An audiogram is a graph that shows the audible threshold for standardized frequencies as measured by an audiometer. The Y axis represents intensity measured in decibels and the X axis represents frequency measured in hertz. The threshold of hearing is plotted relative to a standardised curve that represents 'normal' hearing, in dB. They are not the same as equal-loudness contours, which are a set of curves representing equal loudness at different levels, as well as at the threshold of hearing, in absolute terms measured in dB SPL. Audiograms are set out with frequency in hertz on the horizontal axis, most commonly on a logarithmic scale, and a linear dBHL scale on the vertical axis. For humans, normal hearing is between −10 dB and 15 dB, although 0 dB from 250 Hz to 8 kHz is deemed to be 'average' normal hearing. Hearing thresholds of humans and other mammals can be found by using behavioural hearing tests or physiological tests. An audiogram can be obtained using a behavioural hearing test called Audiometry. For humans the test involves different tones being presented at a specific frequency and intensity. When the person hears the sound they raise their hand or press a button so that the tester knows that they have heard it. The lowest intensity sound they can hear is recorded. The test varies for children, their response to the sound can be a head turn or using a toy. The child learns what they can do when they hear the sound, for example they are taught that when they heard the sound they can put a toy man in a boat. This is referred to as conditioned play audiometry. Visual reinforcement audiometry is also used with children. When the child hears the sound, they look in the direction the sound came from and are reinforced with a light and/or animated toy. A similar technique can be used when testing some animals but instead of a toy, food can be used as a reward for responding to the sound. Physiological tests do not need the patient to respond. For example when performing the brainstem auditory evoked potentials the patient’s brainstem responses are being measured when a sound is played into their ear, or otoacoustic emissions which are generated by a healthy inner ear either spontaneously or evoked by an outside stimulus. In the US, the NIOSH recommends that people who are regularly exposed to hazardous noise have their hearing tested once a year, or every three years otherwise.
Measurement
Audiograms are produced using a piece of test equipment called an audiometer, and this allows different frequencies to be presented to the subject, usually over calibrated headphones, at any specified level. The levels are, however, not absolute, but weighted with frequency relative to a standard graph known as the minimum audibility curve which is intended to represent a 'normal' hearing. This is not the best threshold found for all subjects, under ideal test conditions, which is represented by around 0 Phon or the threshold of hearing on the equal-loudness contours, but is standardised in an ANSI standard to a level somewhat higher at 1 kHz. There are several definitions of the minimal audibility curve, defined in different international standards, and they differ significantly, giving rise to differences in audiograms according to the audiometer used. The ASA-1951 standard for example used a level of 16.5 dB at 1 kHz whereas the later ANSI-1969/ISO-1963 standard uses 6.5 dB, and it is common to allow a 10 dB correction for the older standard.
Most commonly, "conventional" audiometry is used to measure hearing status. For research purposes, or early diagnosis of age-related hearing loss, ultra-high frequency audiograms, requiring special audiometer calibration and headphones, can be measured. Ideally the audiogram would show a straight line, but in practice everyone is slightly different, and small variations are considered normal. Larger variations, especially below the norm, may indicate hearing impairment which occurs to some extent with increasing age, but may be exacerbated by prolonged exposure to fairly high noise levels such as by living close to an airport or busy road, work related exposure to high noise, or brief exposure to very high sound levels such as gunshot or music in either a loud band or clubs and pubs. Hearing impairment may also be the result of certain diseases such as CMV or Ménière's disease and these can be diagnosed from the shape of the audiogram. Otosclerosis results in an audiogram with significant loss at all frequencies, often of around 40 dB. A deficiency particularly around 2 kHz is characteristic of either otosclerosis or a congenital ossicular anomaly. Ménière's disease results in a severe loss at low frequencies. Noise induced deafness or sensorineural loss results in loss at high frequencies, especially around 4 kHz and above, depending on the nature of the exposure to loud noise. Different symbols indicate which ear the response is from and what type of response it is. Red circles are the right ear using headphones and left x's are the left ear using headphones. Brackets < or > demote that a bone conductor was used, not headphones, and this just tests hearing from the middle and inner ear. The direction that the bracket is opening tells you the ear it is testing. These two types of testing help determine if the hearing loss is conductive or sensorineural.
