How to read an audiogram
Other platforms explain it with text and video. In VMS you practice it on the patient.
An audiogram maps the quietest sounds a person can hear. It shows if hearing loss is present, how bad it is and where the problem lies.
Step by step
Learn the axes
Pitch (frequency in Hz) runs left to right from low to high. Loudness (decibels) runs top to bottom, so lower points mean worse hearing. [1]
Know the symbols
O marks the right ear and X the left ear for air conduction. The signs < and > (or brackets) mark bone conduction. [2]
Grade each ear
Look at the air conduction line. Thresholds up to about 25 dB are normal in adults; higher numbers mean more loss. [2]
Compare air and bone
If air and bone are both down together, the loss is sensorineural (inner ear or nerve). If bone is normal and air is more than 10 dB worse, it is conductive (outer or middle ear). [2]
Look at the shape
A slope down at high pitches in both ears fits age-related loss. A dip near 4000 Hz suggests noise damage. [2]
Check for asymmetry
A clear difference between ears needs referral. Sudden sensorineural loss is urgent. [2]
Link to the exam
Match the result with otoscopy and tuning fork tests such as Weber and Rinne. [1]
Common errors
- Reading the loudness axis upside down.
- Mixing up the right and left ear symbols.
- Missing an air-bone gap that shows conductive loss.
Degree of hearing loss (typical adult categories) [2]
| Degree | Threshold (dB HL) | What the patient notices |
|---|---|---|
| Normal | up to 25 | Hears soft speech |
| Mild | 26 to 40 | Misses soft speech, mainly in noise |
| Moderate | 41 to 55 | Struggles with normal conversation |
| Moderately severe | 56 to 70 | Needs loud speech |
| Severe | 71 to 90 | Hears only very loud sounds |
| Profound | 91 or more | May feel sound more than hear it |
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.