This document provides an overview and interpretation of audiograms, tympanograms, and hearing tests. It discusses different types of hearing loss, including conductive, sensorineural, and mixed hearing loss. Examples of various audiograms demonstrating different hearing conditions are presented. Causes, clinical findings, and diagnoses for different hearing loss patterns are also reviewed. Common hearing tests like the Weber test and Rinne test are described.

1. Audiogram and Tympanogram
interpretation
Presented by
Dr.Abdulaziz Bagasi
March 2022

2. Objectives Audiogram Tympanogram
Weber and
Rinne test
interpretation

3. Audiogram

4. Comments on Audiogram
1-DEGREE OF
HEARING LOSS.
2-TYPE OF
HEARING LOSS.

8. Normal Hearing
Normal Hearing

9. Types of hearing loss
can be differentiated
• Conductive hearing loss
• Normal bone-Conduction thresholds, but air-conduction thresholds are poorer
than normal by at least 10 dB. ( air-bone gap)
• Sensorineural hearing loss
• No air-bone gap
• and thresholds are higher than 25 dB HL.
• Mixed hearing loss
• Both conductive and sensorineural components.

10. Clinical Cases

11. Types of hearing loss
Mixed
hearing loss
SNHL
Meniere's disease
Acoustic Neuroma
Presbycusis
Noise-induced hear loss
CHL
Otosclerosis
Cerumen impaction

12. Question 1
What is the diagnosis?
Mention possible causes.

13. •Normal bone-conduction threshold.
•Air-conduction threshold > 20 dB.
•Air-bone gap = greater than or equal to 10 dB difference between AC
and BC
( air-bone gap)
Conductive hearing loss

14. Causes Of CHL
Otitis media
Tympanic
membrane
perforation
Tumors (e.g:
nasopharyngeal
ca.)
Otosclerosis.
Tympanosclerosis
Ear canal
obstruction : ear
wax , FB
Ossicular
problems

15. After the clinical assessment of 60 years old lady who has three
months history of progressive bilateral hearing difficulty. What is
the most appropriate next step?
A. Reassurance.
B. Try irrigation and
manual removal of the
wax
C. Request CT or MRI to
confirm the diagnosis
D. Referral for surgery

16. After the clinical assessment of 60 years old lady who has three
months history of progressive bilateral hearing difficulty. What is
the most appropriate next step?
A. Reassurance.
B. Try irrigation and
manual removal of the
wax
C. Request CT or MRI to
confirm the diagnosis
D. Referral for surgery

17. Question 2
Spot diagnosis?

18. Otosclerosis
• Decrease air
conduction
• Bone conduction is
normal except in 2000
HZ then go back to
normal

19. Question 3
• Describe this audio.
• What is the diagnosis?

20. Sensorineural hearing loss
• No air-bone gap
• The difference between air and bone conduction less than 20 dB

21. 1. Genetics
2. Aging (presbycusis)
3. Noise Exposure
4. Acoustic Neuroma
5. Meniere’s Disease
6. Ototoxic Drugs
Possible Causes of SNHL

22. Question 4
• Describe this audio.
• What is the diagnosis?

23. Meniere`s disease:
Sensory-neural hearing loss ( no air-bone gap)
Note :  it`s intensity is bad in the beginning and
improve in high frequency until 3000Hz then drop
back

24. Below is the pure tone audiogram of a 52-years-old women who
is being investigated for attacks of vertigo and right ear tinnitus.
What is the most likely diagnosis?
A. Acoustic trauma
B. Benign paroxysmal
positional vertigo
C. Otosclerosis
D. Meniére’s disease
Question 5

25. Below is the pure tone audiogram of a 52-years-old women who
is being investigated for attacks of vertigo and right ear tinnitus.
What is the most likely diagnosis?
A. Acoustic trauma
B. Benign paroxysmal
positional vertigo
C. Otosclerosis
D. Meniére’s disease
Question 5

26. Question 6
• Describe this audio.
• What is the diagnosis?

27. Noise-induced hearing loss:
 The dip or notch at 4000 Hz as shown, or at 6000 Hz then
improve at higher frequency

28. A 60 years old man presented
with hearing difficulty, an
audiogram was performed
• what is the diagnosis?
• what is the treatment?
Question 7

29. Answer
• Sensorineural hearing loss, in elderly presbycusis.
• Treatment is hearing aid

30. You are following 38 years old engineer who is complaining of
unilateral tinnitus. What will you tell him?
Spot diagnosis ?
Noise-induced HL
Question 8

31. 52 years old man presents with unsteadiness. On examination he
has nystagmus with a fast phase to the right side and absent
corneal reflex on the left. What is the likely diagnosis?
A. Acoustic Neuroma
B. Benign paroxysmal
positional vertigo
C. Otosclerosis
D. Meniere's disease
Question 9

32. 52 years old man presents with unsteadiness. On examination he
has nystagmus with a fast phase to the right side and absent
corneal reflex on the left. What is the likely diagnosis?
A. Acoustic Neuroma
B. Benign paroxysmal
positional vertigo
C. Otosclerosis
D. Meniere's disease
Question 9

33. Question 3
• Describe this audio.
• What is the diagnosis?

34. • conductive and sensorineural components.
• There is air-bone gap
 And thresholds are higher than 25 dB Hearing Loss (in abnormal
range)
Mixed hearing loss

35. Types of hearing loss
can be differentiated
• Conductive hearing loss
• Normal bone-Conduction thresholds, but air-conduction thresholds are poorer
than normal by at least 10 dB. ( air-bone gap)
• Sensorineural hearing loss
• No air-bone gap
• and thresholds are higher than 25 dB HL.
• Mixed hearing loss
• Both conductive and sensorineural components.

36. Tympanogram

37. Normal Pressure: +100 to -100
mmH2O : Reflect pressure inside
middle ear
Normal compliance: 0.2 to 2.0 ml :
Reflect tympanic membrane
mobility
And Measure air volume displaced
by drum movement

39. Tympanogram Types
•Type A :
pressure > -100 daPa , with peak
AD: high compliance , high peak > 1cm
AS : low compliance , low peak

40. TympanogramTypes
Type B :
flat , low compliance , no peak
Type C :
high negative pressure < -100 daPa , with
peak

41. Causes

42. Weber and Rinne test interpretation

44. Q1
• A 61-year-old man presents to your office complaining that over the last few
months he doesn’t seem to understand what people are saying when they are
standing to his left side. He also has episodes of “dizziness,” especially when he
changes position from sitting to lying and vice versa. He denies nausea/vomiting.
He worked for 30 years in a factory and has had bilateral tinnitus for the last 10
years. He has had no previous hearing problems or evaluation. His past medical
history is significant for CAD and hypertension (well controlled with atenolol and
chlorthalidone). His only other medication is a daily aspirin. There is no family
history of ear disease. On exam, both ears are normal in appearance, with normal
canals, minimal cerumen, normal TMs with landmarks clearly visible. Weber’s
test is best heard by the patient on his right side (remember, the patient’s
complaints are on the left side). Rinne’s test on both sides (air conduction greater
than bone conduction). This is consistent with which type of hearing loss on the
LEFT?
A) Conductive.
B) Sensorineural.
C) Mixed.
D) Unable to tell.

45. Q1
• A 61-year-old man presents to your office complaining that over the last few
months he doesn’t seem to understand what people are saying when they are
standing to his left side. He also has episodes of “dizziness,” especially when he
changes position from sitting to lying and vice versa. He denies nausea/vomiting.
He worked for 30 years in a factory and has had bilateral tinnitus for the last 10
years. He has had no previous hearing problems or evaluation. His past medical
history is significant for CAD and hypertension (well controlled with atenolol and
chlorthalidone). His only other medication is a daily aspirin. There is no family
history of ear disease. On exam, both ears are normal in appearance, with normal
canals, minimal cerumen, normal TMs with landmarks clearly visible. Weber’s
test is best heard by the patient on his right side (remember, the patient’s
complaints are on the left side). Rinne’s test on both sides (air conduction greater
than bone conduction). This is consistent with which type of hearing loss on the
LEFT?
A) Conductive.
B) Sensorineural.
C) Mixed.
D) Unable to tell.

46. A1
Hearing can be assessed in the office using the Weber and Rinne tests. The Weber
test is performed by putting the tuning fork on the forehead and seeing if the sound
lateralizes to one side or the other. The sound will be louder (e.g., the test will
lateralize) to the side with a conductive hearing loss (wax occluding the canal,
otosclerosis, etc.).
The Rinne test is performed by comparing bone conduction (on the mastoid) to air
conduction. Patients will notice poor air conduction versus bone conduction if there
is a conductive hearing loss. Normal Rinne tests in both ears suggest that neither ear
has conductive loss.

47. Thank you !
Abdulaziz.bagasi@gmail.com
Aziz_bagasi