AUDIOGRAM

250 Hz 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz

D AC
125 250 500 1000 2000 3000 4000 6000 8000
BC
S AC
BC
MASKING
D AC
BC
S AC
BC

NAMA PASIEN : ________________________ DIAGNOSA :

USIA : ________________________ DEXTRA ________________________________

NO RM : ________________________ SINISTRA _______________________________

Symbol :Air Bone MASKING Air Bone
Tanggal Pemeriksaan : ____________________
125 250 500 1000 2000 3000D : O4000
D : < 6000 D : 8000
∆ D:[
S :X S :> S :□ S :]

-20 -20
-10 -10
0 0
10 10
Intensitas
20 (dB) 20
30 30
40 40
50 50
60 60
70 70
80 80
90 90
100 100
110 110
120 120

Frequency (Hz)

Pemeriksa