicircular canals is what helps a person do things like stand up from a seated position without falling, walk a straight line, and not run into a door frame when turning a corner into a room,” says Dr. Johnson. In the presence of hearing loss, the reduction in acoustic signals impairs a person’s ability to process spatial information and can mean a higher risk for falling. In turn, falling can lead to broken bones and other injuries and a cascading effect of hospital stays and loss of independence. If you have been unsuccessful with hearing aids in the past, call Johnson Audiology, a hearing health clinic comprised of caring and professional staff. The team can bring a range of options to the table to help people hear better, including hearing aids from all six of the major manufacturers, custom fit products, cochlear implants, and Lyric, the world’s only extended wear hearing aid. Call your office of choice today or schedule online.
A man is wearing a cochlear implant in his ear.
March 6, 2025
Chipper Gocke, 28, has had many poignant moments in the last six weeks since his cochlear implant surgery. “A workmate commented recently that my speaking voice is the appropriate volume now. Not being able to hear myself, I probably often talked too loud before. It seems like a small thing, but it is a way to be more normalized in my professional and other settings.” His mother, Amy Gocke, also has noticed the changes. “Chipper has never called me on the phone before. With his profound lifelong hearing loss and even using powerful hearing aids, he simply couldn’t communicate by phone. Now I look forward to his calls every day after he gets off work.” These daily experiences that people often take for granted—communicating with a workmate or calling a family member to say hello—are now possible for Chipper because of his cochlear implant. Hearing loss has been a part of Chipper’s life since he was a small child. Chipper’s father, Ted Gocke, relates, “From the time he was 18 months old, Chipper had ear infections that had us in and out of the hospital. That led to tubes in his ears and the diagnosis that he had a significant hearing loss.” As a youngster, Chipper received early intervention services before he even reached school age. He also got established with local audiologist, Darnell Scafe, and they reconnected recently when Chipper sought out Darnell for hearing health care services as an adult. Darnell, who joined the Johnson Audiology team in 2018, says, “I remember Chipper as a sweet little boy who didn’t let his hearing loss slow him down. It’s wonderful to get to know the fine, capable young man he has grown into.” Last year, Darnell encouraged Chipper to consider a cochlear implant, and she referred him to Johnson Audiology’s Cochlear Implant Program Director, Dr. Hannah Dearth. Dr. Dearth then was able to complete cochlear implant candidacy testing. In November of last year, Chipper’s surgery was performed at Murfreesboro Medical Clinic (MMC) in Middle Tennessee by an otolaryngologist (ENT). A native of Chattanooga, Chipper traveled for the initial surgery since there is not currently an ENT in Chattanooga who performs CI surgeries. However, Chipper then had his cochlear implant activated at Johnson Audiology (JA) by Dr. Dearth in early January. Also, there to celebrate activation day was Darnell. “It felt like a full circle moment when Dr. Dearth activated Chipper’s cochlear implant, and he began to have those first sound perceptions.” Dr. Dearth explains, “People often wonder how a hearing aid and a cochlear implant are different. Cochlear implants are designed for patients whose hearing aids are no longer assisting them in understanding in both quiet and noisy environments. A hearing aid is designed to provide amplification for speech sounds that are unintelligible without said amplification. Cochlear implants are a surgical option for those who are no longer able to achieve meaningful understanding with a traditional hearing aid. Hearing aids rely on the ear’s natural pathway for hearing to accomplish this and so may not work well for someone with severe damage to the inner ear. A cochlear implant, on the other hand, bypasses the damaged parts of the ear by stimulating the auditory nerve directly with a mild electrical current that sends the sound signal to the brain.” Chipper is committed to his own success with his cochlear implant and in addition to listening to the speech of those around him, he is also tuning in to podcasts and audiobooks that give him even more speech exposure. Dr. Dearth says that is a huge factor in any patient’s ability to thrive with the device. “The patients who are committed to the aural rehabilitation as prescribed experience faster progress and higher success rates long term.” Chipper will continue regular follow-up appointments for the rest of his life to maintain successful progress with his CI. He gets emotional talking about the social isolation that can be a common side effect of profound hearing loss and, also, mentions the spatial awareness that better hearing offers. “Being able to pinpoint sound and localize stimuli from both sides of the head has positive effects for living a safe life,” Dr. Dearth says. Dr. Megan Johnson, audiologist, founder, and owner of JA, says, “Johnson Audiology has provided support for cochlear implant patients since 2017 with care offered through the practice’s location on Lee Highway in the East Brainerd area. After implantation, every other part of a CI patient’s hearing journey can be accomplished at Johnson Audiology—from initial activation to routine mapping.”  Chipper and his parents encourage people to explore the possibility of cochlear implants since it can make such a difference in a person’s daily life and function. Johnson Audiology is accepting new patients who currently wear hearing aids but would like to pursue cochlear implant candidacy as well as those who already have a cochlear implant. Call Johnson Audiology at 423.556.7185 or visit www.johnsonaudiology.com/schedule for more information or to schedule an appointment.