AUDIOGRAM

250 Hz 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz

D AC
BC
S AC
BC
MASKING
D AC
BC
S AC
BC

NAMA PASIEN : ________________________ DIAGNOSA :

USIA : ________________________ DEXTRA ________________________________

NO RM : ________________________ SINISTRA _______________________________

Symbol :Air Bone MASKING Air Bone
Tanggal Pemeriksaan : ____________________ D:O D:< D:∆ D:[
125 250 500 1000 2000 3000S : X 4000
S : > 6000 S : 8000
□ S :]

-20 -20
-10 -10
0 0
10 10
20 20
30 30
Intensitas (dB)
40 40
50 50
60 60
70 70
80 80
90 90
100 100
110 110
120 120
125 250 500 1000 2000 3000 4000 6000 8000
Frequency (Hz)

Pemeriksa