Audiogram of Familiar Sounds

Audiogram of Familiar Sounds
An audiogram is a chart that shows how well you hear certain sounds.
The blue oval shows the loudness of voices in normal conversation.
The O’s show how much sound your right ear is hearing. The X’s
show how much your left ear is hearing.
PITCH IN HERTZ (Hz)
LOW
125
SOFT
Using this chart, your audiologist (hearing specialist) will show you
what kinds of sounds you may be missing.
250
500
1000
HIGH
2000
4000
8000
0
NORMAL
hearing
10
LOUDNESS IN DECIBELS (dB)
20
30
40
p
zv
j
mdb
ng
e
u
50
60
i
a
o r
ch
f s th
h
k
MILD
hearing loss
g
sh
MODERATE
hearing loss
MODERATELY
SEVERE
hearing loss
70
SEVERE
hearing loss
80
90
100
LOUD
PROFOUND
hearing loss
110
120
X ––– X Left Ear
O ––– O Right Ear
Tests show that you have hearing loss. They also show that one or more hearing aids could help. An audiologist will tell you what kind of
hearing aids you might need. You can visit any audiologist in the community or choose from one of our eight convenient locations.
Patient Name
For informational purposes only. Not to replace the advice of your health care provider.
Reprinted with permission of copyright © 2010 Fuel Medical Group. All rights
reserved. SMARTworks 521472 – 01/16.
Provider Name
Date
Your Next Appointment
Appointment Date
Time
Location
Audiologist
The Journey to Better Hearing
Our goal is to help you regain good hearing so you can enjoy the
things you like best. As a first step, please tell us about your lifestyle.
In the checkboxes below, please choose the activities you enjoy on
a regular basis. Then, list things you would like to do but can’t
because of hearing loss.
Which activities do you regularly enjoy today?
Private
Quiet
Active
Dynamic
MINIMAL BACKGROUND NOISE
OCCASIONAL BACKGROUND NOISE
MODERATE BACKGROUND NOISE
FREQUENT BACKGROUND NOISE
If you have a private lifestyle, you
prefer little background noise.
You need to hear:
People with a quiet lifestyle spend
more time outside the home.
Common activities include:
People with an active lifestyle
spend lots of time on the go. They
are out of the house much of the
time. Activities include:
People with a dynamic lifestyle
enjoy excitement. They are always
on the go:
¨¨friends and family members
¨¨door bells
¨¨ringing phones
¨¨alarm clocks, cooking timers
¨¨talking on a home phone
¨¨driving
¨¨religious services
¨¨talking with other adults
¨¨small family events
¨¨eating at quiet restaurants
¨¨talking on a cell phone
¨¨shopping, going to the movies
¨¨working out at a health club
¨¨small meetings
¨¨talking with children
¨¨TV and radio
¨¨listening to music on an mp3
player
¨¨talking on a smart phone
¨¨going to art fairs, trade shows
and other exhibits
¨¨eating at loud or busy
restaurants
¨¨meeting friends, attending
local events
¨¨traveling through airports and
bus stations
¨¨taking part in meetings,
presentations and conference
calls at work
¨¨staying “connected” by
phone, computer, tablet, etc.
What three settings would you like to hear better in?
1.
2.
3.