Patient Name
Word Understanding Score:
Right Left
Low Pitched High Pitched 250 500 1000 2000 4000 8000 Loud Soft
YOUR AUDIOGRAM
0 dB
Normal Hearing: Normal speech recognition
10
20
40
60
80
f
j
z
v
m
d n ng l e u
t th
p i a o r
h ch
k
g sh
s
Mild Hearing Loss: Trouble with soft speech, such as children’s voices, some female voices, hearing in noise, hearing at a distance, television Moderate Hearing Loss: Trouble with whispers, speech in noise, distance, lectures, places of worship, hearing on the telephone, all voices seem weak
Severe Hearing Loss: Difficulty understanding all speech
100
Profound Hearing Loss: Rely mostly on reading lips or sign language 120 dB