Earmart Hearing Clinic
Advanced Hearing Care
123 Main Street, City
📞 +91 00000 00000
✉ clinic@earmart.in
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Age:
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Audiogram
Right Ear
Left Ear
Key to Symbols
Air Conduction
Unmasked Masked
Unmasked × Masked
Bone Conduction
Unmasked < Masked [
Unmasked > Masked ]
Red = Right Ear  |  Blue = Left Ear
Pure Tone Average
Freq Right Left
500 Hz
1000 Hz
2000 Hz
PTA
Hearing Classification (WHO)
Normal≤ 25 dB HL
Mild26 – 40 dB HL
Moderate41 – 60 dB HL
Severe61 – 80 dB HL
Profound81 – 100 dB HL
Total / Deaf> 100 dB HL
Type of Hearing Loss
Type Right Left
Conductive
Sensorineural
Mixed
Normal
Impedance / Tympanometry
Type Right Left
Type A
Type As
Type Ad
Type B
Type C
Relationship of Loss
Bilateral
Unilateral (Right)
Unilateral (Left)
Symmetrical
Asymmetrical
Progressive
Audiologist's Remarks / Recommendations:

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