How do I interpret the results of a hearing test?

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Last updated: July 14, 2025 • View editorial policy

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Interpreting Results of a Hearing Test

Hearing test results should be interpreted based on the type, degree, and pattern of hearing loss, with thresholds greater than 20 dB at any frequency indicating possible hearing loss requiring further evaluation by an audiologist. 1

Understanding the Audiogram

An audiogram is the standard visual representation of hearing test results that shows:

  • Frequencies tested: Typically 500,1000,2000, and 4000 Hz (the speech spectrum)
  • Hearing thresholds: Measured in decibels (dB)
  • Ear-specific results: Right and left ear results plotted separately

Normal vs. Abnormal Results

  • Normal hearing: Thresholds ≤20 dB across all tested frequencies
  • Abnormal hearing: Thresholds >20 dB at any frequency indicate possible hearing loss 1

Degree of Hearing Loss

  • Mild: 21-40 dB
  • Moderate: 41-55 dB
  • Moderately severe: 56-70 dB
  • Severe: 71-90 dB
  • Profound: >90 dB

Types of Hearing Loss

  1. Conductive Hearing Loss

    • Affects outer or middle ear
    • Often shows better bone conduction than air conduction
    • Usually responds well to medical/surgical intervention
    • Typically doesn't significantly affect speech recognition in noise 2

  2. Sensorineural Hearing Loss

    • Affects inner ear (cochlea) or auditory nerve
    • Shows similar bone and air conduction results
    • Often permanent
    • Significantly impacts speech recognition, especially in noise 2

  3. Mixed Hearing Loss

    • Combination of conductive and sensorineural components
    • Shows elements of both types

Red Flags Requiring Immediate Attention

  • Asymmetric hearing loss: Difference between ears may indicate retrocochlear pathology
  • Sudden hearing loss: Medical emergency requiring immediate evaluation
  • Unilateral tinnitus or hearing loss: May indicate acoustic neuroma or other central nervous system lesion 3

Additional Test Components to Consider

Tympanometry

  • Evaluates middle ear function
  • Results categorized as:
    • Type A: Normal
    • Type B: Abnormal (requires medical attention)
    • Type C: Borderline normal (may need medical attention) 1

Speech Recognition Testing

  • Word Recognition Score (WRS): Measures ability to understand speech in quiet
  • Speech-in-Noise Testing: More sensitive measure that better correlates with real-world difficulties
    • QuickSIN test shows deficits even when WRS scores remain excellent 2

Syndromic vs. Non-syndromic Hearing Loss

When interpreting results, consider whether hearing loss may be part of a syndrome by evaluating:

  • Visual anomalies (heterochromia, retinitis pigmentosa, etc.)
  • Facial/cervical dysmorphology
  • Endocrine abnormalities
  • Cardiac signs/symptoms
  • Renal abnormalities
  • Integumentary changes 1

Next Steps Based on Results

  1. Normal hearing: No further action needed
  2. Abnormal screening: Refer to audiologist for comprehensive evaluation 1
  3. Confirmed hearing loss:
    • Determine type and degree of loss
    • Consider genetic evaluation, especially for congenital hearing loss 1
    • Evaluate treatment options (hearing aids, medical intervention)

Important Considerations

  • Pure-tone audiometry in non-sound-treated rooms should be considered screening only 1
  • Hearing thresholds alone account for only about 50-57% of variance in speech recognition ability 2
  • Both objective tests and subjective questionnaires should be used to fully evaluate hearing function 4
  • Age and daily hearing aid use time significantly correlate with subjective hearing outcomes 4

Common Pitfalls in Interpretation

  • Overlooking mild hearing loss: Even mild losses can significantly impact communication
  • Focusing only on pure-tone averages: Speech recognition in noise is often more relevant to real-world function
  • Ignoring asymmetry: May miss important pathology
  • Underestimating conductive components: These may be medically treatable
  • Failing to consider non-audiological factors: Age, cognitive status, and other factors affect functional outcomes

Remember that hearing test interpretation is just the first step in addressing hearing health. Appropriate referrals and interventions based on test results are essential to improve quality of life and reduce morbidity associated with untreated hearing loss.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Audiometry screening and interpretation.

American family physician, 2013

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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