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Interpret
analyse_media
Reading File
Audiogram Interpretation - Saraswathi Institute of Medical Sciences
This is a Pure Tone Audiometry (PTA) report. Here is a full interpretation:
Symbol Key
| Symbol | Ear | Test Type |
|---|---|---|
| Red circles (O) | Right ear | Air conduction |
| Blue crosses (X) | Left ear | Air conduction |
| Red arrows/brackets (>) | Right ear | Bone conduction |
| Blue arrows/brackets (<) | Left ear | Bone conduction |
Threshold Data (Hearing Level in dB HL)
Right Ear (Red)
| Frequency | Air Conduction | Bone Conduction | Air-Bone Gap |
|---|---|---|---|
| 250 Hz | 10 dB | 5 dB | ~5 dB |
| 500 Hz | 15 dB | 5 dB | ~10 dB |
| 1000 Hz | 25 dB | 5 dB | ~20 dB |
| 2000 Hz | 25 dB | 5 dB | ~20 dB |
| 4000 Hz | 25 dB | 5 dB | ~20 dB |
| 8000 Hz | 10 dB | - | - |
Right ear Pure Tone Average (PTA at 500, 1K, 2K Hz) = ~22 dB
Left Ear (Blue)
| Frequency | Air Conduction | Bone Conduction | Air-Bone Gap |
|---|---|---|---|
| 250 Hz | 10 dB | 5 dB | ~5 dB |
| 500 Hz | 10 dB | 5 dB | ~5 dB |
| 1000 Hz | 15 dB | 10 dB | ~5 dB |
| 2000 Hz | 10 dB | 5 dB | ~5 dB |
| 4000 Hz | 20 dB | 5 dB | ~15 dB |
| 8000 Hz | 10 dB | - | - |
Left ear PTA (500, 1K, 2K Hz) = ~12 dB
Interpretation
Right Ear:
- Air conduction thresholds show a mild dip in the mid-frequencies (1K-4K Hz, up to 25 dB), with recovery at 8K Hz - this is a mild, flat/mid-frequency conductive pattern
- Bone conduction is normal throughout (0-5 dB) at all frequencies
- A significant air-bone gap (ABG) of ~15-20 dB is present at mid-frequencies
- This pattern is consistent with a mild conductive hearing loss in the right ear (possibly early otitis media with effusion, Eustachian tube dysfunction, or early ossicular involvement)
Left Ear:
- Air and bone conduction thresholds are both essentially within normal limits across all frequencies (all ≤ 20 dB)
- Minimal air-bone gap
- Normal hearing in the left ear
Summary Diagnosis
| Right Ear | Left Ear | |
|---|---|---|
| Hearing status | Mild conductive loss | Normal |
| Type | Conductive (AC > BC, ABG present) | Normal |
| Degree | Mild (~22 dB PTA) | Normal (~12 dB PTA) |
| Pattern | Mid-frequency dip | Flat, normal |
Clinical Significance
- The normal bone conduction with elevated air conduction in the right ear confirms the cochlea and auditory nerve are intact - the problem lies in the outer or middle ear (conductive pathway)
- Common causes to consider: otitis media with effusion ("glue ear"), tympanic membrane perforation, Eustachian tube dysfunction, or early otosclerosis
- Tympanometry (impedance audiometry) would be the recommended next test to confirm middle ear pathology
- Given the mild degree, medical treatment (rather than surgery or hearing aid) is likely the first-line approach, depending on the underlying cause
But the patient et tube is slightly downwards
The patient has a patulous (abnormally open/downward-displaced) Eustachian tube - this is an important clinical correlate that fits well with the audiogram findings.
How a Patulous/Dysfunctional ET Explains This Audiogram
Normally, the Eustachian tube opens briefly to equalize pressure, then closes. When the ET is hypotonic or displaced downward, it can malfunction in two ways:
1. Intermittent Obstruction / Poor Equalization
- A downward-angled ET drains poorly (normal ET angle in adults is ~45°; if more horizontal or downward, mucociliary clearance is impaired)
- This leads to negative middle ear pressure → tympanic membrane retraction → mild conductive hearing loss
- Explains the air-bone gap seen in the right ear
2. Middle Ear Effusion Risk
- Poor ET function → fluid accumulates in the middle ear → stiffens the ossicular chain
- Results in low-to-mid frequency conductive loss - exactly what this audiogram shows (dip at 1K-4K Hz on the right)
Revised Clinical Picture
| Feature | Finding |
|---|---|
| Audiogram pattern | Mild conductive loss, right ear |
| ET position | Downward displaced - poor drainage angle |
| Likely mechanism | ET dysfunction → negative middle ear pressure or effusion |
| Cochlear function | Intact (bone conduction normal) |
What to Expect on Tympanometry
Given a dysfunctional ET with possible effusion, you would likely see:
- Type B tympanogram (flat curve) - if fluid is present in the middle ear
- Or Type C tympanogram (peak shifted to negative pressure) - if there is negative middle ear pressure without frank effusion
Both are consistent with ET dysfunction.
Management Considerations
- Nasal decongestants / topical nasal steroids - reduce mucosal edema around the ET orifice
- Autoinflation (Valsalva / Politzer) - helps re-open the tube and normalize middle ear pressure
- Treat underlying cause - allergic rhinitis, adenoid hypertrophy, or GERD can all displace/compress the ET
- If persistent effusion - myringotomy with grommet (ventilation tube) insertion may be needed
- Surgery - ET balloon dilation (BDET) is an option in refractory cases
The audiogram is reassuring - cochlear function is fully preserved, so hearing should normalize once ET function is restored.
Sorry eac is downward
The External Auditory Canal (EAC) is directed downward - this is a very relevant clinical finding that can directly affect audiometry results and interpretation.
Clinical Significance of a Downward-Directed EAC
1. Effect on Audiometry (Test Validity)
- A downward-angled EAC makes it harder to properly seat the ear tip/probe during testing
- If the earphone or insert tip was not fully sealed, you get sound leakage → falsely elevated (worse) air conduction thresholds
- This could mean the mild air-bone gap seen in the right ear may be artifactual, not a true conductive loss
2. Otoscopy Implication
- To visualize the tympanic membrane in a downward EAC, the pinna must be pulled downward and backward (instead of the standard upward and backward pull in adults)
- If this was not done correctly during otoscopy, the TM may have been incompletely assessed
3. Wax Impaction Risk
- Downward-angled canals tend to trap cerumen more easily (poor self-cleaning)
- Cerumen impaction causes conductive hearing loss and can explain the mild AC threshold elevation seen here - with completely normal bone conduction
Revised Interpretation
| Factor | Implication |
|---|---|
| EAC directed downward | Probe seating may have been suboptimal |
| Mild AC elevation (right ear) | Could be cerumen impaction or probe leak artifact |
| Normal bone conduction | Cochlea intact |
| Air-bone gap | May be real OR artifactual due to EAC anatomy |
Recommended Next Steps
- Otoscopy with correct pinna traction (pull downward-backward) - rule out wax impaction or TM abnormality
- Cerumen removal if present, then repeat audiometry - if the gap closes, it was wax/artifact
- Tympanometry - an objective test not affected by EAC direction; will confirm whether middle ear is normal
- If tympanogram is Type A (normal) and the gap disappears after cerumen removal → the audiogram was artifactual
This is a good example of why clinical examination must always accompany audiometric interpretation.
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