Audiometria

Audiometria

Data do exame: ___/____/____

Nome: __________________________________________________________

Data do exame: ___/____/____

Nome: __________________________________________________________

Data de nasc.: ___/____/___ Idade: ________

Data de nasc.: ___/____/___ Idade: ________

Audimetro :

Calibrado em:

Audimetro:

Calibrado em:

Meatoscopia OD: ________________________________

Meatoscopia OD: ________________________________

Meatoscopia OE: ________________________________

Meatoscopia OE: ________________________________

OD

OD

AUDIOGRAMA
250

500

750

1K

1,5K

2K

3K

4K

6K

8K

Hz

dB
-10
VA

dB

VO

dB

MONO

MT

IPRF

DISS

MT

0
10

SDT

dB

MCL

dB

dB

DISS

30
dB

dB

IPRF MONO

20

SRT

VA
VO

40
50

%
%

SRT

dB

SDT

dB

MCL

dB

60

OE

OE

70
80

VA

dB

VO

dB

MONO

DISS

MT

IPRF

SDT

dB

MCL

dB

VA

dB

VO

dB

IPRF MONO
DISS

120
dB

Referncia adotada:
Audiometria Tonal: Tipo e Configurao: Silman e Silverman,1997. Grau: Lloyd e Kaplan, 1978.
Logoaudiometria: Classificao do IPRF: Jerger, Speaks e Tramnult, 1968

100
110

SRT

Concluso:____________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Concluso:
________________________________________________________
___________________

MT

90

Freqncia em HERTZ (ciclos por segundo)

%
%

SRT

dB

SDT

dB

MCL

dB

Concluso:____________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
___________________
Referncia adotada:
Audiometria Tonal: Tipo e Configurao: Silman e Silverman,1997. Grau: Lloyd e Kaplan, 1978.
Logoaudiometria: Classificao do IPRF: Jerger, Speaks e Tramnult, 1968