Pure-tone audiometry (audiogram)

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released December 6, 2014; last updated January 30, 2017; expires January 30, 2020

Key points

 

• Audiometry is the measurement of the range and sensitivity of a person's sense of hearing.

 

• Pure-tone audiometry utilizes a series of pure tones presented at selected frequencies within the range of hearing essential for understanding speech in order to develop a profile of auditory acuity.

 

• An audiogram provides a graphical summary or profile of auditory acuity as a function of sound frequency, which can be used to characterize the degree, type, and configuration of a hearing loss.

 

• With conductive hearing loss, hearing is impaired for air-conducted sounds but not forgone-conducted sounds, producing an air-bone gap on the audiogram, whereas with sensorineural hearing loss, hearing is impaired for both air- and bone-conducted sounds.

 

• There are different audiogram patterns for different causes of sensorineural hearing loss: presbycusis is typically associated with a downward-sloping high-frequency loss pattern; noise-induced hearing loss is typically associated with a notched pattern (generally at 4 kHz); and Meniere disease is associated with a low-frequency trough pattern.

Historical note and terminology

Audiometry is the measurement of the range and sensitivity of a person's sense of hearing. In general clinical use, this typically incorporates a battery of tests of a person's hearing ability and related assessments of the function and integrity of the ear and its neural projections. Subjective audiometry includes pure-tone audiometry, speech audiometry, and Bekesy audiometry, whereas objective audiometry includes acoustic impedance audiometry/tympanometry and evoked response audiometry.

This article addresses the basic interpretation of pure-tone audiometry as measured using a pure-tone audiometer and as summarized in a standard graphical format called an audiogram. An audiogram is a convenient tool that characterizes the degree, type, and configuration of a hearing loss.

Image: Audiogram

As early as 1885, Arthur Hartmann designed an “auditory chart” that graphically presented acuity to standard tuning forks as a function of frequency (Vogel et al 2007). Later means of graphically presenting auditory acuity as a function of frequency were developed in the early 20th century (Vogel et al 2007).

In 1899, American psychologist Carl Emil Seashore (1866–1949) invented an audiometer that was marked initially around 1900 (Seashore 1899; Stoddard 1950; Miles 1956; Vogel et al 2007).

Image: Carl Seashore
In the 1920s, Western Electric developed a commercially successful electronic audiometer (Vogel et al 2007). It went through a series of technological improvements, including the incorporation of bone-conduction testing capability by 1928. An early type of automated audiometer was invented by Hungarian-American biophysicist and Nobel laureate Georg von Békésy (1899–1972) and released in 1946.

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