Understanding Your Audiogram Results

What Is an Audiogram?

An audiogram is the standard visual representation of your hearing ability, produced during a pure tone audiometry test. It is essentially a graph that maps out the softest sounds you can hear across a range of different pitches, giving your audiologist — and you — a detailed picture of your hearing in each ear. Every hearing test you have will produce an audiogram, and understanding how to read it puts you in a much stronger position to engage with your hearing healthcare and make informed decisions about treatment.

According to the British Society of Audiology (BSA), audiometric testing is the gold standard for measuring hearing sensitivity and is the basis on which hearing loss is diagnosed, classified, and managed across the UK`s NHS and private audiology services. While your audiologist will always explain your results, many people find that understanding the basics of audiogram interpretation helps them feel more confident and in control of their hearing health journey.

This guide explains everything you need to know about reading an audiogram — from understanding the axes and symbols, to interpreting different degrees and types of hearing loss, and knowing what happens next once your results are in.

How the Audiogram Graph Works

At first glance, an audiogram can look confusing, but the underlying concept is straightforward. The graph has two axes, each measuring a different aspect of sound:

The horizontal axis: frequency (pitch)

The horizontal axis (x-axis) runs from left to right and shows frequency, measured in Hertz (Hz). Frequency is the pitch of a sound — how high or low it sounds to your ear. The audiogram typically covers the range most important for understanding speech:

• 250 Hz (far left) — low-pitched sounds, such as a bass drum, a man`s deep voice, or the hum of a refrigerator
• 500 Hz — the lower range of conversational speech, vowel sounds like "oo" and "ah"
• 1000 Hz (1 kHz) — mid-range, the heart of conversational speech
• 2000 Hz (2 kHz) — important for consonant clarity, sounds like "s", "f", and "th"
• 4000 Hz (4 kHz) — higher-pitched consonants and sounds like birdsong
• 8000 Hz (8 kHz) (far right) — high-pitched sounds such as a whistle, a child`s voice, or the "s" sound in speech

Some audiograms extend beyond this range, testing frequencies up to 12,000 or 16,000 Hz, which can be useful for detecting very early hearing changes or monitoring the effects of ototoxic medications. However, the standard clinical audiogram focuses on 250 to 8,000 Hz.

The vertical axis: intensity (volume)

The vertical axis (y-axis) runs from top to bottom and shows intensity, measured in decibels hearing level (dB HL). This represents how loud a sound needs to be for you to just barely hear it — your hearing threshold. Here is where the audiogram can feel counterintuitive:

• The top of the graph (around -10 to 0 dB) represents very soft sounds — this is where excellent hearing plots
• The bottom of the graph (around 100 to 120 dB) represents very loud sounds — marks plotted here indicate significant hearing loss

In other words, the higher up the graph your marks appear, the better your hearing at that frequency. Marks that drop lower on the graph indicate that sounds need to be louder for you to hear them — which means poorer hearing at those pitches. This inverted scale is the single most confusing aspect of audiograms for most people, but once you understand it, the rest becomes much clearer.

Understanding the Symbols

The audiogram uses a standardised set of symbols, defined by the BSA, to represent the results for each ear and each type of testing. The most important symbols you will see are:

Air conduction

Air conduction testing is performed with headphones and measures your overall hearing ability — including the outer ear, middle ear, and inner ear working together:

• Right ear — red circles (O) connected by a red line
• Left ear — blue crosses (X) connected by a blue line

A useful memory aid: Red = Right. The blue crosses for the left ear can be remembered by thinking of the "x" in "left" (a stretch, but it works for many people).

Bone conduction

Bone conduction testing is performed using a small vibrating device placed on the bone behind your ear (the mastoid process). This sends sound directly to the inner ear (cochlea), bypassing the outer and middle ear entirely:

• Right ear — red angle brackets pointing right ( > or [ )
• Left ear — blue angle brackets pointing left ( < or ] )

The comparison between air conduction and bone conduction results is crucial for determining the type of hearing loss you have, which we will explain in detail below.

Masked results

Sometimes the audiologist needs to apply "masking" — playing noise into the non-test ear to prevent it from picking up sounds intended for the ear being tested. Masked results are shown with different symbols (triangles for air conduction, square brackets for bone conduction). Your audiologist will explain if masking was used and why.

Degrees of Hearing Loss

Hearing loss is categorised by its degree (severity), based on the average hearing threshold across key speech frequencies. The classification used by the BSA and the World Health Organization (WHO) is:

• Normal hearing: -10 to 20 dB — You can hear soft sounds easily. No difficulty in any listening situation.
• Mild hearing loss: 21 to 40 dB — You may have difficulty hearing soft speech, whispered conversation, and following dialogue in noisy environments such as restaurants or busy offices. This is often the stage where people first notice they are struggling to hear but may not yet seek help.
• Moderate hearing loss: 41 to 70 dB — Normal conversational speech becomes difficult to hear without amplification. You will likely benefit significantly from hearing aids. Group conversations and telephone calls are particularly challenging.
• Severe hearing loss: 71 to 90 dB — Only loud speech and sounds are audible without hearing aids. Powerful hearing aids are typically needed, and you may rely significantly on lip-reading and visual cues. Communication strategies become important.
• Profound hearing loss: 91 dB and above — Most sounds are inaudible without powerful hearing aids or cochlear implants. Many people with profound hearing loss rely on lip-reading, sign language, and/or cochlear implant technology.

It is important to note that hearing loss is often different at different frequencies. You might have normal hearing in the low frequencies but moderate loss in the high frequencies — this is extremely common and explains why you might hear that someone is speaking but struggle to make out what they are saying (because consonant sounds, which give speech its clarity, are predominantly high-frequency).

Types of Hearing Loss on the Audiogram

Comparing your air conduction and bone conduction results tells the audiologist what type of hearing loss you have. This distinction is critical because it determines the most appropriate treatment pathway.

Sensorineural hearing loss

If both your air conduction and bone conduction thresholds are reduced by the same amount (i.e., the red/blue circles and the angle brackets are plotted at similar levels), this indicates sensorineural hearing loss. The problem lies in the inner ear (cochlea) or the auditory nerve. This is the most common type of permanent hearing loss and is typically caused by:

• Age-related changes (presbycusis) — the most common cause in adults over 50
• Noise-induced damage — from occupational or recreational noise exposure
• Genetic factors — often showing a specific audiogram pattern
• Ototoxic medications — certain drugs that can damage the delicate hair cells of the inner ear

Sensorineural hearing loss is usually permanent and is managed with hearing aids. In cases of severe to profound loss, cochlear implants may be considered.

Conductive hearing loss

If your bone conduction thresholds are normal (or near-normal) but your air conduction thresholds are reduced, this indicates conductive hearing loss. The gap between the two measurements is called an air-bone gap. This means the inner ear is functioning well, but something in the outer or middle ear is preventing sound from being conducted efficiently. Common causes include:

• Ear wax buildup blocking the ear canal
• Glue ear (otitis media with effusion) — fluid in the middle ear, especially common in children
• Middle ear infections
• Otosclerosis — abnormal bone growth fixing the stapes bone in place
• Perforated eardrum
• Eustachian tube dysfunction

The good news is that conductive hearing loss is often treatable — sometimes with medication, sometimes with a minor surgical procedure, and sometimes simply by removing ear wax. Tympanometry is often used alongside the audiogram to help pinpoint the cause.

Mixed hearing loss

If both air and bone conduction thresholds are reduced, but air conduction is worse than bone conduction (creating an air-bone gap), this indicates mixed hearing loss — a combination of sensorineural and conductive components. For example, someone with age-related inner ear damage who also has ear wax blocking their canal would show a mixed pattern. Treatment addresses both components: the conductive element may be medically or surgically treatable, while the sensorineural element is typically managed with hearing aids.

Common Audiogram Patterns and What They Mean

The shape or configuration of the audiogram — the pattern formed when the threshold marks are connected — provides important diagnostic clues about the cause of hearing loss:

High-frequency sloping loss

This is the most common audiogram pattern. Hearing is relatively good in the low frequencies (250-1000 Hz) but drops progressively in the higher frequencies (2000-8000 Hz). This pattern is characteristic of:

• Age-related hearing loss (presbycusis) — the most frequent cause, affecting the majority of adults over 60
• Noise-induced hearing loss — often showing a distinctive "notch" (dip) at 4000 Hz, sometimes called the "4 kHz notch"

People with a high-frequency sloping loss typically report that they can hear people speaking but cannot always make out the words clearly — this is because vowel sounds (low-frequency) are still audible, but consonant sounds (high-frequency) are lost.

Flat audiogram

Hearing loss is roughly equal across all frequencies. This can indicate hereditary hearing loss, certain inner ear conditions, or middle ear problems affecting all frequencies equally.

Low-frequency (rising) loss

Hearing is worse in the low frequencies and better in the highs. This is less common and may suggest Meniere`s disease, particularly in the early stages, or certain types of sudden hearing loss.

Cookie-bite (U-shaped) loss

Hearing is relatively good in both the low and high frequencies, but drops in the mid-range (1000-2000 Hz), creating a U-shaped dip on the audiogram. This distinctive pattern often suggests a genetic or hereditary cause and may be present from birth or develop in early adulthood.

Asymmetric hearing loss

When one ear shows significantly different results from the other, this is described as asymmetric hearing loss. The BSA and NICE guidelines recommend that an asymmetric audiogram should prompt further investigation, typically including an MRI scan. This is to rule out conditions such as acoustic neuroma (vestibular schwannoma) — a benign tumour on the auditory nerve. While acoustic neuromas are uncommon (affecting approximately 1 in 100,000 people per year), they are important to detect early.

The Speech Banana: Understanding Everyday Sounds

One of the most helpful concepts for understanding your audiogram in practical terms is the "speech banana". This is a banana-shaped area plotted on the audiogram that shows where the sounds of speech fall in terms of frequency and volume. Different speech sounds occupy different positions:

• Vowel sounds (a, e, i, o, u) — lower frequency, louder; they sit in the lower-left area of the speech banana
• Consonant sounds (s, f, th, sh, p, k) — higher frequency, softer; they sit in the upper-right area

If your hearing thresholds fall within or above the speech banana, you should be able to hear those sounds. If your thresholds dip below parts of the banana, you will miss those particular speech sounds. This is why many people with high-frequency hearing loss say they can hear speech but cannot understand it — they are catching the vowels but missing the consonants that give words their definition and clarity.

Your audiologist may use the speech banana to explain your results in a way that relates directly to your everyday listening experience. This can be particularly helpful for understanding why certain situations — like following conversation in a busy restaurant or hearing a grandchild`s voice — are more challenging than others.

What Happens After Your Audiogram

Your audiogram results, combined with your symptoms, medical history, and the findings from any additional tests (such as tympanometry, speech-in-noise testing, or otoacoustic emissions), guide the audiologist`s recommendations. The next steps depend on your results:

• Normal hearing — No treatment needed, but the audiologist will advise on hearing protection and recommend a follow-up schedule. Your audiogram becomes a valuable baseline for future comparison. See our guide on how often you should have a hearing test.
• Mild hearing loss — Depending on the impact on your daily life, the audiologist may recommend monitoring with repeat audiograms, hearing aids, or lifestyle adjustments. Even mild loss can benefit from amplification, particularly in challenging listening environments.
• Moderate to severe hearing loss — Hearing aids will typically be recommended. Through the NHS, digital behind-the-ear hearing aids are available free of charge. Private audiologists offer a wider range of styles including receiver-in-canal and completely-in-canal devices. See our guide to choosing hearing aids.
• Conductive hearing loss — You may be referred to an ENT (ear, nose, and throat) specialist for further investigation and potential medical or surgical treatment.
• Asymmetric or unusual patterns — Further investigation, potentially including MRI, may be recommended to rule out underlying conditions.
• Profound hearing loss — Referral for cochlear implant assessment may be appropriate.

Always ask your audiologist for a copy of your audiogram to keep in your records. If you see a different professional in the future — whether at a different clinic, through the NHS, or at a high-street provider such as Hidden Hearing — having your previous results allows direct comparison and accurate tracking of any changes over time. Understanding your audiogram empowers you to take an active role in your hearing health and ensures you get the most from every audiology appointment.