How to Read Your Audiogram: A Plain-Language Guide to Your Hearing Test Results

What an audiogram is — and what it is not

An audiogram is a graph that shows the softest sounds you can hear at different pitches (frequencies). It is produced during a pure-tone audiometry test, which is the standard hearing evaluation performed by audiologists and hearing instrument specialists.

It is important to understand what an audiogram does not show: it does not measure how well you understand speech in noise, how well your brain processes sound, or the full picture of your hearing ability in real-world environments. It is a foundational measurement — the starting point for understanding your hearing, not the complete picture.

Reading the axes: frequency and loudness

The horizontal axis: frequency (pitch)

The horizontal axis represents frequency, measured in Hertz (Hz). Frequencies increase from left to right — low pitches (like a bass guitar or a rumbling engine) on the left, high pitches (like a bird chirping or a whistle) on the right.

Standard audiograms test frequencies from 250 Hz to 8,000 Hz. This range covers the frequencies most important for understanding speech. The frequencies most critical for speech intelligibility — particularly consonant sounds — fall between 1,000 Hz and 4,000 Hz.

The vertical axis: loudness (intensity)

The vertical axis represents loudness, measured in decibels Hearing Level (dB HL). Crucially, the scale runs from quiet at the top to loud at the bottom — the opposite of what many people expect. A threshold plotted near the top of the graph (0–20 dB HL) means you can hear very soft sounds at that frequency. A threshold plotted lower (40, 60, 80 dB HL) means you need sounds to be louder before you can detect them.

The symbols: what X and O mean

Each ear is plotted separately using different symbols:

O (circle): Right ear thresholds, typically plotted in red

X (cross): Left ear thresholds, typically plotted in blue

Each symbol represents your hearing threshold at that frequency — the softest sound you could reliably detect during the test. The audiologist connects the symbols with lines to create the characteristic shape of your audiogram.

You may also see other symbols on a more detailed audiogram:

[ and ]: Bone conduction thresholds (right and left), which test the inner ear directly, bypassing the outer and middle ear

Arrows: Indicate that the threshold is at or beyond the limits of the audiometer — the person could not hear the sound even at maximum output

Degrees of hearing loss: what the numbers mean

Hearing loss is classified by degree based on the average threshold across the speech frequencies (typically 500 Hz, 1,000 Hz, 2,000 Hz, and sometimes 4,000 Hz). This average is called the Pure Tone Average (PTA):

Normal hearing: 0–25 dB HL — you can hear very soft sounds

Mild hearing loss: 26–40 dB HL — you may miss soft speech, especially in noise

Moderate hearing loss: 41–55 dB HL — conversational speech at normal volume is difficult

Moderately severe: 56–70 dB HL — you need speech to be loud to understand it

Severe hearing loss: 71–90 dB HL — only very loud sounds are audible without amplification

Profound hearing loss: 91+ dB HL — little or no usable hearing without powerful amplification or cochlear implants

The shape of the audiogram: what patterns mean

The shape of your audiogram — how the thresholds vary across frequencies — often points to the cause of your hearing loss:

Flat audiogram

Thresholds are similar across all frequencies. Common causes include conductive hearing loss (fluid, earwax, middle ear problems) and some forms of sensorineural loss.

High-frequency sloping loss ("ski slope")

Normal or near-normal hearing in the low frequencies, with progressively worse thresholds at higher frequencies. This is the most common pattern and is associated with age-related hearing loss (presbycusis) and noise-induced hearing loss.

Notch at 4,000 Hz

A specific dip in thresholds around 4,000 Hz with relatively better hearing above and below. This is the classic signature of noise-induced hearing loss — the 4 kHz notch is caused by the specific vulnerability of the cochlear region that processes this frequency to acoustic trauma.

Low-frequency loss ("reverse slope" or "cookie bite")

Worse hearing in the low frequencies than the high frequencies. This pattern is less common and is associated with Meniere's disease (especially early stages), certain genetic hearing losses, and some autoimmune conditions.

Cookie bite (mid-frequency loss)

Normal hearing at low and high frequencies with a dip in the middle frequencies. Often genetic in origin.

Air conduction vs. bone conduction: understanding the gap

A complete audiogram tests both air conduction (sounds delivered through headphones or earphones, traveling through the outer and middle ear to the inner ear) and bone conduction (a vibrator placed behind the ear that stimulates the inner ear directly, bypassing the outer and middle ear).

Comparing these two sets of thresholds is diagnostically important:

If air and bone thresholds are similar: The loss is sensorineural — the problem is in the inner ear or auditory nerve.

If air thresholds are worse than bone thresholds (an "air-bone gap"): The loss is conductive — there is a problem in the outer or middle ear (earwax, fluid, perforated eardrum, ossicle damage) that is blocking sound from reaching an otherwise normal inner ear. Conductive losses are often medically treatable.

If both air and bone thresholds are elevated, but air is worse: Mixed hearing loss — both conductive and sensorineural components are present.

What your audiogram means for hearing aid candidacy

Your audiogram is the primary tool audiologists use to determine whether you are a hearing aid candidate and, if so, what type of device and settings are appropriate:

Mild to moderate sensorineural loss across the speech frequencies is the ideal profile for both OTC and prescription hearing aids.

Severe or profound loss typically requires prescription hearing aids with more powerful amplification — OTC devices are not designed for this degree of loss.

Conductive loss may be better addressed medically before considering amplification.

Asymmetric loss (significantly different thresholds between ears) warrants medical evaluation before hearing aid fitting.

If you have questions about your audiogram results, the best resource is the audiologist who performed your test. They can explain your specific pattern, discuss what it means for your daily hearing challenges, and help you understand your options.