Hostname: page-component-74656f9884-j7cmm Total loading time: 0 Render date: 2026-11-07T23:06:38.943Z Has data issue: false hasContentIssue false
  • English
  • Français

The characteristic of conventional and extended high-frequency audiometry in older adults – a community-based investigation in South China

Published online by Cambridge University Press:  10 April 2025

Qiyang Sun ,
Mengqi Zhao ,
Xiaomei Sun ,
Yanfeng Deng ,
Yuzhi Zhang ,
Guanxia Xiong  and
Fanqin Wei Open the ORCID record for Fanqin Wei [Opens in a new window]
Qiyang Sun
Affiliation:
Department of Otolaryngology Head & Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Mengqi Zhao
Affiliation:
Department of Otolaryngology Head & Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Xiaomei Sun
Affiliation:
Department of Otolaryngology Head & Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Yanfeng Deng
Affiliation:
Sun Yat-sen University Zhongshan School of Medicine, Guangzhou, China
Yuzhi Zhang
Affiliation:
Sun Yat-sen University Zhongshan School of Medicine, Guangzhou, China
Guanxia Xiong*
Affiliation:
Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Fanqin Wei*
Affiliation:
Department of Otolaryngology Head & Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
*
Corresponding author: Fanqin Wei; Email: weifanq@mail.sysu.edu.cn and Guanxia Xiong; Email: xguanx@mail.sysu.edu.cn
Corresponding author: Fanqin Wei; Email: weifanq@mail.sysu.edu.cn and Guanxia Xiong; Email: xguanx@mail.sysu.edu.cn
Rights & Permissions [Opens in a new window]

Abstract

Objectives

To define extended high-frequency hearing threshold ranges in normal hearing elderly (aged 55 years and above) and identify associated risk factors for extended high-frequency hearing loss.

Methods

Pure-tone thresholds (0.25–16 kHz) and word recognition scores were measured using portable audiometric equipment. Lifestyle and medical histories were collected, and generalised linear models analysed risk factors for extended high-frequency hearing (10–12 kHz).

Results

In normal hearing elderly (28 ears, 18 subjects), 95 per cent confidence intervals for 10 and 12 kHz were 34.770–49.301 and 56.976–65.809, respectively. Among 342 ears (200 subjects), hypertension emerged as a leading risk factor for extended high-frequency hearing loss, while lipid-lowering medications showed potential protective effects.

Conclusion

Preliminary extended high-frequency hearing thresholds were established, with hypertension identified as a key risk factor and lipid-lowering medications as a potential protective factor.

Keywords

PresbycusisAudiometrySensorineural Hearing Loss

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 139 , Issue 8 , August 2025 , pp. 687 - 695
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

Introduction

Presbycusis, or age-related hearing loss (ARHL), is among the most common chronic conditions among elderly individuals.Reference Bowl and Dawson1 It greatly affects the quality of life (QOL) of older adults, leading to social isolation, depression and decreased communication abilities, which exacerbate the challenges faced by both the individuals and their caregivers.Reference Ying, Zhao, Xu, Su and Xie2, Reference Chern and Golub3 Presbycusis typically develops insidiously, with patients seeking medical attention when it has already progressed to moderate to severe sensorineural hearing loss (SNHL), which is often irreversible. Therefore, early detection of presbycusis in the elderly is of paramount importance.

Currently, the diagnosis and assessment of presbycusis still rely primarily on conventional pure-tone audiometry (PTA) testing at frequencies below 8000 Hz. Research has indicated that extended high-frequency (EHF) hearing thresholds, at frequencies above 8000 Hz, increase with age and show changes earlier in the progression of presbycusis compared to PTA. Therefore, EHF is considered an important indicator for the early diagnosis of presbycusis.Reference Osterhammel4, Reference Osterhammel and Osterhammel5 However, the reference values for EHF in older individuals are not well-established, limiting the value of EHF in the early diagnosis of presbycusis.

Many previous studies have investigated the EHF threshold in the elderly population.Reference Matthews, Lee, Mills and Dubno6–Reference Wang, Ai, Han, Fan, Shi and Wang10 However, all these previous studies primarily rely on the definition of normal hearing based on PTA. Given that one characteristic of presbycusis is a decline in speech recognition abilities, which may precede abnormalities in pure-tone thresholds,Reference Hoppe, Hocke and Iro11 and that EHF is useful for speech recognition in noisy environments,Reference Motlagh Zadeh, Silbert, Sternasty, Swanepoel, Hunter and Moore12 some individuals with normal PTA may already have experienced a decline in EHF hearing and speech recognition ability. Aziz et al. found that over half of adults with normal PTA (aged 25–54) had unmeasurable EHF distortion product otoacoustic emissions (DPOAE), indirectly supporting our concerns.Reference Aziz, Md Daud, Nik Othman and Abd Rahman13 Consequently, defining ‘normal hearing’ in elderly individuals based solely on normal PTA and establishing EHF threshold reference values may not fully serve the purpose of early detection of presbycusis.

Unlike the association between conventional PTA hearing loss and chronic diseases (e.g. hypertension and diabetes), which have been extensively investigated,Reference Agarwal, Mishra, Jagade, Kasbekar and Nagle14–Reference Miyata, Umesawa, Yoshioka and Iso17 the association between EHF hearing loss and chronic diseases is only found in isolated reports.Reference Das, Sumit, Ahsan, Kato, Ohgami and Akhand18, Reference Güven and Ç19 We still need a more systematic insight into this issue.

To define the normal EHF threshold for the elderly population, we conducted a community-based investigation in elderly individuals using conventional PTA, EHF hearing test and word recognition tests in South China. Additionally, a comprehensive investigation and analysis of lifestyle habits and the medical history of chronic diseases were performed to explore the potential risk factors of EHF hearing loss.

Materials and methods

This study employed a cross-sectional survey to conduct conventional PTA, EHF hearing test and word recognition tests on study participants. The following demographic and health-related information was recorded for each participant: gender, age, Body Mass Index (BMI), history of hypertension, history of diabetes, history of hyperlipidaemia, smoking history and alcohol consumption history.

Participants

From May 2022 to August 2022, elderly individuals were recruited for a hearing and questionnaire survey in five communities in Haizhu District, Guangzhou, Guangdong Province, China. All the procedures conformed to the principles of the Declaration of Helsinki and relevant ethical guidelines. Before the examinations, otolaryngologists conducted ear examinations to remove earwax and other obstructions from the external ear canal. Inclusion criteria for study participants were as follows:(1) age 55 years or older; (2) normal cognitive function, capable of expressing their feelings clearly; (3) informed consent and voluntary participation in the study.

Exclusion criteria included: (1) definitive history of suppurative otitis media, sudden hearing loss, a history of malignant tumour with radiation or chemotherapy, or a history of cranial trauma or surgery; (2) physical condition preventing tolerance of hearing tests or an inability to understand the questionnaire content.

Hearing tests

Conventional PTA (0.125 to 8 kHz) was performed using the Foshan Bozhi SFTest 330 testing equipment (Foshan Bozhi Medical Technology, Foshan, China), accompanied by DD45 headphones (Radioear, Middelfart, Denmark), EHF threshold was obtained using the same audiometer with a Sennheiser HDA 200 closed circumaural earphone (Sennheiser, Wedemark, Germany), following the methods specified in the national standard GB/T 16296.1-2018. The tests were conducted in a quiet environment with background noise controlled to be within 30 dB. The testing was carried out by specialised personnel trained in the field. Air conduction thresholds at 0.5, 1 2 and 4 kHz were tested for both ears, with the average values at these frequencies used to calculate the PTA. The EHF threshold was calculated using the air conduction thresholds at 8, 10 and 12 kHz.

Word recognition score

Word recognition testing used audio files from the ‘Mandarin Speech Audiometry – Monosyllable Recognition Test’ compiled by Xi.Reference Xi, Ji, Chen, Zhao, Zhao and Xu20 A list of monosyllabic words (25 monosyllables) was played, and the testing method followed GB/T 16296.3-2017. The sound intensity at which a participant can correctly recognise 50 per cent of the spoken words was recorded as WRS50. The difference between WRS50 and the average PTA threshold is denoted as PTA-WRS50. When this difference falls within the range of ± 6 dB, it is considered ‘normal’. Otherwise, it suggests the presence of other potential pathologies in the auditory pathway.Reference Olsen, Matkin and Rintelmann21

Lifestyle and medical history data collection

All general information, lifestyle habits and past medical history data in this study were collected through face-to-face interviews with the participants. For instance, when inquiring about a history of hypertension, researchers would ask participants if they had a history of hypertension, the duration of the history and make corresponding records. ‘BP=0’ indicates no history of hypertension, ‘BP=1’ signifies a history of hypertension within the last ten years, ‘BP=2’ represents a history of hypertension from 11 to 20 years, ‘BP=3’ corresponds to a history of hypertension from 21 to 30 years, ‘BP=4’ denotes a history of hypertension from 31 to 40 years, ‘BP=5’ stands for a history of hypertension from 41 to 50 years. ‘DM’ refers to a history of diabetes, with numerical classification criteria similar to the history of hypertension. ‘Alcohol=0’ indicates no alcohol consumption, ‘Alcohol=1’ implies a previous history of alcohol consumption with cessation for more than six months and ‘Alcohol=2’ represents a long-term history of alcohol consumption. ‘Lipid=0’ refers to no diagnosed high blood lipid levels, ‘Lipid=1’ signifies a diagnosis of hyperlipidaemia without standard treatment, and ‘Lipid=2’ indicates regular use of lipid-lowering medications. ‘Smoke=0’ stands for no history of smoking, ‘Smoke=1’ represents a previous history of smoking with quitting for more than six months, and ‘Smoke=2’ indicates a long-term smoking history.

Statistical analysis

Statistical analysis was conducted using SPSS Statistics 21 software (IBM, Armonk, New York, USA). Descriptive statistics were used for quantitative data, with mean and standard deviation. Group comparisons were made using t-tests. Qualitative data were described using rates, composition ratios or percentages (%), with group comparisons done using the chi-square test. The study employed generalised linear models (GLM) to analyse the lifestyle habits and chronic health factors that might influence PTA or EHF. A significance level of p = < 0.05 was considered statistically significant.

Results

Characteristics of the participants

Two hundred elderly individuals from five communities in the Guangzhou area were recruited to participate in on-site hearing tests and questionnaire surveys. After excluding cases with suppurative otitis media, a history of sudden hearing loss, a history of radiation or chemotherapy, and cranial tumours, a total of 342 ears were included in the study. The average age of the participants was 69.6 years, with 222 ears belonging to females (Tables 1 and 2).

Table 1.

Statistical Description of Factors Related to Hearing Impairment in 342 Ears

Table 2.

Gender Distribution and Mean Age of Participants

*M = Male; F = Female

Detection rates of hearing thresholds at 8–16 kHz in different age groups

In all 4 age groups, the detection rate of hearing thresholds at 8 kHz and below was 100 per cent, indicating that participants in any age group could have their thresholds measured at 8 kHz and below. As age increased, there was a downward shift in the EHF frequency where hearing thresholds were not detected. Furthermore, with increasing frequency, the detection rate of EHF pure-tone thresholds showed a declining trend, with nearly half of the individuals aged 60 and above unable to elicit threshold values at 16 kHz (Table 3).

Table 3.

Detection Rates of Hearing Thresholds at 8–16 kHz (%)

* y = years old

Hearing threshold levels at 0.25–16 kHz in different age groups

In each age group, the PTA shows a general trend of increasing with higher frequencies. As age increases, there is an upward trend in hearing thresholds at various frequencies. Specifically, the 70–79 age group has significantly higher thresholds at 4 kHz to 16 kHz, and the 80 and above age group has significantly higher thresholds at 0.25 kHz to 16 kHz when compared to the 55–59 age group (Figure 1). Additionally, the 55–59 and 60–69 age groups exhibit an upward trend in EHF with increasing frequency. In contrast, the 80 and above age group shows a downward trend in EHF thresholds with increasing frequency. Therefore, the differences between different age groups in the EHF range tend to converge as the frequency increases. When the frequency reaches 16 kHz, the threshold data for all 4 age groups are similar, ranging between 40 dB and 50 dB. This convergence may be related to the limitations of the audiometric equipment, as the sound level at 16 kHz cannot reach above 50 dB HL.

Figure 1.

Hearing thresholds for Different Age Groups at Frequencies 0.25-16 kHz. The four groups exhibit a trend of increasing hearing thresholds with higher frequencies in the 0.25-8 kHz range. Among them, the 55-79 age group still shows an upward trend in hearing thresholds in the 8-12 kHz range(Data are presented as mean ± standard deviation). In comparison, the 80 and above age group exhibits a downward trend in hearing thresholds above 8 kHz, eventually converging with the other three groups at 16 kHz. Compared to the 55-59 age group, the 60-69 age group shows no significant differences in hearing thresholds at various frequencies. The 70-79 age group has significantly higher thresholds at 4-16 kHz, while the 80 and above age group shows significant increases in hearing thresholds at all frequencies from 0.25-16 kHz (p<0.05, multiple t-tests, corrected by Holm-Sidak method).

Factors influencing PTA and EHF in individuals aged 55 and above

By incorporating variables such as age, BMI, smoking history, alcohol consumption history, diabetes history and hypertension history into a generalised linear model (GLM), both PTA and EHF were analysed as dependent variables. There was a significant increase in PTA and EHF with advancing age (p = 0.00).

For PTA (Table 4), diabetes history and smoking were likely vital factors affecting hearing threshold. The group with a diabetes history of around 30–40 years had significantly poorer hearing (p = 0.002), although the trend analysis was insignificant (p = 0.362). Thus, we could not conclusively establish that a more extended diabetes history was directly related to worse PTA. In the case of smoking history, individuals with a long history of smoking displayed a notable trend of worse PTA compared to those with no smoking history or those who had quit smoking for more than six months (p = 0.009).

Table 4.

GLM Analysis of PTA

When EHF was considered as the dependent variable (Table 5), it was observed that individuals with a history of hypertension for around 10–20 years had significantly poorer EHF (8–12 kHz). However, in the trend analysis, the effect of hypertension was not statistically significant (p = 0.104). Thus, it could not be firmly established that a more extended hypertension history directly led to worse EHF. Surprisingly, in this study, individuals with a history of hyperlipidaemia who consistently took lipid-lowering medication exhibited significantly better EHF than those without a clear history of hyperlipidaemia (p = 0.041).

Table 5.

GLM Analysis of EHF

* ‘BP=0’ indicates no history of hypertension; ‘BP=1’ signifies a history of hypertension within the last ten years; ‘BP=2’ represents a history of hypertension from 11 to 20 years; ‘BP=3’ corresponds to a history of hypertension from 21 to 30 years; ‘BP=4’ denotes a history of hypertension from 31 to 40 years, ‘BP=5’ stands for a history of hypertension from 41 to 50 years. ‘DM’ refers to a history of diabetes, with numerical classification criteria like the history of hypertension. ‘Alcohol=0’ indicates no alcohol consumption; ‘Alcohol=1’ implies a previous history of alcohol consumption with cessation for more than six months; and ‘Alcohol=2’ represents a long-term history of alcohol consumption. ‘Lipid=0’ refers to no diagnosed high blood lipid levels; ‘Lipid=1’ signifies a diagnosis of hyperlipidaemia without standard treatment; and ‘Lipid=2’ indicates regular use of lipid-lowering medications. ‘Smoke=0’ stands for no history of smoking; ‘Smoke=1’ represents a previous history of smoking with quitting for more than six months; and ‘Smoke=2’ indicates a long-term smoking history.

Reference values for EHF in individuals aged 55 and above

In order to establish reference values for EHF in the elderly, participants were grouped based on their PTA and WRS50. As shown in Figure 2, individuals with normal PTA (less than 25 dB) that matched their WRS50 within -6 dB to 6 dB were categorised as having ‘normal hearing’. A total of 28 ears were included, consisting of 7 ears from individuals aged 55–59, 19 ears from those aged 60–69, and 2 ears from those aged 70–79. The mean and 95 per cent confidence intervals for EHF for normal hearing elderly individuals were 42.036 (34.770, 49.301) at 10 kHz and 61.392 (56.976, 65.809) at 12 kHz. With an increase in the PTA, there was a noticeable rise in the corresponding EHF.

Figure 2.

Distribution of PTA and WRS50 in Different Age Groups

The PTA (0.5-4kHz) for the four age groups were 31.25±10.15, 34.41±9.67, 42.55±9.49, and 57.03±13.19 dB, while the average WRS50 values were 30.07±8.97, 33.19±11.28, 39.25±9.19, and 53.29±16.22 dB, respectively. Both the PTA and WRS50 scores showed an increasing trend with age. The differences in PTA-WRS50 values for the four age groups were 1.73±7.11, 2.16±7.31, 3.17±8.07, and 1.22±8.83 dB, respectively.

Furthermore, it was noted that for individuals with mild hearing loss, the 95 per cent confidence intervals for the 10 kHz and 12 kHz thresholds partially overlapped with those with normal hearing. In contrast, for those with moderate to severe hearing loss, the 95 per cent confidence intervals for the 10 kHz and 12 kHz thresholds significantly overlapped (Figure 3). By analysing the correlation and differences in threshold values between the 8 kHz–4 kHz and 12 kHz–8 kHz intervals across various hearing groups, it was observed that there was no significant difference in the 12 kHz–8 kHz threshold difference when compared to the 8 kHz–4 kHz threshold difference in normal hearing and mild hearing loss groups. However, a significant negative correlation existed between the two. In the case of moderate to moderately severe hearing loss groups, the 12 kHz–8 kHz threshold difference was significantly lower than the 8 kHz–4 kHz threshold difference, and a significant negative correlation was also present. Nevertheless, in the severe to profound hearing loss group, the 12 kHz–8 kHz threshold difference was significantly lower than the 8 kHz–4 kHz threshold difference, with most individuals displaying a difference of less than 0. However, the correlation was not statistically significant (Figure 4).

Figure 3.

Mean PTA and EHF for the Normal (PTA < 25 dB HL) Group and Hearing Loss Groups.

In the normal hearing group aged 55 and above, the 10 and 12 kHz threshold values had 95% confidence intervals of (34.77, 49.30) and (56.98, 65.81), respectively. In the mild hearing loss group, the 95% confidence intervals for 10 and 12 kHz thresholds were (48.95, 56.53) and (59.38, 64.30), respectively. Significant differences were observed in the threshold levels between the normal hearing group and the mild hearing loss group from 0.25 kHz to 10 kHz (multiple t-tests, corrected by the Holm-Sidak method). However, there was a significant overlap in the 12kHz thresholds, and no significant difference was found between the two groups at this frequency.
Figure 4.

Correlation and Comparison of 8 kHz-4 kHz and 12 kHz-8 kHz Threshold Differences in Different Hearing Groups.

(C-D) In the moderate-to-moderately severe hearing loss group, the 12 kHz-8 kHz threshold difference was 4.09±19.07, significantly lower than the 8 kHz-4 kHz threshold difference of 12.88±17.68, and both showed a significant negative correlation.In the severe-to-profound hearing loss group, the 12 kHz-8 kHz threshold difference was -15.89±10.17, significantly lower than the 8 kHz-4 kHz threshold difference of 8.39±10.97. Although most individuals in this group had a 12 kHz-8 kHz threshold difference less than 0, the correlation between the two differences was not statistically significant. (A-B) In the normal hearing and mild hearing loss groups, the 12 kHz-8 kHz threshold difference was 19.91±19.22, and the 8 kHz-4 kHz threshold difference was 13.38±15.06. There was no significant difference between the two differences, but they showed a significant negative correlation.

Discussion

Sound waves travel from the base of the cochlea to the apex, where the base corresponds to the high-frequency region and the apex corresponds to the low-frequency region. The EHF area, which includes frequencies above 8000 Hz, is mainly located within 0–7 mm from the round window and is more susceptible to various damaging factors in the middle ear environment.Reference Li, Helpard, Ekeroot, Rohani, Zhu and Rask-Andersen22 Additionally, research has shown differences between the cochlear base and apex. Compared to the cochlear apex, the cochlear base has more L-type calcium channels, making it more susceptible to calcium overload, which can damage hair cells. Moreover, the apex has higher antioxidants, providing more vital protection.Reference Fettiplace and Nam23, Reference Shen, Yu, Hiel, Liao, Yue and Fuchs24 Hensen’s cells, for example, release lipid droplets for mechanical regulation in the cochlea. Compared to the apex, there are fewer lipid droplets in the cochlear base, leading to lower nutrient availability for hair cells and making them more susceptible to damage.Reference Urrutia and Kalinec25 These findings may explain why high-frequency hearing, especially EHF hearing, is more susceptible to damage in the ageing process.

Extended high-frequency is considered an early warning indicator for monitoring hearing loss, including ototoxic chemotherapy drugs and noise-induced hearing loss.Reference Lough and Plack26 However, EHF testing has not been widely adopted in clinical practice, and one of the reasons is the lack of a universally applicable reference baseline for normal thresholds, which makes it challenging to quantify threshold shifts and assess the normalcy of EHF audiometric results. Therefore, there is an urgent need for a reference range that can be used for comparison in clinical settings.

Previous studies have investigated EHF in elderly populations with normal PTA.Reference Matthews, Lee, Mills and Dubno6 However, we believe that defining ‘normal elderly individuals’ solely based on normal PTA thresholds may not be sufficient for the elderly population. One common characteristic of presbycusis is the early manifestation of being ‘able to hear but unable to understand’.Reference Hoppe, Hocke and Iro11 For these elderly individuals, although their PTA may still be within the normal range, their auditory system may already be impaired. In addition to possible cochlear pathology, the loss of EHF hearing could also be a significant factor in the decline of speech recognition ability in older individuals.Reference Motlagh Zadeh, Silbert, Sternasty, Swanepoel, Hunter and Moore12 To define ‘normal hearing’ more accurately in elderly populations during investigation, this study introduced the WRS as an indicator. Previous research has suggested that under normal conditions, speech recognition rates at around 50 per cent (WRS50) correspond roughly to PTA, and a difference of more than 6 dB between WRS50 and PTA may indicate cochlear pathology or other issues.Reference Goshtasbi, Chua, Risbud, Sarna, Jamshidi and Abouzari27 In this study, to establish reference ranges for EHF in individuals aged 60 and above with normal hearing, participants had to meet normal PTA and a WRS50 within 6 dB of their PTA. Based on this criterion and using data from 28 ears with normal PTA and WRS, we generated reference ranges for EHF (10 kHz and 12 kHz) in the elderly community population (mean and 95 per cent confidence intervals). Ultimately, we found that in this study, the EHF for elderly individuals (aged 60 and above) with normal hearing were around 42 dB at 10 kHz, significantly better than the data reported by Matthews and others (approximately 60 dB) in earlier studies.Reference Matthews, Lee, Mills and Dubno6 While there could be several factors contributing to this difference, such as testing environment and equipment performance, this result, to some extent, confirmed our suspicion that these so-called ‘normal hearing’ elderly individuals in previous studies had significant EHF hearing loss. This study further distinguished normal hearing individuals with normal PTA by incorporating the WRS. One of the main objectives of this study was to assist in the early detection of hearing loss by defining normal reference values for EHF in the elderly community population. However, we did not find a significant difference in EHF thresholds at 12 kHz and 16 kHz between individuals with normal PTA and those with mild hearing loss. Considering the relatively small sample size of the normal PTA group in this study and the common issue of unresponsiveness in EHF tests in the elderly, where the likelihood of data loss increases with age and frequency, it is possible that these factors contributed to the lack of significant differences. Additionally, the testing equipment was limited to a maximum threshold of 50 dB at 16 kHz, a significant bottleneck in our attempt to define reference values for EHF hearing in the elderly community population. Future research will require larger-scale investigations to establish reference values for EHF in community-dwelling elderly individuals.

In this study, we also investigated factors related to lifestyle habits and chronic health conditions in the study participants that may affect PTA and EHF. Through generalised linear model analysis, we found that smoking history was an essential factor influencing PTA in the elderly. This result aligns with epidemiological findings in countries like Australia and the United States.Reference Campo, Morata and Hong28 The mechanism behind this may be related to smoking exacerbating oxidative and inflammatory stress in the body.Reference Csiszar, Podlutsky, Wolin, Losonczy, Pacher and Ungvari29 In previous reports, gender, obesity and diabetes were considered potentially essential factors affecting hearing levels in the elderly.Reference Cruickshanks, Nondahl, Dalton, Fischer, Klein and Klein30–Reference Tang, Tran, Dawes and Gopinath32 However, this study did not find a clear association between these factors and PTA. It may be due to the focus of our investigation on the duration of diseases like hypertension and diabetes, with a lack of data on disease severity and control. For EHF, we found that individuals with a history of hypertension of approximately 10–20 years had significantly worse EHF. However, the trend of worsening EHF with an extended history of hypertension was not significant. We also found that individuals with hyperlipidaemia who regularly took lipid-lowering medication had significantly improved EHF compared to those without hyperlipidaemia, which contradicts the general understanding that hyperlipidaemia accelerates hearing ageing. This result may be related to two factors. Firstly, individuals with a clear history of hyperlipidaemia may be more attentive to dietary intake and lifestyle adjustments. In contrast, those who self-report no history of hyperlipidaemia may have high cholesterol levels without knowing it. Secondly, regular use of statin lipid-lowering medications may have a protective effect on hearing. Previous studies have shown that statin medications can significantly reduce hearing loss caused by platinum-based chemotherapy drugs,Reference Fernandez, Allen, Campbell, Page, Townes and Li33 and recent animal experiments have reported that statin medications can slow the progression of presbycusis.Reference Choo, Lee, Kim, Kim, Lee and Kim34 To our knowledge, this study is the first to analyse the association between lifestyle habits, chronic health factors and EHF in a community-dwelling elderly population. Due to the lack of previous research for reference, it is difficult to conclude the relationship between hyperlipidaemia in the elderly and EHF until further investigation data is obtained, including specific blood tests.

Conclusion

Through our investigation of the elderly population in Guangzhou, we have established preliminary EHF hearing threshold reference values for individuals aged 55 and above with normal hearing. The GLM analysis suggests hypertension is likely an important factor contributing to EHF hearing loss, and using lipid-lowering medications may be beneficial in protecting EHF hearing. Further research on a larger scale and a more detailed investigation into the medical history of chronic conditions in the elderly is needed.

Financial support

This study was funded by Guangdong Basic and Applied Basic Research Foundation (2023A1515012713).

Competing interests

There are no conflicts of interest, financial, or otherwise.

Ethical statement and informed consent

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University.

CRediT authorship contribution statement

Qiyang Sun: Writing – original draft, Methodology. Mengqi Zhao: Writing – original draft. Xiaomei Sun: Data curation, Visualization. Yanfeng Deng: Formal analysis, Visualization. Yuzhi Zhang: Data curation, Visualization. Guanxia Xiong and Fanqin Wei: Conceptualization, Supervision, Writing – review & editing, Funding acquisition.

Footnotes

*

Equal first authors

The data that support the findings of this study are available upon reasonable request.

References

Bowl, MR, Dawson, SJ. Age-related hearing loss. Cold Spring Harb Perspect Med 2019;9:a033217CrossRefGoogle ScholarPubMed
Ying, G, Zhao, G., Xu, X, Su, S, Xie, X. Association of age-related hearing loss with cognitive impairment and dementia: an umbrella review. Front Aging Neurosci 2023;15:1241224CrossRefGoogle ScholarPubMed
Chern, A, Golub, JS. Age-related hearing loss and dementia. Alzheimer Dis Assoc Disord 2019;33:285–90CrossRefGoogle ScholarPubMed
Osterhammel, D. High frequency audiometry. Clinical aspects. Scand Audiol 1980;9:249–56CrossRefGoogle ScholarPubMed
Osterhammel, D, Osterhammel, P. High-frequency audiometry Age and sex variations. Scand Audiol 1979;8:73–81CrossRefGoogle ScholarPubMed
Matthews, LJ, Lee, FS, Mills, JH, Dubno, JR. Extended high-frequency thresholds in older adults. J Speech Lang Hear Res 1997;40:208–14CrossRefGoogle ScholarPubMed
Lee, J., Dhar, S, Abel, R, Banakis, R, Grolley, E, Lee, J, et al. Behavioral hearing thresholds between 0.125 and 20 kHz using depth-compensated ear simulator calibration. Ear Hear 2012;33:315–29CrossRefGoogle ScholarPubMed
Rodríguez Valiente, A, Trinidad, A, García Berrocal, JR, Górriz, C, Ramírez Camacho, R. Extended high-frequency (9–20 kHz) audiometry reference thresholds in 645 healthy subjects. Int J Audiol 2014;53:531–45CrossRefGoogle ScholarPubMed
Škerková, M, Kovalová, M, Rychlý, T, Tomášková, H, Šlachtová, H, Čada, Z, et al. Extended high-frequency audiometry: hearing thresholds in adults. Eur Arch Otorhinolaryngol 2023;280:565–72CrossRefGoogle ScholarPubMed
Wang, M, Ai, Y, Han, Y, Fan, Z, Shi, P, Wang, H. Extended high-frequency audiometry in healthy adults with different age groups. J Otolaryngol Head Neck Surg 2021;50:52CrossRefGoogle ScholarPubMed
Hoppe, U, Hocke, T, Iro, H. Age-related decline of speech perception. Front Aging Neurosci 2022;14:891202CrossRefGoogle ScholarPubMed
Motlagh Zadeh, L, Silbert, NH, Sternasty, K, Swanepoel, W, Hunter, LL, Moore, DR. Extended high-frequency hearing enhances speech perception in noise. Proc Natl Acad Sci U S A 2019;116:23753–9CrossRefGoogle ScholarPubMed
Aziz, A, Md Daud, MK, Nik Othman, NA, Abd Rahman, N. Early detection of high-frequency presbycusis among normal hearing individuals. Otol Neurotol 2020;41:e989–92CrossRefGoogle ScholarPubMed
Agarwal, S, Mishra, A, Jagade, M, Kasbekar, V, Nagle, SK. Effects of hypertension on hearing. Indian J Otolaryngol Head Neck Surg 2013;65:614–8CrossRefGoogle ScholarPubMed
Bainbridge, KE, Hoffman, HJ, Cowie, CC. Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999–2004 Diabetes Care 2011;34:1540–5CrossRefGoogle ScholarPubMed
Hara, K, Okada, M, Takagi, D, Tanaka, K, Senba, H, Teraoka, M, et al. Association between hypertension, dyslipidemia, and diabetes and prevalence of hearing impairment in Japan. Hypertens Res 2020;43:963–8CrossRefGoogle ScholarPubMed
Miyata, J, Umesawa, M, Yoshioka, T, Iso, H. Association between high systolic blood pressure and objective hearing impairment among Japanese adults: a facility-based retrospective cohort study. Hypertens Res 2022;45:155–61CrossRefGoogle ScholarPubMed
Das, A, Sumit, AF, Ahsan, N, Kato, M, Ohgami, N, Akhand, AA. Impairment of extra-high frequency auditory thresholds in subjects with elevated levels of fasting blood glucose. J Otol 2018;13:29–35CrossRefGoogle ScholarPubMed
Güven, SG, Ç, Binay. The importance of extended high frequencies in hearing evaluation of pediatric patients with Type 1 Diabetes. J Clin Res Pediatr Endocrinol 2023;15:127–37CrossRefGoogle ScholarPubMed
Xi, X, Ji, F, Chen, AT, Zhao, WL, Zhao, Y, Xu, J, et al. [Development and evaluation of standardized Mandarin monosyllable audiometric materials]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010;45:7–13Google ScholarPubMed
Olsen, WO, Matkin, ND. Speech audiometry. In: Rintelmann, WF, ed. Hearing Assessment. Baltimore: University Park Press, 1979;39–140Google Scholar
Li, H, Helpard, L, Ekeroot, J, Rohani, SA, Zhu, N, Rask-Andersen, H, et al. Three-dimensional tonotopic mapping of the human cochlea based on synchrotron radiation phase-contrast imaging. Sci Rep 2021;11:4437CrossRefGoogle ScholarPubMed
Fettiplace, R, Nam, JH. Tonotopy in calcium homeostasis and vulnerability of cochlear hair cells. Hear Res 2019;376:11–21CrossRefGoogle ScholarPubMed
Shen, Y, Yu, D, Hiel, H, Liao, P, Yue, DT, Fuchs, PA, et al. Alternative splicing of the Ca(v)1.3 channel IQ domain, a molecular switch for Ca2+-dependent inactivation within auditory hair cells. J Neurosci 2006;26:10690–9CrossRefGoogle Scholar
Urrutia, RA, Kalinec, F. Biology and pathobiology of lipid droplets and their potential role in the protection of the organ of Corti. Hear Res 2015;330:26–38CrossRefGoogle ScholarPubMed
Lough, M, Plack, CJ. Extended high-frequency audiometry in research and clinical practice. J Acoust Soc Am 2022;151:1944CrossRefGoogle ScholarPubMed
Goshtasbi, K, Chua, JT, Risbud, A, Sarna, B, Jamshidi, S, Abouzari, M, et al. Treatment of long-term sudden sensorineural hearing loss as an otologic migraine phenomenon. Otol Neurotol 2021;42:1001-7CrossRefGoogle Scholar
Campo, P, Morata, TC, Hong, O. Chemical exposure and hearing loss. Dis Mon 2013;59:119–38CrossRefGoogle ScholarPubMed
Csiszar, A, Podlutsky, A, Wolin, MS, Losonczy, G, Pacher, P, Ungvari, Z. Oxidative stress and accelerated vascular aging: implications for cigarette smoking. Front Biosci (Landmark Ed) 2009;14:3128–44CrossRefGoogle ScholarPubMed
Cruickshanks, KJ, Nondahl, DM, Dalton, DS, Fischer, ME, Klein, BE, Klein, R, et al. Smoking, central adiposity, and poor glycemic control increase risk of hearing impairment. J Am Geriatr Soc 2015;63:918–24CrossRefGoogle ScholarPubMed
Gopinath, B, Flood, VM, McMahon, CM, Burlutsky, G, Smith, W, Mitchell, P. The effects of smoking and alcohol consumption on age-related hearing loss: the Blue Mountains Hearing Study. Ear Hear 2010;31:277–82CrossRefGoogle ScholarPubMed
Tang, D, Tran, Y, Dawes, P, Gopinath, B. A narrative review of lifestyle risk factors and the role of oxidative stress in age-related hearing loss. Antioxidants (Basel) 2023;12: 878CrossRefGoogle ScholarPubMed
Fernandez, KA, Allen, P, Campbell, M, Page, B, Townes, T, Li, CM, et al. Atorvastatin is associated with reduced cisplatin-induced hearing loss. J Clin Invest 2021;131:e142616CrossRefGoogle ScholarPubMed
Choo, OS, Lee, YY, Kim, YS, Kim, YJ, Lee, DH, Kim, H, et al. Effect of statin on age-related hearing loss via drug repurposing. Biochim Biophys Acta Mol Cell Res 2022;1869:119331CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Statistical Description of Factors Related to Hearing Impairment in 342 Ears

Figure 1

Table 2. Gender Distribution and Mean Age of Participants

Figure 2

Table 3. Detection Rates of Hearing Thresholds at 8–16 kHz (%)

Figure 3

Figure 1. Hearing thresholds for Different Age Groups at Frequencies 0.25-16 kHz. The four groups exhibit a trend of increasing hearing thresholds with higher frequencies in the 0.25-8 kHz range. Among them, the 55-79 age group still shows an upward trend in hearing thresholds in the 8-12 kHz range(Data are presented as mean ± standard deviation). In comparison, the 80 and above age group exhibits a downward trend in hearing thresholds above 8 kHz, eventually converging with the other three groups at 16 kHz. Compared to the 55-59 age group, the 60-69 age group shows no significant differences in hearing thresholds at various frequencies. The 70-79 age group has significantly higher thresholds at 4-16 kHz, while the 80 and above age group shows significant increases in hearing thresholds at all frequencies from 0.25-16 kHz (p<0.05, multiple t-tests, corrected by Holm-Sidak method).

Figure 4

Table 4. GLM Analysis of PTA

Figure 5

Table 5. GLM Analysis of EHF

Figure 6

Figure 2. Distribution of PTA and WRS50 in Different Age Groups

The PTA (0.5-4kHz) for the four age groups were 31.25±10.15, 34.41±9.67, 42.55±9.49, and 57.03±13.19 dB, while the average WRS50 values were 30.07±8.97, 33.19±11.28, 39.25±9.19, and 53.29±16.22 dB, respectively. Both the PTA and WRS50 scores showed an increasing trend with age. The differences in PTA-WRS50 values for the four age groups were 1.73±7.11, 2.16±7.31, 3.17±8.07, and 1.22±8.83 dB, respectively.
Figure 7

Figure 3. Mean PTA and EHF for the Normal (PTA < 25 dB HL) Group and Hearing Loss Groups.

In the normal hearing group aged 55 and above, the 10 and 12 kHz threshold values had 95% confidence intervals of (34.77, 49.30) and (56.98, 65.81), respectively. In the mild hearing loss group, the 95% confidence intervals for 10 and 12 kHz thresholds were (48.95, 56.53) and (59.38, 64.30), respectively. Significant differences were observed in the threshold levels between the normal hearing group and the mild hearing loss group from 0.25 kHz to 10 kHz (multiple t-tests, corrected by the Holm-Sidak method). However, there was a significant overlap in the 12kHz thresholds, and no significant difference was found between the two groups at this frequency.
Figure 8

Figure 4. Correlation and Comparison of 8 kHz-4 kHz and 12 kHz-8 kHz Threshold Differences in Different Hearing Groups.

(C-D) In the moderate-to-moderately severe hearing loss group, the 12 kHz-8 kHz threshold difference was 4.09±19.07, significantly lower than the 8 kHz-4 kHz threshold difference of 12.88±17.68, and both showed a significant negative correlation.In the severe-to-profound hearing loss group, the 12 kHz-8 kHz threshold difference was -15.89±10.17, significantly lower than the 8 kHz-4 kHz threshold difference of 8.39±10.97. Although most individuals in this group had a 12 kHz-8 kHz threshold difference less than 0, the correlation between the two differences was not statistically significant. (A-B) In the normal hearing and mild hearing loss groups, the 12 kHz-8 kHz threshold difference was 19.91±19.22, and the 8 kHz-4 kHz threshold difference was 13.38±15.06. There was no significant difference between the two differences, but they showed a significant negative correlation.