CLASSIFICATION

OF
AUDIOGRAMS
SLPA 450/850
Authors: Stephen Boney, PhD and Kelly Pritchett, AuD
CLASSIFICATION OF AUDIOGRAMS
• What the audiogram tells us about the
hearing loss.

*Type

*Degree

*Configuration
CLASSIFICATION OF AUDIOGRAMS
• TYPE - refers to what we call the “site of
lesion”. Where in the auditory system hearing
loss is located.
• DEGREE - refers to the severity of the hearing
loss. We can use a dB value, an adjective
descriptor, or both.
• CONFIGURATION - refers to the shape and
slope of the pure tone air conduction results
across the frequencies tested.
 TYPE OF HEARING LOSS
• Recall that the type of
hearing loss refers to the
probable site of lesion in the
peripheral auditory system.

• To determine the type of

hearing loss, we compare
the pure-tone test results
from air conduction and
bone conduction.
 TYPE OF HEARING LOSS
• To facilitate the discussion of type of loss, let’s
separate the ear into two mechanisms:

1. CONDUCTIVE - outer ear & middle ear - acts to

conduct or transfer the sound to the cochlea

2. SENSORINEURAL - inner ear (IE) & 8th nerve. IE =

sensory problem 8th nerve = neural problem
 TYPE OF HEARING LOSS
• NORMAL HEARING
– As the name implies, there is no loss of hearing;
therefore, air conduction and bone conduction are
all within normal limits and the same level.
– Note: Even if bone conduction and air conduction
are both within the normal limits. You can still
have a conductive component reducing hearing.
For example: a child with otitis media may have
bone conduction scores at -5 but air conduction at
15. Technically not a hearing loss but, with a
significant air-bone gap and need for medical
follow up.
 TYPE OF HEARING LOSS
• CONDUCTIVE
HEARING LOSS
– As the name implies,
the damage or lesion is
in the outer or middle
ear.
– There is a loss by air
conduction, with
normal bone
conduction thresholds.
 TYPE OF HEARING LOSS
• CONDUCTIVE LOSS - the sound is attenuated or
decreased as it travels through the outer or middle
ear. Therefore, it reaches the cochlea at the reduced
level.

• Bone conduction results are normal. This is because

we “bypass” the outer and middle ears and tests the
cochlea directly and there is no damage there.
 CONDUCTIVE

• The hallmark of conductive loss is what is called the

AIR-BONE-GAP (ABG).
• This means that the difference between air
conduction and bone conduction thresholds are 15
dB or greater.
• These types of losses are generally medically or
surgically treatable; therefore, most aren’t
permanent losses.
 TYPE OF HEARING LOSS
• SENSORINEURAL
– In this type of loss, the
damage is in the inner
ear or 8th nerve.
– These is a loss by air
conduction, when
sound reaches the
inner ear it is
decreased.
 SENSORINEURAL
• There is also a loss by bone conduction - since
we’re testing the inner ear directly, and this is
the location of damage, there will be an equal
loss.
• There may be an ABG for some frequencies
that is <15 dB; therefore, there is no
conductive component to the loss.
 SENSORINEURAL
• Most sensorineural losses are permanent.
There are no medical or surgical ways to
improve the hearing levels.

• Possible causes: drugs, noise exposure, illness

or disease, heredity (genetic), aging.
 TYPE OF HEARING LOSS
• MIXED
– There is both a
conductive and a
sensorineural
component.
– There is a loss by air
conduction.
– There is a loss by bone
conduction; however,
there is still a
significant ABG
present.
 DEGREE OF
HEARING LOSS
• There is no universally accepted way to classify
degree of hearing loss.

• Most commonly we used adjective descriptors to

describe the degree of hearing (e.g. mild, moderate,
etc.)

• You can also say a person has a 45-50 dB HL hearing

loss.
 DEGREE OF
HEARING LOSS
• There are some cases where people describe the
degree of hearing loss in percentages. This is done
primarily in medical-legal cases where someone is
trying to secure compensation for sustaining a
hearing loss.

• There are numerous formulas for determining

percentage of hearing loss.
 DEGREE OF
HEARING LOSS
• There are people who inappropriately
interchange the degree of hearing loss in dB
for a percentage.

• For example, if someone has a 50 dB HL

hearing loss, they may say they have a 50%
loss. This is not correct. They did not lose 1/2
of their hearing.
 DEGREE OF
HEARING LOSS
• A calculation

– PURE TONE AVERAGE

 DEGREE OF
HEARING LOSS

• The PURE TONE AVERAGE is the average of the air

conduction thresholds at 500, 1000, and 2000 Hz
(round up or down - don’t put in decimal values).

• We use these frequencies because they are thought

to be the most critical to understand speech.
 DEGREE OF
HEARING LOSS

• Exception - If there is a 20 dB HL or greater

difference between any of the 3 frequencies,
calculate the average using only the
thresholds are the 2 better frequencies - that
is the 2 frequencies which exhibit the lowest
HL thresholds.
 DEGREE OF
HEARING LOSS
• Categories to define degree of loss
– -10 - 20 = within normal limits
– 21 - 40 = mild
– 41 - 55 = moderate
– 56 - 70 = moderate/severe
– 71 - 90 = severe
– Above 90 = profound
 DEGREE OF
HEARING LOSS
• This classification system is meant merely as a
guideline.

• It become difficult sometimes to classify the

degree of loss with only using an adjective
because not all hearing losses are flat or equal
across all frequencies.
 DEGREE OF
HEARING LOSS

• Therefore, we need to consider the

configuration of the hearing loss.
CONFIGURATION OF HEARING
LOSS
 CONFIGURATION OF HEARING LOSS
• Configuration refers to the slope or shape of the
hearing loss.
• Different types of configurations that are possible

1. Most common is a high-frequency slope - that is, a

greater loss in the high frequencies (2k and above)
than in the lows.
 CONFIGURATION OF HEARING LOSS
• This can be :
– Gradual: 5-10 dB per octave
– Sharp: 15 - 20 dB per octave
– Precipitous: > 25 dB per octave

2. Flat loss - <5-10 dB difference across

audiometric thresholds.
 CONFIGURATION OF HEARING LOSS
3. Low frequency loss - this is where the hearing loss
is confined primarily to low frequencies or greater
at the lows than the highs.
4. A less common type is called by many names u-
shaped, trough, and cookie-bite. This type of
audiogram shows a greater loss of hearing in the
mid-frequencies of the audiogram.
 CONFIGURATION OF HEARING LOSS
5. Saucer Shaped - better hearing in the mid
frequencies and poorer hearing in the low
and high frequencies.

6. Notched - there is a dip in one region or the

audiogram with significantly better or
normal hearing at surrounding frequencies.
 CONFIGURATION OF HEARING LOSS
• A combination of the above hearing loss
configurations is possible.

• When describing the loss, you may need to

make reference to the degree of loss for
various frequency regions on the audiogram.
 CONFIGURATION OF HEARING LOSS

• For example, “hearing was within normal

limits through 2000 Hz, sloping to a moderate
high-frequency hearing loss”.
CLASSIFICATION OF AUDIOGRAMS

• You can also have a loss configuration with

parts of the audiogram showing a conductive
loss and other parts showing a sensorineural
loss.
CLASSIFICATION OF AUDIOGRAMS
• Some terminology:

– Bilateral - both ears

– Unilateral - one ear
– Symmetrical - same or similar
– Asymmetrical - dissimilar