Understanding Your Hearing Test Results: A Tinnitus Patient's Guide

You have had a hearing test. Your audiologist handed you a sheet with graphs, numbers, and abbreviations. Maybe they explained it briefly, maybe they were rushed, maybe you were too anxious about your tinnitus to absorb the details. Now you are staring at an audiogram wondering what "mild sloping sensorineural hearing loss" means and whether it explains your tinnitus.

This guide explains every component of a standard audiological evaluation in plain language, with specific attention to what each result means for tinnitus patients. Understanding your hearing profile is not academic -- it directly informs which management strategies are most likely to work for you.

Reading Your Audiogram

The audiogram is the primary output of a hearing test. It is a graph that plots your hearing sensitivity across different frequencies (pitches). Here is how to read it:

The horizontal axis (x-axis) shows frequency in Hertz (Hz), ranging from low-pitched sounds on the left (typically 250 Hz, like a bass drum) to high-pitched sounds on the right (typically 8,000 Hz, like a whistle). Some clinics test extended high frequencies up to 16,000 Hz -- this is particularly important for tinnitus patients.

The vertical axis (y-axis) shows hearing level in decibels (dB HL), ranging from -10 or 0 dB at the top (excellent hearing) to 120 dB at the bottom (profound loss). Importantly, the scale is inverted: better hearing is at the top, worse hearing is at the bottom. This confuses many patients who expect "higher = better."

Symbols: O (red) marks represent right ear air conduction thresholds. X (blue) marks represent left ear air conduction thresholds. Brackets ([ and ]) represent bone conduction thresholds, which test the inner ear directly by bypassing the outer and middle ear. If air conduction and bone conduction thresholds match, the hearing loss is sensorineural (inner ear or nerve origin). If bone conduction is better than air conduction, there is a conductive component (outer or middle ear origin).

The audiogram maps your hearing across frequencies. For tinnitus patients, the slope and shape of the audiogram often reveals the frequency region where tinnitus originates.

Hearing Level Classifications

• Normal hearing: 0-25 dB HL across all frequencies
• Mild hearing loss: 26-40 dB HL (difficulty with soft speech, distant conversation)
• Moderate hearing loss: 41-55 dB HL (difficulty with normal conversation)
• Moderately severe: 56-70 dB HL (difficulty even with loud speech)
• Severe: 71-90 dB HL (only very loud sounds heard)
• Profound: 91+ dB HL (very limited or no hearing)

Frequency vs Decibels Explained

Frequency is pitch -- how high or low a sound is. Human hearing ranges from approximately 20 Hz to 20,000 Hz. The standard audiogram tests 250-8,000 Hz, covering the critical speech range. Most tinnitus exists in the 3,000-8,000 Hz range, which is also where noise-induced and age-related hearing loss typically begins.

Decibels (dB) measure intensity -- how loud a sound is. The dB scale is logarithmic: 10 dB is 10 times more intense than 0 dB, and 20 dB is 100 times more intense. In audiological terms, your hearing threshold at a given frequency is the quietest sound you can detect at that pitch. A threshold of 30 dB at 4,000 Hz means you cannot hear sounds softer than 30 dB at 4,000 Hz.

For tinnitus patients, the audiometric edge -- the frequency where hearing drops from normal to abnormal -- is particularly important. Research by Moore et al. (2010) in Hearing Research demonstrated that tinnitus pitch typically corresponds to the edge frequency of hearing loss. This is the frequency where the auditory cortex transitions from receiving normal input to receiving reduced input, creating the neural hyperactivity that produces the tinnitus signal.

Knowing your edge frequency is directly actionable: it informs the target frequency for notch therapy and helps Lushh's frequency matcher guide you to an accurate tinnitus pitch match.

Speech Discrimination Testing

Pure tone audiometry tells you how well you detect sounds. Speech audiometry tells you how well you understand speech -- a critical distinction because tinnitus can impair speech understanding even when pure tone thresholds are relatively normal.

Speech Reception Threshold (SRT): The softest level at which you can correctly repeat 50% of two-syllable words (like "baseball" or "hotdog"). SRT should closely match your pure tone average (the average of thresholds at 500, 1000, and 2000 Hz). A significant discrepancy may indicate auditory processing issues beyond simple hearing loss.

Word Recognition Score (WRS): Also called speech discrimination score. You listen to a list of single-syllable words at a comfortable volume and repeat what you hear. A score of 92-100% is normal. Scores below 80% suggest difficulty that may not be apparent in quiet environments but becomes significant in background noise -- exactly the situations tinnitus patients find most challenging.

For tinnitus patients, reduced word recognition despite normal or near-normal pure tone thresholds may indicate cochlear synaptopathy -- the "hidden hearing loss" that damages neural connections without affecting the hair cells that standard tests measure.

Tympanometry: Middle Ear Function

Tympanometry tests how well your middle ear is functioning by measuring the movement of the eardrum (tympanic membrane) in response to pressure changes. It is a quick, non-invasive test that provides critical information for tinnitus patients:

• Type A (normal): A peaked curve centered near 0 daPa. The middle ear is functioning normally. This rules out middle ear conditions as a tinnitus cause.
• Type B (flat): No peak. Suggests fluid behind the eardrum (otitis media with effusion), eardrum perforation, or cerumen impaction. All of these can cause or worsen tinnitus and are treatable.
• Type C (negative pressure): Peak shifted to the negative side. Indicates Eustachian tube dysfunction, which is common and can cause tinnitus, fullness, and pressure sensations. Often treatable with nasal decongestants, autoinsufflation, or in persistent cases, surgical intervention.
• Type As (shallow): Reduced eardrum mobility. May indicate otosclerosis or tympanosclerosis -- conditions that stiffen the middle ear ossicles and can cause conductive hearing loss with associated tinnitus.

Otoacoustic Emissions (OAE)

OAE testing measures sounds produced by the outer hair cells in your cochlea. These tiny cells are actively motile -- they vibrate in response to sound and amplify quiet signals. When functioning normally, they produce their own faint sounds (otoacoustic emissions) that can be detected by a sensitive microphone placed in the ear canal.

Present OAEs: Outer hair cells at the tested frequencies are functioning. This does not rule out tinnitus (inner hair cells and neural pathways can still be affected) but indicates the peripheral cochlea is intact at those frequencies.

Absent OAEs: Outer hair cell damage at those frequencies. This is the most common finding in noise-induced and age-related hearing loss and directly correlates with the frequency region where tinnitus typically originates.

OAE testing is particularly valuable because it can detect outer hair cell damage before it appears on a standard audiogram. Reduced OAE amplitude at specific frequencies, even with normal audiometric thresholds, may be an early indicator of cochlear damage and explain the presence of tinnitus with "normal hearing."

What Results Mean for Tinnitus Management

Your hearing test results directly inform your tinnitus management strategy:

• Normal audiogram with tinnitus: Request extended high-frequency audiometry (8,000-16,000 Hz). Consider OAE testing if not already done. Your tinnitus may be related to hidden hearing loss or high-frequency damage not captured by standard testing. Notch therapy, sound enrichment, and CBT are primary management tools.
• High-frequency hearing loss with tinnitus: The most common profile. Your tinnitus likely originates at the edge frequency where hearing drops off. Notch therapy targeting this frequency, hearing aids if loss exceeds 25 dB in speech frequencies, and sound therapy are evidence-based approaches. Match your tinnitus frequency precisely with Lushh →
• Conductive component (air-bone gap): A conductive component may indicate a treatable condition. Middle ear infections, otosclerosis, and Eustachian tube dysfunction can all be medically or surgically addressed, potentially reducing or eliminating the tinnitus.
• Asymmetric hearing loss: If one ear has significantly worse hearing than the other, your audiologist should investigate further. Asymmetric loss can indicate conditions like acoustic neuroma (vestibular schwannoma) that require imaging. This is not common, but it is the reason asymmetric findings warrant additional evaluation.

For a broader understanding of the hearing-tinnitus relationship, see our guide on tinnitus and hearing loss: the connection. And for standardized distress measurement, read about understanding your THI score.

When to Retest

• Annual monitoring: If you have chronic tinnitus, annual audiometry monitors for progressive changes and provides updated data for management.
• After tinnitus changes: If your tinnitus suddenly changes in pitch, volume, or character, get tested promptly. Changes may indicate new damage or a treatable condition.
• After noise exposure: If you experience a significant noise exposure event (concert without earplugs, industrial accident, fireworks), get tested within 2 weeks to assess for threshold shift.
• Before starting notch therapy: An audiogram helps validate your frequency match and ensures the notch is accurately placed.
• Every 4-6 months in the first year: If you are newly diagnosed, more frequent testing in the first year establishes your baseline pattern and detects early changes.

Regular audiological monitoring provides the data foundation for optimizing your tinnitus management strategy over time.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified audiologist for hearing evaluation and tinnitus diagnosis.