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    Sample Blank Audiogram

    Uploaded by

    Peter Salim
    The document is an audiogram report that summarizes a patient's hearing test results. It includes a chart showing the patient's hearing thresholds at different frequencies in decibels. It also lists speech reception thresholds, word discrimination scores, and tympanometry results. The comments section provides additional notes on the patient's air and bone conduction thresholds.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Sample Blank Audiogram

    Uploaded by

    Peter Salim
    2K views1 page
    The document is an audiogram report that summarizes a patient's hearing test results. It includes a chart showing the patient's hearing thresholds at different frequencies in decibels. It also lists speech reception thresholds, word discrimination scores, and tympanometry results. The comments section provides additional notes on the patient's air and bone conduction thresholds.

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    sample-blank-audiogram.docx

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    The document is an audiogram report that summarizes a patient's hearing test results. It includes a chart showing the patient's hearing thresholds at different frequencies in decibels. It also lists speech reception thresholds, word discrimination scores, and tympanometry results. The comments section provides additional notes on the patient's air and bone conduction thresholds.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    2K views1 page

    Sample Blank Audiogram

    Uploaded by

    Peter Salim
    The document is an audiogram report that summarizes a patient's hearing test results. It includes a chart showing the patient's hearing thresholds at different frequencies in decibels. It also lists speech reception thresholds, word discrimination scores, and tympanometry results. The comments section provides additional notes on the patient's air and bone conduction thresholds.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Patient: Date of Test:

    Audiologist:
    FREQUENCY IN HERTZ Hz

    125 250 500 750 1000 1500 2000 3000 4000 6000 8000
    -10
    NORMAL
    0
    Ability to understand speech
    10
    MILD

    HEARING LEVEL IN DECIBELS (ANSI) 1989


    20 No significant difficulty with
    faint speech
    30 MODERATE
    40 Difficulty only with faint speech

    50 Amplification needed
    Frequent difficulty with
    60 normal speech

    70 SEVERE

    Frequent difficulty with loud speech


    80
    Understand only shouted
    90 or amplified speech

    PROFOUND
    100
    May not understand even
    110 amplified speech

    120 8% 14% 22% 33% 23%


    <Value List Missing>
    IMPORTANCE OF SPEECH INTELLIGIBILITY

    SPEECH RESULTS TYMPANOGRAM pres


    sure (mmH2O)
    Speech Most Un-
    Reception Comfortable Comfortable Word Discrimination .9
    Threshold Level Level Discrimination Level
    (SRT) (MCL) (UCL) Percentage (dB) .8
    .7

    Compliance
    Right .6
    .5
    Left .4
    Binaural .3
    .2
    Unaided
    Soundfield .1
    Aided
    Soundfield
    0

    -300 -200 -100 0 +100 +200

    COMMENTS AUDIOGRAM KEY


    L R NR L NR R L R NR L NR R
    Bone Conduction
    Air Conduction X O X O Forehead V V V V
    Air Conduction Bone Conduction
    Masked Forehead Mask
    Threshold of
    Bone Conduction > < > < Discomfort Pure

    Bone Conduction
    Masked ] [ ] [

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