The Best Hearing Loss Simulations: Understanding Audiograms and the Impact of the Speech Banana

Updated on May 11, 2017
leahlefler profile image

After working as a chemist, Leah is now a freelance writer and mom to two wonderful boys. One of her sons was born with hearing loss.

Different Types of Hearing Loss

Hearing is not an all-or-nothing proposition: the levels of hearing loss can vary immensely from person to person. The levels of hearing loss are typically defined as:

Slight: 15dB-25dB

This level of hearing loss applies only to children. Children who have hearing in this range are defined as having a "slight" hearing loss. These children will not need hearing aids, but should be monitored on a frequent basis to verify the hearing loss is not progressing.

Mild: 25dB-40dB

This is a mild hearing loss. For children, a "mild" hearing loss is not a slight difficulty: a mild hearing loss can cause major difficulties with articulation and some language acquisition skills. People with a mild hearing loss often miss the softer consonant sounds like s, t, th, and f. Hearing becomes even more difficult in the presence of background noise. Children with hearing in this range benefit from the use of hearing aids.

Moderate: 41dB-55dB

This is a moderate hearing loss. The newborn hearing screening program is designed to pick up hearing losses in the moderate range (or greater). Individuals with hearing loss in this range will require hearing aids for conversational speech, and children will need intervention with auditory therapy to obtain age appropriate speech and language skills.

Moderately Severe: 56-70dB

This is a moderately severe hearing loss. Individuals with this level of hearing loss cannot hear any of the sounds of speech at typical conversational levels without hearing aids. Children will require auditory therapy and hearing aids to obtain age appropriate speech and language skills.

Severe: 71-90dB

This is a severe hearing loss. Hearing aids begin to lose effectiveness as the degree of hearing loss increases, due to sound distortion (caused by the amplified signal and the missing inner hair cells in the cochlea). Powerful hearing aids are beneficial to some individuals, while others will use cochlear implants to obtain access to sound.

Hearing aids or cochlear implants, along with auditory rehabilitation therapy are necessary to develop age-appropriate speech and language skills in children. If an auditory-oral pathway is not selected, children can develop language through the use of sign language (such as American Sign Language, among others).

Profound: Greater than 91dB

This is a profound hearing loss. Hearing aids are generally not effective for obtaining all of the sounds of speech with this level of hearing loss. Some young children will wear hearing aids to stimulate the auditory nerve until a cochlear implant is obtained.

Cochlear implants are able to provide access to all of the sounds of speech, so that many children who obtain implants and have early auditory rehabilitation therapy are able to develop age-appropriate speech and language skills. If an auditory-oral pathway is not selected, children can develop language through the use of sign language (such as American Sign Language, among others).

An audiogram: the lower frequency sounds are on the left, and the higher frequency sounds are on the right. Sound volume increases down the vertical axis.
An audiogram: the lower frequency sounds are on the left, and the higher frequency sounds are on the right. Sound volume increases down the vertical axis.

Audiograms: Charting Hearing Ability

An audiogram is a graph of an individual's hearing ability.

  • The frequency, or pitch of the sound, is along the horizontal axis. Lower pitched sounds are on the left-hand side of the chart, and higher frequency sounds are along the right-hand side of the chart. A deep, bass drum would be a low frequency sound, while a shrill, chirping bird would be a high frequency sound. For the purposes of human speech, the important frequencies are from 250Hz - 8,000Hz. For reference purposes, Middle C on a piano is at 250 Hz.
  • The volume of the sound is along the vertical axis. Sound volume increases down the length of the chart. Sound is measured in decibels (dB), which does not increase in a linear fashion. 50dB is much, much louder than 10dB.
  • The "speech banana" is the figurative area on an audiogram where individual speech sounds take place. The speech banana superimposed on the audiogram on the right is an English speech banana: each language has its own sounds of speech, and its own speech banana. Low frequency sounds like "M" and "Z" are on the left, and high frequency sounds like "F" and "S" are on the right.

An example of a person's hearing loss charted on an audiogram. This individual cannot hear the sounds highlighted in red.
An example of a person's hearing loss charted on an audiogram. This individual cannot hear the sounds highlighted in red.

Example of an Audiogram

The audiogram above is of a typical sloping moderate hearing loss. This person can hear low frequency sounds better than high frequency sounds: men would seem to have clearer voices than women or children for this individual.

This person can hear the sounds below the line: sounds like "J" and "B" are audible. This person cannot hear sounds above the line (highlighted in red). Sounds like "P," "CH," "F," and "S" are not audible. This person would have difficulty hearing birds chirping and vacuum cleaners, but could hear lawn mowers, dogs barking, and babies crying.

As this audiogram indicates, hearing levels can vary across the different frequency ranges. A person might have a mild hearing loss at one frequency, and a more severe hearing loss at another frequency.

The Best Hearing Loss Simulator

Hearing loss simulations are very useful for educating parents, teachers, and friends about what a hearing loss "sounds" like. The NIOSH hearing loss simulator is extremely helpful, as it allows a person to input any audiogram and listen to what the hearing loss sounds like. The user can select a woman's voice or a man's voice to hear the difference in sound quality for a specific hearing loss. This simulator is also capable of running a simulation of hearing ability based on a person's age or for years of noise exposure (noise-induced hearing loss).

The various types of audiograms (click to enlarge).
The various types of audiograms (click to enlarge). | Source

Types of Audiograms

Each person with a hearing loss has an individual hearing profile, but audiograms can be classified into general groups based on the shape:

Sloping: This is the most common audiogram. A person can hear low frequency sounds better than high frequency sounds.

Reverse-Slope: This is a rarer type of audiogram. People with conductive hearing losses often have a rising audiogram, though it is possible for sensorineural hearing losses to have a rising shape, too. In a very rare type of reverse-slope hearing loss (extreme reverse-slope), an individual may not be able to hear thunder, but can hear whispers across the room!

Cookie-Bite: This audiogram looks like someone took a bite right out of the middle of the graph. A person with this hearing loss hears low and high frequency sounds better than the mid-frequency sounds. This type of hearing loss is usually genetic, and may progress over time.

Tent-Shaped: This type of hearing loss is not very common. The individual with this type of hearing loss can hear the middle frequencies the best, but has difficulty with the high and low frequencies. Sometimes a tent shaped hearing loss develops when a person with a reverse-slope loss ages and begins to lose the high frequency sounds due to presbyacusis (age-related hearing loss).

Flat: The person with this type of hearing loss hears at about the same level across the speech frequencies. Both conductive and sensorineural hearing losses may take this shape.

Corner: When a person has a small amount of residual hearing in the low frequencies, but no recordable hearing on the rest of the audiogram, the person has a corner audiogram. A person with this type of audiogram would be a candidate for a cochlear implant.

The Flintstones Simulate Hearing Loss Levels

Other Hearing Loss and Cochlear Implant Simulations

Hearing Loss Simulation By Frequency

Questions & Answers

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      • leahlefler profile image
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        Leah Lefler 3 years ago from Western New York

        Thanks, prakash. I hope it was helpful!

      • profile image

        prakash jagtap 3 years ago

        Very useful information for me .. Thanks a lot...

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        Thank you! I write as time allows, so hopefully I will manage to get a few more hubs written over the next month or so!

      • ParadiseForever profile image

        ParadiseForever 7 years ago from Chennai, India.

        You really deserve to win leahlefler. Simply superb hub with lot of in-depth information. Congrats! Keep writing!

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        Thank you, StillGreen and mannyminds. I can't wait to see what you are inspired to write, mannyminds!

      • StillGreen profile image

        StillGreen 7 years ago

        i love this hub! favourited!!

      • mannyminds profile image

        mannyminds 7 years ago from Philippines

        wow this is amazing,I am inspired to write too.

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        Thanks, everyone! I hope it is helpful!

      • profile image

        KiwiTeam 7 years ago

        Great!

      • profile image

        Fay Paxton 7 years ago

        Excellent hub. I learned thing about hearing I never knew.

        up/useful

      • anglnwu profile image

        anglnwu 7 years ago

        Very informative and thorough. Congrats!

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        Thanks, everyone!

      • olgakhumlo profile image

        olga khumlo 7 years ago from Mira Road Mumbai India

        Congratulations Leah! Simple and well portrayed.

      • Treasuresofheaven profile image

        Sima Ballinger 7 years ago from Michigan

        Congratulations on your win. You put much work in his hub.

      • EarnMate profile image

        EarnMate 7 years ago from Bangkok, Thailand

        Congratulations. This is well written hub.

        Your effort deserves the winner.

      • BethanRose profile image

        BethanRose 7 years ago from South Wales

        Very informative and interesting to read!

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        Thank you! travel_man1971, how is the Whisper test conducted? Is the goal to verify a person can still hear a whisper (with amplification)? That is interesting! Nolan does standard audiology tests (started with conditioned/behavioural audiometry and then we moved to play audiometry). In a couple of years he'll move to a more adult-style test of simply raising his hand when he hears the tone.

      • daffodil2010 profile image

        daffodil2010 7 years ago

        congratulations on winning! this is a nice hub!

      • tritrain profile image

        And Drewson 7 years ago from United States

        Very, very informative. Thank you!

      • travel_man1971 profile image

        Ireno Alcala 7 years ago from Bicol, Philippines

        Congrats, Ms. Leah. This is a great guide. Whisper test is also conducted to all sailors who have hearing deficiency. I'm glad I didn't undergo such test yet, only a regular audiometry test.

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        Melbel, thanks for the compliment (and the vote)! There are so many great hubs coming out of the writing contest!

      • melbel profile image

        Melanie Shebel 7 years ago from Midwest USA

        Congratulations on the big win. I read your hub when it came out and was astounded by the amount of information provided. I liked a lot of the finalists, but ultimately voted for yours. Hands down, it was seriously one of the best hubs I've ever read.

      • BlissfulWriter profile image

        BlissfulWriter 7 years ago

        This is great info that I have to bookmark it.

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        The hearing loss charts (audiograms) are rather scientific - they can be really confusing when you first see one. I wanted to find the best hearing loss simulators so that people who were given an audiogram by their hearing health care professional could get an idea of what that graph "sounded" like. Our son started off with a reverse slope, and now has a flat loss - we have been able to "listen" to the change in his hearing with the hearing simulators.

      • profile image

        Johnnydowney 7 years ago

        These scientific terms are just so confusing! Thanks for the great hub.

      • cat on a soapbox profile image

        Catherine Tally 7 years ago from Los Angeles

        Thank you for this informative guide to hearing impairment. It is very well written and researched. Congratulations on your win!

      • ltimagination profile image

        ltimagination 7 years ago from Victoria, Canada

        Great hub. Congrats on the win. Well deserved.

      • Peggy W profile image

        Peggy Woods 7 years ago from Houston, Texas

        Very informative hub and congratulations on your win. Well deserved.

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        The speech banana is a constant reference for parents (and professionals) who deal with kids and hearing loss. We can actually tell if our son has lost some hearing in a specific frequency, because he'll lose those sounds. For instance, he will suddenly stop using /s/ or will start confusing /m/ and /oo/. We frequently drill him on the Ling sounds (sounds that span the English frequency range) to verify his hearing aids are working appropriately!

      • eileeneleanor profile image

        eileeneleanor 7 years ago from Surrey, BC

        Great information and use of charts and video. Well done!

      • profile image

        Baileybear 7 years ago

        I'd never heard of a speech banana. Congratulations on your prize-winning hub

      • Charlu profile image

        Charlu 7 years ago from Florida

        No problem I'm a search ranking addict :) and you deserve it

      • leahlefler profile image
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        Leah Lefler 7 years ago from Western New York

        Wow - #1? I didn't realize that, Charlu! Thanks for the heads up!

      • fucsia profile image

        fucsia 7 years ago

        Very interesting and informative page. Thanks for sharing.

      • Charlu profile image

        Charlu 7 years ago from Florida

        Great hub and #1 when on Google search. Awesome job

      • Hometogarden profile image

        Hometogarden 7 years ago from home

        Congratulations with.

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        Thank you, everyone! When my son was born, I desperately tried to find simulators to guess at what he could (and couldn't) hear. The NIOSH simulator really let me get an idea of how his world sounded.

      • manthy profile image

        Mark 7 years ago from Alabama,USA

        Thanks for all the info & Kudos on winning ;0)

      • Native Gardener profile image

        Native Gardener 7 years ago from Topanga Canyon, California

        Great post. So much new info.

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        Thanks, akirchner! I am so happy!

      • akirchner profile image

        Audrey Kirchner 7 years ago from Washington

        Fantastic job Leah~! Congrats on your win. This is beautifully done!!!

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        That is one of my favorite simulations, because it shows teachers how quiet sound gets for kids with mild and moderate hearing losses!

      • Ruby H Rose profile image

        Maree Michael Martin 7 years ago from Northwest Washington on an Island

        Hearing loss and the Flintstones, I think that's the best.

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        Thanks, everyone! I am walking on air!

      • Sunnyglitter profile image

        Sunnyglitter 7 years ago from Cyberspace

        Congrats on winning! You did a great job putting this hub together.

      • WannaB Writer profile image

        Barbara Radisavljevic 7 years ago from Templeton, CA

        Congratulations on winning with this very informative resource.

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        Ohmygoodness! I won?? Really? YIPPEEEE! Thanks!!!

      • prairieprincess profile image

        Sharilee Swaity 7 years ago from Canada

        wow, congratulations! this is very informative and thorough!

      • emdi profile image

        emdi 7 years ago

        Congrats

      • Ms Dee profile image

        Deidre Shelden 7 years ago from Texas, USA

        Congratulations leahlefler! I see what the judges mean :) I can see I and others will be referring back to this to understand hearing loss. Awesome!

      • Simone Smith profile image

        Simone Haruko Smith 7 years ago from San Francisco

        And congrats, leahlefler! This Hub won the Staff Pick award for Day 2 of the So You Think You Can Write Online contest!

      • Simone Smith profile image

        Simone Haruko Smith 7 years ago from San Francisco

        What an absolutely fantastic guide. I had never even heard of auduograms or speech bananas before reading this, and you've provided excellent explanations. The images and videos help a great deal, too. Amazing Hub!

      • leahlefler profile image
        Author

        Leah Lefler 7 years ago from Western New York

        Thank you! The NIOSH simulator is great, because you can put in a specific hearing loss profile and listen to different voices. It really helped us understand our son's hearing loss.

      • Hyphenbird profile image

        Brenda Barnes 7 years ago from America-Broken But Still Beautiful

        This Hub is so well researched and laid out. It is informative and easy to read and understand. Thanks so much for your hard work on this.

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