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Basic audiometry · Lesson 1.3

From audiogram to clinical summary

Turn a completed basic audiogram into a clear summary of degree, type, configuration, symmetry, patient meaning and next steps.

Back to lesson 1.2 Return to pathway
1.3.1

What is a clinical summary?

A clinical summary turns the completed audiogram into a clear, structured explanation.

Technical explanation

Once an audiogram has been completed, the next step is to describe the result clearly.

A clinical summary turns the plotted thresholds into a short, structured explanation. It should help another clinician understand the result quickly, and it should help the patient understand what the audiogram means in everyday terms.

A useful basic summary usually includes the degree of hearing loss, the type of hearing loss, the shape or configuration, whether the two ears are similar or different, what the result may mean for the patient, and what the likely next step is.

At this stage, the aim is not to include every possible clinical detail. The aim is to describe the audiogram accurately, clearly and cautiously.

Patient explanation

“We’ve completed the hearing test. The next step is to explain what the chart shows. We look at how much hearing is reduced, which pitches are affected, whether both ears are similar, and what this may mean for everyday listening.”

Guidance reference

BSA describes audiometric descriptors as a useful summary, but cautions that they should not replace a fuller understanding of configuration, communication difficulty and wider clinical context.

1.3.2

Describe the degree of hearing loss

Use severity terms carefully and include the dB HL range behind them.

Technical explanation

The degree of hearing loss describes how far the hearing thresholds sit from the expected hearing range.

-10 to 20 dB HLWithin normal limits
21 to 40 dB HLMild hearing loss
41 to 70 dB HLModerate hearing loss
71 to 95 dB HLSevere hearing loss
96 dB HL and aboveProfound hearing loss

These terms are useful because they give a quick overall impression of the audiogram. However, degree should not be used on its own. A patient with a flat moderate hearing loss may have a very different audiogram from a patient with normal low-frequency hearing and moderate high-frequency hearing loss.

A stronger summary should describe both the degree and the pattern. For example, “mild to moderate high-frequency hearing loss” is more informative than simply “moderate hearing loss.”

Patient explanation

“Your hearing levels fall mainly in the mild to moderate range. This means some sounds needed to be made louder before you could hear them. The amount varies depending on the pitch.”

Guidance reference

BSA section 9 describes mild, moderate, severe and profound descriptors. These are based on the average of air-conduction thresholds at 250 Hz, 500 Hz, 1 kHz, 2 kHz and 4 kHz. BSA also notes that averages do not imply a particular configuration of hearing loss.

1.3.3

Describe the type of hearing loss

Compare air-conduction and bone-conduction results.

Technical explanation

The type of hearing loss is described by comparing air-conduction and bone-conduction results.

If AC and BC thresholds are both raised and sit close together, this usually suggests a sensorineural pattern.

If AC thresholds are raised but BC thresholds are within normal limits or significantly better, this suggests a conductive component.

If both AC and BC thresholds are raised, but AC thresholds are still poorer than BC thresholds, this suggests a mixed pattern.

At this basic stage, focus on the relationship between AC and BC. Masking, cross-hearing and advanced interpretation will be covered later.

Patient explanation

“These results help us understand where the hearing change may be coming from. Sometimes the pattern suggests the inner ear is involved. Sometimes it suggests sound is not travelling through the outer or middle ear as well as expected. Sometimes there can be a mixture of both.”

Guidance reference

BSA pure-tone audiometry guidance describes procedures for measuring both air-conduction and bone-conduction thresholds. The clinical relationship between those two measurements helps inform whether a pattern is described as sensorineural, conductive or mixed.

1.3.4

Describe the shape or configuration

The configuration tells us which parts of the frequency range are most affected.

Technical explanation

The configuration describes the shape of the audiogram across frequency.

Common basic configurations include flat, sloping, rising, high-frequency, low-frequency and notched patterns.

The shape matters because two audiograms can have a similar average degree of hearing loss but very different clinical meanings. For example, one patient may have a flat moderate hearing loss across most frequencies. Another may have normal low-frequency hearing with a moderate high-frequency hearing loss.

Patient explanation

“The shape of the chart tells us which pitches are most affected. In your case, the lower-pitched sounds are easier to hear, while some higher-pitched sounds need to be louder before you hear them.”

Guidance reference

BSA section 9 notes that average-based descriptors do not imply any particular configuration of hearing loss and do not exclude additional terms such as high-frequency hearing loss.

1.3.5

Compare the two ears

A clinical summary should state whether the result is symmetrical or asymmetrical.

Technical explanation

A good clinical summary should say whether the two ears are similar or different.

Useful phrases include symmetrical, broadly symmetrical, asymmetrical, right worse than left, or left worse than right.

At a basic level, compare the overall degree, shape and frequencies affected. If one ear is clearly poorer than the other, this should be stated. This module introduces asymmetry as clinically important, while detailed referral rules remain in the referral criteria section.

Patient explanation

“Your two ears are quite similar overall.”

or

“Your right ear is hearing less well than your left ear at some pitches. We would take that into account when deciding what should happen next.”

Guidance reference

NICE NG98 includes referral and imaging considerations for adults with sensorineural hearing loss where pure-tone audiometry shows asymmetry. This detailed referral content should remain in the referral criteria section, but learners should recognise that asymmetry is clinically relevant.

1.3.6

Build the summary sentence

Combine side, degree, shape, type and symmetry.

Technical explanation

A basic clinical summary can often be built in this order: side, degree, shape and type.

For one ear: “Right ear: mild to moderate high-frequency sensorineural hearing loss.”

For both ears: “Bilateral mild to moderate high-frequency sensorineural hearing loss, broadly symmetrical.”

If the ears differ: “Right ear: moderate sensorineural hearing loss. Left ear: mild high-frequency sensorineural hearing loss. The result is asymmetrical, with the right ear poorer.”

The summary should be short enough to understand, but specific enough to be useful.

Patient explanation

“A simple way to summarise your result is that both ears show a mild to moderate hearing loss, mainly affecting the higher-pitched sounds. The pattern is fairly similar in both ears.”

Guidance reference

BSA descriptors can help describe degree, but the clinical summary should also include configuration and whether the ears are similar or different.

1.3.7

Explain what it may mean functionally

Connect the audiogram to everyday listening without over-promising.

Technical explanation

An audiogram does not show everything about communication, but it can help explain likely listening difficulties.

High-frequency hearing loss can affect access to higher-frequency speech sounds, which may make speech sound less clear. A person may hear that someone is talking but miss some of the detail, especially in background noise.

A flat hearing loss may affect access to a wider range of sounds across the speech frequencies. The explanation should connect the audiogram to the patient’s reported difficulties, but it should not assume that every patient experiences the same problems.

Patient explanation

“This pattern can make speech sound less clear, especially when there is background noise or when people are speaking softly. You may hear that someone is talking but miss some of the detail.”

Guidance reference

NICE NG98 recommends discussing the pure-tone audiogram, the impact hearing loss may have on communication, and hearing deficits that may not be obvious from the audiogram.

1.3.8

Decide what happens next

The summary should lead into an appropriate management plan.

Technical explanation

A clinical summary often leads into a management plan.

At a basic level, possible next steps may include reassurance and routine monitoring, hearing-aid discussion, communication advice, further testing, or onward referral if indicated.

The audiogram should not be interpreted in isolation. The patient’s history, symptoms, otoscopy, tympanometry, speech understanding and clinical context all matter. This module introduces the idea of next steps, while detailed referral criteria remain in the referral criteria section.

Patient explanation

“Based on your results and what you’ve told me, we can talk about the most appropriate next step. That may include hearing-aid options, communication strategies, monitoring, or referral if anything needs further medical review.”

Guidance reference

NICE NG98 covers assessment, management, hearing-aid discussion and referral considerations for adults with hearing loss. This supports linking the audiogram summary to an appropriate next step, while keeping detailed referral criteria in a dedicated section.

1.3.9

Worked example

Build the summary from a basic completed audiogram.

Example audiogram

Look at the completed audiogram in the right pane. Use the plotted AC and BC results to decide the degree, type, configuration and symmetry before reading the summary.

Technical summary Bilateral mild to moderate sloping high-frequency sensorineural hearing loss, broadly symmetrical.

This summary includes degree, configuration, type and symmetry.

Patient explanation

“Both ears show a similar pattern. Your hearing is better for lower-pitched sounds and reduced for higher-pitched sounds. This type of pattern can make speech less clear, especially in background noise.”

Guidance reference

This summary uses degree, configuration, type and symmetry. BSA section 9 supports audiometric descriptors while cautioning that descriptors should not replace a fuller description of configuration and listening impact.

1.3.10

Module 1.3 recap

A final check that the learner can turn the audiogram into a clear summary.

A useful clinical summary should describe:

  • the degree of hearing loss
  • the type of hearing loss
  • the shape or configuration
  • whether the two ears are similar or different
  • what the result may mean for the patient
  • what the likely next step is
Example final summary Bilateral mild to moderate sloping high-frequency sensorineural hearing loss, broadly symmetrical.

This pattern is likely to affect speech clarity, particularly in background noise. Discuss hearing-aid options, communication needs and patient goals.

Section 1 complete

You can now move from reading the audiogram, to performing basic PTA, to summarising the result clearly.

Back to Basic audiometry

Guidance reference

The audiogram is an important part of assessment, but it should be interpreted alongside the patient’s history, symptoms, communication needs and wider clinical findings.

Summary builder

Build the clinical phrase

1.3
Current focus Summary ingredients

A strong summary usually describes degree, type, configuration and whether the ears are similar or different.

Side + Degree + Shape + Type + Symmetry
Example phrase Bilateral mild to moderate sloping high-frequency sensorineural hearing loss, broadly symmetrical.

Keep the wording clear, specific and cautious.