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Inicio Acta Otorrinolaringológica Española Extended High-frequency Audiometry (9000–20000Hz). Usefulness in Audiological ...
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Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y

Vol. 67. Issue 1.
Pages 40-44 (January - February 2016)
Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y
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Vol. 67. Issue 1.
Pages 40-44 (January - February 2016)
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DOI: 10.1016/j.otoeng.2015.02.001
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Extended High-frequency Audiometry (9000–20000Hz). Usefulness in Audiological Diagnosis
Audiometría con extensión en altas frecuencias (9.000-20.000Hz). Utilidad en el diagnóstico audiológico
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Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y
Antonio Rodríguez Valiente
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, Amaya Roldán Fidalgo , Ithzel M. Villarreal Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y , José R. García Berrocal
Grupo de Investigación Otológica, Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Table 1. Subjects on Whom Extended High-frequency Audiometry was Performed.
Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y

Early detection and appropriate treatment of hearing loss are essential to minimise the consequences of hearing loss. In addition to conventional audiometry (125–8000Hz), extended high-frequency audiometry (9000–20000Hz) is available. This type of audiometry may be useful in early diagnosis of hearing loss in certain conditions, such as the ototoxic effect of cisplatin-based treatment, noise exposure or oral misunderstanding, especially in noisy environments. Eleven examples are shown in which extended high-frequency audiometry has been useful in early detection of hearing loss, despite the subject having a normal conventional audiometry. The goal of the present paper was to highlight the importance of the extended high-frequency audiometry examination for it to become a standard tool in routine audiological examinations.

Extended high-frequency audiometry
Hearing loss
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La detección precoz y el tratamiento adecuado de la hipoacusia es fundamental para minimizar las consecuencias de la pérdida auditiva. Además de la audiometría convencional (125-8.000Hz), disponemos de la audiometría con extensión en altas frecuencias (9.000-20.000Hz), que puede ser de gran utilidad en el diagnóstico precoz de hipoacusia en ciertas patologías, como es el efecto ototóxico de los tratamientos quimioterápicos, la exposición a ruido o el mal entendimiento del lenguaje, especialmente en ambientes ruidosos. Aquí se presentan 11 casos clínicos en los que la audiometría con extensión en altas frecuencias ha ayudado en la detección precoz de la hipoacusia en diversas patologías, a pesar de tener una audiometría normal en frecuencias convencionales. Se pretende así destacar la importancia de la exploración audiométrica en altas frecuencias, con el fin de que se convierta en una herramienta habitual en la exploración audiológica.

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Audiometría con extensión en altas frecuencias
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Many factors are known to affect hearing, such as age, exposure to noise and taking potentially hearing-toxic drug. Both early detection of hearing loss and early intervention are essential to minimise hearing loss.Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y

Hearing is assessed through conventional tonal audiometry (125–8000Hz). However, the human ear possesses an auditory range that reaches up to 20000Hz. Frequencies between 9000 and 20000Hz are called extended high frequencies Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y (EHFs) in the international literature. Castilian Spanish has no defined equivalent term; such frequencies are called high frequencies, ultra-high frequencies or extended high frequencies by different authors, with the last term being the one that we are going to use to refer to them.

The involvement of EHFs in auditory pathology is multiple. They can affect locating the sound 1 and understanding language, especially in noisy surroundings. 2,3 They have also been linked with age-related hearing loss, ototoxicity and acoustic trauma. The ability to hear reduces bit by bit with age; this loss begins at the highest frequencies and progressively extends toward the lowest frequencies. The EHFs consequently become of special importance in age-related hearing loss, as a method for early detection of such loss.

An important role is played by EHF audiometry in monitoring the ototoxic effect of drugs such as cisplatin, which produces an initial hearing loss in the EHF range, later affecting conventional frequencies. 4 However, the usefulness of EHF audiometry compared with conventional frequencies in early detection of acoustic trauma is still being debated. 5–8

Reference hearing thresholds distributed by age groups have recently been published for both conventional frequencies 9 and EAF. 10,11 These values let us compare a subject's hearing with the standard for an otologically normal population and establish the extent to which the subject's hearing departs from normality expressed as a percentile. We can thus evaluate patients being treated with chemotherapy or exposed to noise that report a hearing loss and for whom there is no prior audiometry available.

The objective of this study was to emphasise the importance of EHF audiometry, to help to make it a normal tool in audiological examination. To do so, we present a series of clinical cases in which this type of audiometry has aided in early detection of various pathologies.

Methods Subjects

The data for 11 subjects that consulted with suspicion of auditory pathology have been gathered. Each subject's audiometry at conventional frequencies was normal, and we performed an EHF audiometry on all the subjects (Table 1). The patients selected presented several pathologies that can cause hearing loss over the evolution of the disease.

Table 1.

Subjects on Whom Extended High-frequency Audiometry was Performed.

Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y
Case Age Sex Pathology
1 24 Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y M Fabry disease
2 26 M Tinnitus following minoxidil
3 20 F Nasopharyngeal Ca treated with RT
4 21 M Rock musician
5 26 M Sinonasal Ca treated with RT+cisplatin
6 39 M Lack of understanding in noisy surroundings
7 38 M Suspicion of genetic hearing loss
8 33 M Fluctuating hearing loss
9 39 F Suspicion of autoimmune hearing loss
10 49 M Tinnitus
11 45 F Treatment with cyclophosphamide+MTX+5-FU

Ca: carcinoma; FU: fluorouracil; M: male; F: female; MTX: methotrexate; RT: radiotherapy.

Instrumental and Procedure

All selected subjects received air-conduction pure-tone audiometry to determine the hearing threshold at different frequencies (125–20000Hz). The audiometric results obtained were compared with the previously-published normal Spanish population values at conventional frequencies 9 and at EAFs. 10 Reposapiés Plegable 391808 Modelo Onshore Camuflaje Silla Con kOuiZTPX

For the conventional frequency audiometry at conventional frequencies (125–8000Hz), a Madsen Orbiter 922 clinical audiometer and supra-aural Telephonics TDH-39 earphones were used. The EHF audiometry (9000–20000Hz) was performed with the same audiometer and Koss HV/1A circumaural earphones. All the audiometric material was calibrated according to the manufacturers’ recommendations as well as to ISO 389-112 and IEC 60645-113 standards. The transducers were calibrated according to ISO 389-112 standards.

The audiometry was performed manually by trained personnel, in agreement with ISO 8253-114 standards, within a sound-proof booth. Auditory thresholds were determined based on the ascending method established in ISO 8253-114 standards. The thresholds at the conventional frequencies were calculated in decibels hearing level (dB HL) and the thresholds at EHFs, in dB sound pressure level (dB SPL).


Table 1 presents a summary of the characteristics of the subjects on which audiometry was performed using both conventional frequencies and EHFs.

Cases 1, 2, and 3 presented normal hearing levels up to 8000Hz, with a drop to under the 95th percentile (P95) for their age group (20–29 years) at the frequencies from 9000Hz (Fig. 1).

Figure 1.

Audiometry for subjects 1–5 compared with the median (m) and the 95th percentile (P95) for the age group of 20–29 years.

Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y

Case 4, who had been a musician in a rock group for 2 years, presented a hearing level lower than P95 only at the frequencies of 9000, 11200 and 12500Hz (Fig. 1). The frequencies at which the subject departed most from the median were 12000 and 16000Hz.

Case 5 was a 26-year-old woman with sinonasal carcinoma, who had received treatment with radiotherapy and 3 cycles of cisplatin a year earlier. She presented a hearing level lower than P95 from 4000Hz (Fig. 1).

Case 6, who reported difficulties understanding in noisy surroundings, presented a hearing level very close to the median for his age group (30–39 years), with a drop to under P95 at frequencies from 14000Hz (Fig. 2).

Figure 2.

Audiometry for subjects 6–9 compared with the median (m) and the 95th percentile (P95) for the age group of 30–39 years.

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Cases 7, 8 and 9 presented hearing levels lower than P95 from 9000, 8000 and 4000Hz, respectively (Fig. 2).

Case 10 reported having tinnitus without hearing loss. Audiometry revealed a hearing level below P95 for the subject's age group (40–49 years) from 9000Hz. Hearing at all the conventional frequencies was very close to the median for the age group (Fig. 3).

Figure 3.

Audiometry for subjects 10 and 11 compared with the median (m) and the 95th percentile (P95) for the age group of 40–49 years.


Case 11, a 45-year-old man that had received treatment with cyclophosphamide, methotrexate and 5-fluorouracil, presented a hearing level under P95 from 9000Hz. Audiometry in conventional frequencies was normal, although it was very close to P95 at 500 and 2000Hz (Fig. 3).


Certain systemic pathologies can cause sensorineural hearing loss, which can be detected early by performing EHF audiometry. Fabry disease is a hereditary x-linked lysosomal storage disease. Within the clinical picture this disease produces is sensorineural hearing loss. In Case 1, the subject showed no hearing loss, with normal audiometry at conventional frequencies, which could lead us to believe that this subject presented no hearing compromise. However, when EHF audiometry was performed, an important loss at all the frequencies between 9000 and 20000Cromo Oficina MetalnegroSillas Patas Silla De Con Polipropileno Ruedas Janice QrCxBedoWHz was seen.

Many patients come to consultation for tinnitus, without reporting hearing loss, as Cases 2 and 10 did. In Case 2, the subject reported tinnitus and dizziness after using minoxidil. Audiometry at conventional frequencies was normal; however, the EHF audiometry revealed that the hearing thresholds were much below normal, a loss that could explain the tinnitus.

Radiotherapy in the head area is another cause of sensorineural hearing loss. In Case 3, a patient treated with radiotherapy due to a nasopharyngeal carcinoma, presented a hearing loss that was only detectable in the EHF audiometry, especially at the frequencies between 9000 and 16000Hz.

Case 4 was a subject exposed to very loud music. A hearing loss could be seen in EHF audiometry, especially at the frequencies located between 11200 and 14000Hz, departing further from the median at 12000 and 16000Hz.

Some authors have found that acoustic trauma affects the frequencies of 3000–6000Hz and that it also affects EAF considerably,5 especially at 14000Hz6 and 16000Hz.7 EHF audiometry is more sensitive than conventional audiometry, particularly in young subjects,7 although not all authors believe that EHF audiometry provides additional information.8 Consequently, we still do not have conclusive data to establish the usefulness of EHF audiometry in early detection of noise-induced hearing loss.

The usefulness of EHF audiometry is well know in early detection of hearing loss in subjects submitted to platinum-derived chemotherapy treatments, with cisplatin being the drug that presents the greatest risk of developing ototoxic effects. Other chemotherapy drugs such as methotrexate and cyclophosphamide are also known to cause sensorineural hearing loss. In Case 5, the patient was treated with cisplatin and, in the audiometry, a severe hearing loss was revealed, even detectable at the conventional frequencies (4000Hz). It is important to point out that, although the hearing threshold was extremely reduced, hearing was maintained at all the frequencies up to 20000Hz. This is something that occurs in younger subjects, who preserve their hearing up to very high frequencies, even though their hearing is lower than normal (Fig. 1). In Case 11, the compromise in hearing could only be seen when the audiometry was performed at EHFs.

The frequencies included between 500 and 4000Hz have traditionally been considered to be the most important for understanding speech. The range of conversational frequencies of the human voice lies between 250 and 3000Hz; however, it is true that some phonemes are located between 4000 and 8000Ruedas Portátil Viaje Silla De Ligero Tránsito Plegable nv8Nwm0OHz, or even at higher frequencies, especially in fricative consonants.3 Understanding speech poorly in noisy environments, as occurred in Case 6, could be explained by the hearing loss at the higher frequencies (in this case, at the frequencies above 14000Hz).

Many cases with suspicion of deafness arising from genetic or autoimmune origin can benefit from performing an EHF audiometric test for early detection of the hearing loss. In Cases 7, 8 and 9, this loss of hearing was revealed at the EHFs, with greater or lesser compromise of the highest conventional frequencies.

For all these reasons, EHF audiometry can be extremely useful in early detection of sensorineural hearing loss. Performance of EHF audiometry should consequently be established in normal clinical practice to expand the study of patient hearing ranges.

Conflict of Interests

The authors have no conflicts of interest to declare.

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Hermosa Comedor Sillas De Oca La Silla Modernas Y Disea±o mnvN0wO8y
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[8]De Silla Modelo Color Ossa Bali En Blanca Tejido Pálido Rosa Oficina K3FcuTl1J
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Please cite this article as: Rodríguez Valiente A, Roldán Fidalgo A, Villarreal IM, García Berrocal JR. Audiometría con extensión en altas frecuencias (9.000-20.000Hz). Utilidad en el diagnóstico audiológico. Acta Otorrinolaringol Esp. 2016;67:40–44.

Copyright © 2015. Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial
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