Lede: An audiogram looks like a mountain range of dots and lines—mysterious, a little intimidating, and full of clues. Once you know how to read it, you can predict which sounds are slipping away, why conversations feel hard, and what to ask your audiologist next. Let’s turn those squiggles into useful action.
First: What an audiogram actually shows
An audiogram is a map of the quietest sounds you can hear at different pitches (frequencies). It uses headphones (air conduction) and, sometimes, a small bone vibrator behind the ear (bone conduction) to test your inner ear and the pathway through the outer/middle ear.
The axes and the units (made friendly)
- Horizontal axis (left to right): Pitch in Hertz (Hz)—from low rumble (125–250 Hz) to high sparkle (8,000 Hz and beyond).
- Vertical axis (top to bottom): Loudness in decibels Hearing Level (dB HL). Zero dB HL isn’t “no sound”—it’s the average softest level young, normal-hearing ears can detect. Down means worse hearing.
Those circles and Xs are your thresholds—the softest level you heard at each pitch. The red line (right ear) and blue line (left ear) create the “shape.”
How much is “mild” vs “severe”?
Pros often summarize your hearing with a pure-tone average (PTA) across key speech pitches (500, 1k, 2k Hz). Ranges vary by organization, but a common sense guide:
- Normal: −10 to 20 dB HL
- Mild: 21–40 dB HL
- Moderate: 41–55 dB HL
- Moderately severe: 56–70 dB HL
- Severe: 71–90 dB HL
- Profound: 91+ dB HL
Numbers are only part of the story. Two audiograms with the same average can feel very different in real life, depending on shape and your brain’s ability to use sound in noise.
Meet the “speech banana” (and why consonants are the ninjas)
On a typical audiogram chart, many providers overlay the “speech banana”—a banana-shaped region showing where common speech sounds live. Vowels (A, E, I, O, U) are lower-pitched and louder. Consonants (S, F, TH, K, T) are higher-pitched and softer.
Translation: If your high frequencies drop, speech can sound clear in quiet but smear in noise—because the crisp consonant clues are missing. If lows are affected, voices may feel thin, distant, or lacking body.
Shapes that tell stories (without diagnosing)
Shapes can hint at common patterns. These are helpful clues, not diagnoses. Always discuss specifics with your audiologist or ENT.
1) Sloping high‑frequency loss
What it looks like: Good hearing in bass pitches that gradually gets worse into the treble.
Often linked with: Age-related change (presbycusis), lifetime noise exposure.
Daily impact:
- Speech clarity drops, especially in restaurants or meetings.
- “S” and “F” vanish. People mumble. The TV creeps up.
Helpful tech/features:
- Open-fit hearing aids that leave lows natural while boosting highs.
- Directionality and noise reduction tuned for conversation.
- Frequency lowering for very steep losses (shifts ultra-high info into audible ranges).
2) The 3–6 kHz “noise notch”
What it looks like: A dip around 3–6 kHz with better hearing on either side.
Often linked with: Loud impulse sounds (gunfire, fireworks) or long-term machine/engine noise without protection.
Daily impact: Like the sloping loss, it steals crispness. You can hear “something” but miss details.
Action now: Use well-fitted ear protection around loud tools, concerts, and sports. Smart hearing care isn’t just amplification—it’s prevention.
3) Reverse‑slope (low‑frequency loss)
What it looks like: Poorer hearing at low pitches with better highs.
Often linked with: Conditions that affect inner-ear fluid pressure, certain genetic patterns, or middle-ear stiffness. Discuss with a clinician, especially if symptoms fluctuate or one ear is worse.
Daily impact:
- Voices can seem thin or distant.
- Background rumbles (HVAC, traffic) mask speech more easily.
Fitting nuance: Seals and venting matter to avoid that “boomy” own-voice feel. Your audiologist can fine-tune.
4) Cookie‑bite (mid‑frequency loss)
What it looks like: Better lows and highs with a dip in the middle.
Often linked with: Genetic patterns; sometimes present from younger years and slowly changes.
Daily impact: Conversation can be surprisingly tough even if pure tones don’t look “that bad.” Targeted amplification across mid-pitches helps.
5) Flat loss
What it looks like: Similar thresholds across pitches.
Often linked with: Conductive issues (e.g., middle-ear fluid) or sensorineural changes that affect the cochlea more evenly.
Daily impact: Everything is softer. Hearing aids can provide across-the-board lift. If there’s a conductive component, medical treatment may help; ask your clinician.
6) Corner or profound loss
What it looks like: Very high thresholds across most frequencies, sometimes with only low-pitch hearing remaining.
Often linked with: Severe inner-ear damage from various causes.
Daily impact: Conventional hearing aids may offer limited benefit. Cochlear implant evaluation can be life-changing—ask for a referral if you suspect this pattern.
Bonus clue: asymmetry
What it looks like: One ear significantly worse than the other, or different shapes.
Why it matters: Asymmetry deserves medical attention to rule out treatable causes. If you notice imbalance, don’t wait—book with an audiologist or ENT.
Air vs bone: Clues to conductive vs sensorineural
Your test might include little brackets or symbols for bone conduction. Comparing air and bone tells us where the problem lives:
- Air–bone gap present: Bone thresholds are better (higher up the chart) than air. Often points to a conductive component (outer/middle ear), such as earwax, eardrum issues, or middle-ear fluid. Many are medically treatable.
- No gap, both reduced: Suggests a sensorineural component (inner ear/nerve). Hearing aids and aural rehabilitation are the main tools.
Your provider may add tympanometry (a quick eardrum flexibility test). A flat or negative-pressure tracing can support a conductive picture. Acoustic reflexes can offer extra clues. These tests help your care team choose the right path.
Beyond beeps: speech tests are your superpower
Pure tones don’t capture everything. Speech testing fills in the real-life gaps:
- Word Recognition Score (WRS): The percentage of single words you repeat correctly at a comfortable loudness. High WRS with a mild-to-moderate loss? Great prognosis with well-fitted hearing aids. Low WRS even when words are loud enough? Expect ongoing difficulty; strategy and technology both matter.
- Speech-in-Noise tests (e.g., QuickSIN): How well you understand with background noise. These results guide hearing aid features, accessories (like remote mics), and communication strategies.
- Uncomfortable Loudness Levels (UCLs): How quickly sounds become too loud (recruitment). Crucial for precise hearing aid fitting so amplified sound is clear, not harsh.
Turning shapes into smart next steps
If you see a sloping or notch pattern
- Prioritize hearing protection in loud environments. Keep foam plugs in your bag; consider custom plugs if you’re around noise regularly.
- Ask your audiologist about directionality, noise reduction, and frequency lowering if highs are significantly reduced.
- Consider remote microphones for meetings, classrooms, and restaurants.
If you see a flat loss or air–bone gap
- Ask whether middle-ear issues could be at play. Tympanometry results help. Some causes are medically treatable—an ENT can advise.
- For persistent conductive components, bone-conduction devices may be considered. Discuss candidacy with a specialist.
If you see reverse-slope or cookie-bite
- Make sure your fitting includes careful venting and own-voice tuning.
- Advocate for real-ear measurements so your prescription matches your ear canal acoustics.
For everyone
- Schedule regular follow-ups (often annually) to track change and optimize settings.
- Bring your communication goals to the appointment (e.g., “hear my soft-spoken partner in the car,” “understand in team meetings”). Goals guide features and training.
- Learn a few brain-side strategies: face the speaker, reduce distance, improve lighting, and consider short, consistent auditory training sessions to boost clarity over time.
Reading your own audiogram PDF? Use this quick checklist
- Confirm which ear is which (red right, blue left).
- Note the overall shape (sloping, notch, flat, cookie-bite, reverse-slope).
- Look for an air–bone gap (brackets or different symbols). If present, ask about middle-ear evaluation.
- Find your WRS and any speech-in-noise scores—these predict real-world success more than PTA alone.
- Compare with prior tests for change. A significant shift warrants a conversation.
- Jot down 3 listening situations you want to improve and bring them to your next appointment.
Pro tip: If you took an online hearing check, treat it as a screening only. Headphone quality, background noise, and calibration all affect results. Use it as a nudge to book a proper test, not a final verdict.
Red flags that deserve prompt attention
- Sudden drop in one or both ears, or new unilateral tinnitus/fullness—seek urgent evaluation.
- Asymmetry (one ear noticeably worse) without a clear explanation.
- Persistent ear pain, discharge, or dizziness/vertigo with hearing changes.
These signs don’t automatically mean something serious, but speed matters. When in doubt, call an audiologist or ENT.
Why your hearing aids don’t “fix” the audiogram—but can transform your day
Hearing aids don’t move the dots on your audiogram; they shape the sound that reaches your brain, restoring audibility and comfort. Success hinges on a few things:
- Precise fitting with real-ear measurements (REM) to hit your prescription targets.
- Feature matching to your shape and lifestyle (directional mics, noise reduction, frequency lowering, Bluetooth accessories).
- Follow-up fine-tuning to solve real-world annoyances and improve clarity.
- Practice. Your brain adapts. A few weeks of consistent wear and brief training can unlock noticeably better understanding.
Consider this your invitation to collaborate: bring your audiogram, your goals, and your day-to-day challenges. Your clinician brings the tech and the know-how; together you build the hearing you want.
Protecting what you have: the quiet habits that add up
- Keep a pair of plugs on your keychain. Use them for power tools, stadiums, and loud classes.
- Lower the dose: Shorten time in noisy places, take breaks, and mind the volume on headphones.
- Review ototoxic medications with your healthcare team, especially if you notice changes.
- Test annually (or sooner if you notice a change). Tracking your audiogram over time is like watching your hearing health credit score.
Curious, concerned, or ready to upgrade your hearing? A licensed audiologist can translate your audiogram into a personalized action plan. Bring this article to your appointment and use it as your conversation starter.
Further Reading
- When One Ear Falls Behind: Why Asymmetric Hearing Loss Matters (and What to Do) (Hearing Loss) - Sudden Hearing Loss, Fast Action: Your First 48 Hours (Hearing Loss) - Clarity Over Loudness: Word Recognition, Speech-in-Noise, and Your Hearing Options (Hearing Loss) - Diabetes and Your Hearing: What High Blood Sugar Does to Your Ears (and How to Protect Them) (Hearing Loss)Frequently Asked Questions
Is a 25 dB loss bad?
Many charts call 0–20 dB HL “normal.” Around 25 dB HL is often labeled “borderline” or “very mild.” Even small changes can matter, though—especially for hearing soft voices, children’s speech, or in noise. If you’re struggling, don’t wait for the numbers to get bigger; talk with an audiologist about strategies, communication tweaks, and whether amplification could help.
Why is my word score low if my audiogram looks mild?
Pure tones and speech understanding measure different things. You might hear beeps fine but still have reduced clarity due to damaged synapses or hair cells that affect timing and detail, especially in noise. That’s why speech testing (including speech-in-noise) is essential. The fix is often a mix of well-fitted hearing aids, accessories like remote mics, and listening strategies.
Can an audiogram miss hidden hearing loss?
Yes. Standard audiograms measure the quietest sounds you detect in quiet, not how well your auditory system handles complex, noisy scenes. People can have normal thresholds but struggle in noise. Speech-in-noise tests and a careful case history help uncover these issues, and training plus tech can improve day-to-day listening.
Do hearing aids improve my audiogram?
They don’t change your measured thresholds, but they improve what reaches your brain. With the right fitting and features, you can regain access to soft consonants, boost speech-in-noise performance, and reduce listening fatigue. Think of hearing aids as precision glasses for sound—worn during life, not during the test.
