PTA Audiogram

Patient name

MRN Date of PTA

Report language Readings (paste labeled rows)

Labels: R/L + AC/BC. Numbers align left→right (AC from 250 Hz, BC from 500 Hz). Use NR/CNT for no response, _ to skip an untested frequency. Mark masked with a trailing m (30m) or a masked label on the line.

Right ear loss type Left ear loss type

As per WHO hearing loss grading

Compare pre-op & post-op
Readings above = post-op; enter pre-op below (drawn in a lighter shade). Add aided audiometry
Sound-field thresholds with hearing device on, plotted as "A". Leave Readings empty to plot aided only. Comments (optional, printed on the report)