Audiometric Testing Results: Understanding Normal vs Abnormal Findings

One of the most important distinctions in occupational audiometry is how results are categorised and communicated. Results are not “Pass/Fail”—a crucial point because “fail” carries stigma that doesn’t apply to occupational hearing. Understanding the result categories helps WHS managers and HR professionals communicate appropriately with workers and take timely action when referral is recommended.

Result Categories: The Key Distinction

Workplace audiometric testing results are categorised into two main groups, NOT pass/fail:

Normal / Pass

Definition: Hearing thresholds are within normal limits (0–25 dB HL) at all frequencies tested.

Interpretation: Hearing is within the expected range. No action required beyond ongoing monitoring per the testing schedule.

Individual communication: “Your hearing is normal. No concerns at this time. We’ll retest in [12/24 months].”

Employer action: Continue current program. No additional intervention needed.

Note on terminology: While “Pass” is sometimes used colloquially, “Normal” is more accurate. It’s not that the worker “passed” a test; rather, their hearing is within normal parameters.

Refer

Definition: Hearing thresholds exceed 25–40 dB HL at one or more frequencies, OR significant threshold shift compared to baseline.

Interpretation: Further evaluation is recommended. This does NOT mean the worker has permanent hearing loss; it means results warrant specialist assessment to determine cause and implications.

Categories within Refer:

Mild elevation: Thresholds 26–40 dB HL; may be age-related, occupational, or other causes
Significant threshold shift: Change of 15+ dB at any frequency compared to baseline
Unilateral findings: One ear affected more than the other; suggests asymmetric exposure or pathology
Other findings: Sudden-onset loss, very high-frequency loss, asymmetric pattern unusual for occupational exposure

Individual communication: “Your test shows elevated thresholds at certain frequencies compared to normal ranges. This doesn’t mean you have permanent hearing loss, but we’re recommending a specialist assessment to understand what’s happening and plan next steps.”

Employer action: Arrange specialist referral; review and potentially improve noise controls; monitor the worker’s status during the referral process.

Understanding the Normal/Pass Result

What it means: Thresholds at all tested frequencies (250–8000 Hz) are at or below 25 dB HL.

Does it mean perfect hearing? Not necessarily. “Normal” hearing thresholds don’t mean hearing is perfect; they mean hearing is within age-appropriate, population-normal ranges. An 60-year-old with thresholds of 20–25 dB HL has “normal” hearing for their age, even though a 25-year-old with those same thresholds would be at the high end of normal.

Does it mean no hearing loss? It means no measurable hearing loss detected on this test. Subtle changes, communication difficulties in noise, or subjective hearing concerns may still exist despite normal thresholds.

Does it mean the worker is protected from future loss? No. A Normal result shows current status. Continued noise exposure without adequate controls can cause future hearing deterioration, detected on subsequent testing.

Understanding the Refer Result

What it does NOT mean:

The worker is fired or reassigned (unless specialist assessment supports this)
The worker has permanent hearing loss (threshold elevation doesn’t confirm permanent damage)
The worker failed the test (the test isn’t pass/fail)
The worker is “deaf” (some Refer results are mild elevations, not severe loss)
The worker cannot continue working (depends on specialist findings)

What it DOES mean:

Thresholds are elevated compared to normal population ranges at one or more frequencies
Further clinical evaluation is needed to determine cause
The employer should review controls to ensure they’re adequate
Monitoring and follow-up may be intensified

Common causes of Refer results:

Early noise-induced hearing loss (occupational or recreational)
Age-related hearing loss (presbycusis)
Conductive pathology (ear infection, ear wax, middle ear fluid)
Medical condition (sudden sensorineural hearing loss, Meniere’s disease, etc.)
Medication effect (ototoxic drugs)
Previous acoustic trauma (gunshot, explosion, loud impact)
Genetic or congenital hearing loss

Employer Summary Report vs Individual Worker Result

Privacy and proper information management distinguish employer and worker reporting:

Employer Summary Report

The employer receives a summary only, not individual audiograms:

Total workers tested: 80
Normal results: 72 workers
Refer results: 8 workers
Significant threshold shifts: 2 workers
Recommendations: Review noise controls; arrange specialist referrals

Privacy protection: The employer doesn’t receive individual audiograms or identifiable results linking specific workers to Refer findings. This protects worker privacy and prevents stigma or discrimination.

Caveat: In some cases, the employer may need individual results with worker permission (e.g., to arrange specific accommodations, modify a worker’s role). In that case, the worker must consent, and results should be treated as confidential health information.

Individual Worker Result

The worker always receives their own results:

Detailed audiogram with thresholds at each frequency
Comparison to baseline (if previous test exists)
Plain-language interpretation from the tester
Referral recommendation (if applicable)

Privacy protection: The worker’s individual results are protected health information. Only the worker, their healthcare providers, and the employer (on a need-to-know basis) should access them. Workers should not share individual colleagues’ results without consent.

What Actions Are Required When Workers Receive Refer Results

Employer obligations:

Notify the worker: Inform the worker that further assessment is recommended
Arrange specialist referral: Within 2–4 weeks, coordinate referral to an audiologist or ENT specialist (employer pays for the assessment)
Review controls: Evaluate whether current hearing protection and engineering controls are adequate
Monitor status: During the referral process, ensure the worker continues in appropriate role with adequate protection
Follow specialist recommendations: Once specialist assessment is completed, implement any recommendations (hearing aids, modified duties, workplace adjustments, etc.)

Worker options: The worker can accept or decline specialist referral. If declined, document the decision. The employer should encourage acceptance, as specialist assessment clarifies whether work-related action is needed.

The “Borderline” Result and When Retesting Is Recommended

In some cases, results fall into a grey zone:

Thresholds very close to normal range (20–25 dB HL at most frequencies)
Only slight elevation at one frequency (27–30 dB HL)
Shift of 12–14 dB (close to the 15 dB STS threshold but not quite meeting it)

In these cases, retesting before committing to specialist referral may be reasonable:

Retest after 2–4 weeks: Confirms whether the finding is consistent or represents test variability
If repeat shows normal: May have been test variability; continue routine monitoring
If repeat confirms finding: Proceed with specialist referral

Your testing provider can advise whether retesting is appropriate based on the specific results.

Age-Related Hearing Loss vs NIHL on the Audiogram

Can you distinguish work-related loss from age-related loss on an audiogram alone?

Not entirely, but patterns help:

Age-Related (Presbycusis) Pattern

Gradual, symmetric high-frequency loss (worse at 6–8 kHz)
Affects both ears similarly
Smooth sloping curve rather than notches
No sudden dips

Noise-Induced (NIHL) Pattern

4 kHz notch (characteristic dip at 4000 Hz)
Often bilateral (both ears affected)
May show recovery at 6–8 kHz (asymmetric pattern)
Can occur at younger ages (before significant age-related loss would appear)

Reality: Many workers have both. An older worker with occupational noise exposure may show a combination of age-related and noise-related patterns. Specialist assessment, work history, and medical history help clarify the contribution of each.

Frequently Asked Questions

Q1: If I get a Refer result, does that mean I’m going deaf?

No. Refer means further evaluation is recommended. Many Refer results are mild, manageable conditions. Specialist assessment will clarify your specific situation.

Q2: Can a Refer result mean something other than hearing loss?

Yes. Refer results may also indicate ear wax, ear infection, middle ear problems, or medication effects. Specialist assessment determines the cause.

Q3: If my result is Normal this year but Refer next year, what changed?

Your hearing has deteriorated compared to the previous year—likely a threshold shift. This triggers the need for specialist assessment and control review. It doesn’t mean you have permanent damage yet, but it indicates deterioration that warrants investigation.

Q4: Who sees my individual audiogram?

Primarily you (the worker). The audiometrist, any specialist you’re referred to, and your employer (on a need-to-know basis for workplace management) have access. Your permission is required before your individual results are shared with anyone else.

Q5: Can my employer fire me if I get a Refer result?

No, not based on the test result alone. The employer must follow WHS procedures (referral, control review, specialist assessment). If the specialist recommends you’re unable to continue in a noisy role, then redeployment or modified duties may be required. But the initial Refer result doesn’t trigger termination.

Q6: If results are Normal, can I skip the next test?

No. Regular testing (annual or biennial per your program) is still required to detect future changes. A Normal result now doesn’t mean you’re protected forever.

Q7: Can I get a second opinion on my Refer result?

Yes. If you’re unhappy with a Refer result, you can seek a second audiogram from another provider. However, if your original provider used compliant equipment and methods, the result is likely reliable.

Q8: What if multiple workers get Refer results in the same testing?

It suggests the workplace noise environment may be higher than expected, or control measures may be inadequate. This is a signal for the employer to review and improve controls immediately, not just for the individuals referred but for the whole population.