PTA & Tympanometry / SRT Report

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Patient Info

Patient ID

Gender

First name

Address 1

Last name

Referred by

Birth date

PTA Manual Graph

Left Air (•)

Right Air (×)

Bone (△/▽, dashed)

Mask mark

PTA method Right HL: — Left HL: —

Tympanometry – manual

Right Peak (daPa)

Right Compliance (ml)

Right Gradient (daPa)

Right ECV (ml)

Left Peak (daPa)

Left Compliance (ml)

Left Gradient (daPa)

Left ECV (ml)

Acoustic Reflex – manual thresholds

R 500

R 1k

R 2k

R 4k

L 500

L 1k

L 2k

L 4k

Auto Comments (live & editable)

PTA Comment

Tympanometry Comment

SRT/Reflex Comment

Signatures

Signature (Page 1)

Signature (Page 2)

ADVANCED HEARING

24/1 Shan Tower (3rd Floor - Lift 3) Shantinagar
Chamelibagh, Dhaka-1217, Bangladesh
01755574799, 01814091509 | info@advancedhearingbd.com
www.advancedhearingbd.com

Patient ID —

Gender —

First name —

Address 1 —

Last name —

Referred by —

Birth date —

Pure Tone Audiometry

Grading Of Hearing Loss (According to WHO)

-10–25 dB	Normal Hearing
26–40 dB	Mild Hearing Loss
41–55 dB	Moderate Hearing Loss
56–70 dB	Moderately Severe Hearing Loss
71–90 dB	Severe Hearing Loss
91–120 dB	Profound Hearing Loss

Comments:

—

Signature

Advanced Hearing

This software was designed & developed by MD OMAR FARUK — www.advancedhearingbd.com/user/faruk

ADVANCED HEARING

24/1 Shan Tower (3rd Floor - Lift 3) Shantinagar
Chamelibagh, Dhaka-1217, Bangladesh
01755574799, 01814091509 | www.advancedhearingbd.com

1: Tympanometry

Right, 226 Hz, 400 daPa/s, Ya

Left, 226 Hz, 400 daPa/s, Ya

2: Acoustic reflex

REPORT NOTES

Impedance:
Right Ear: —
Left Ear: —

SRT:
—

Comments:
—

Signature

Advanced Hearing

This software was designed & developed by MD OMAR FARUK — www.advancedhearingbd.com/user/faruk