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  • Updated 09.10.2021
  • Released 12.06.2014
  • Expires For CME 09.10.2024

Pure-tone audiometry (audiogram)


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 for bone-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 persons 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 or 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.

This is the standard audiogram format, with auditory acuity plotted as dB HL (decibels hearing loss) along the y-axis and the frequency of the pure-tone auditory stimuli plotted in Hz (hertz or cycles per second) along the x-axis....

As early as 1885, Arthur Hartmann designed an auditory chart that graphically presented acuity to standard tuning forks as a function of frequency (33). Later means of graphically presenting auditory acuity as a function of frequency were developed in the early 20th century (33).

In 1899, American psychologist Carl Emil Seashore (18661949) invented an audiometer that was marked initially around 1900 (25; 28; 18; 33).

Carl Seashore
Carl Seashore developed one of the first commercial audiometers around 1899. (Contributed by Dr. Douglas Lanska.)

In the 1920s, Western Electric developed a commercially successful electronic audiometer (33). 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 (18991972) and released in 1946.

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