Download PDF
J Am Acad Audiol 2020; 31(06): 371-383
DOI: 10.3766/jaaa.19030
Research Article
American Academy of Audiology. All rights reserved. (2020) American Academy of Audiology

Determinants of the Audiometric Notch at 4000 and 6000 Hz in Young Adults

Ishan Sunilkumar Bhatt
1   Department of Communication Sciences & Disorders, Northern Arizona University, Flagstaff, AZ
› Author Affiliations
Further Information

Publication History

Publication Date:
03 August 2020 (online)

   Permissions and Reprints

Abstract

Background Noise-induced hearing loss (NIHL) is often characterized by the presence of an audiometric notch at 3000-6000 Hz in a behavioral audiogram. The audiometric notch is widely used to investigate NIHL in children and young adults. However, the determinants of the audiometric notch in young adults largely remain unknown.

Purpose The study aimed to investigate the determinants of the audiometric notch in young adults.

Research Design A cross-sectional design was adopted for the study.

Study Sample A sample of 124 adults (38 males and 86 females) aged 18-35 years with normal otoscopic and tympanometric findings was recruited.

Data Collection and Analysis Hearing thresholds and real-ear sound pressure levels (RESPLs) were obtained with calibrated ER-3A (Etymotic Research, Elk Grove Village, IL) andTDH-50P receivers (Telephonics, Farmingdale, NY). Distortion-product otoacoustic emissions (DPOAEs) were used to evaluate the cochlear function. The external auditory canal (EAC) length was measured using the acoustical method. Noise exposure background (NEB) was estimated using the Noise Exposure Questionnaire. The notched audiograms were identified using: Phillips, Coles, and Niskar criteria.

Results The prevalence of notched audiograms was substantially higher for TDH-50P supra-aural receivers than for ER-3A insert receivers. RESPLs at 6000 and 8000 Hz were the major predictors of notched audiograms for TDH-50P receivers. These predictors explained around 45% of the variance in the notched audiograms. The notched audiograms obtained with TDH-50P receivers showed no association with NEB. Individuals with notched audiograms measured using TDH-50P did not show convincing evidence of cochlear dysfunction as assessed by DPOAEs. Individuals with notched audiograms obtained with TDH-50P receivers revealed an average of shorter EAC and a poorer hearing threshold at 6000 Hz.

Conclusions The calibration error in the RESPLs at 6000 and 8000 Hz that are likely to be influenced by the shorter EAC was the major determinant of the notched audiograms when the supra-aural transducers were used to measure hearing thresholds. Therefore, the supra-aural receivers should not be used to estimate the prevalence of NIHL in children and young adults when the less restrictive notch identification criteria are used to identify NIHL. Real-ear calibration techniques that are least influenced by the standing waves in the EAC should be preferred when investigating the prevalence of and risk factors for NIHL in young adults.

Keywords

audiometric notch - noise-induced hearing loss - notched audiograms - real-ear sound pressure level - real-ear threshold sound pressure level

Supplementary Material

 

  • References

  • 1 Agarwal Y, Platz EA, Niparko JK. Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. Otol Neurotol 2009; 30 (02) 139-145
    CrossrefPubMedGoogle Scholar
  • 2 American National Standards Institute (ANSI). American National Standard, Specification for Audiometers (ANSI S3. 6-2010). New York, NY: ANSI; 2010
    Google Scholar
  • 3 Attias J, Horovitz G, El-Hatib N, Nageris B. Detection and clinical diagnosis of noise-induced hearing loss by otoacoustic emissions. Noise Health 2001; 03 (12) 19-31
    Google Scholar
  • 4 Barlow C, Davison L, Ashmore M, Weinstein R. Amplitude variation in calibrated audiometer systems in clinical simulations. Noise Health 2014; 16 (72) 299-305
    CrossrefPubMedGoogle Scholar
  • 5 Bhatt I. Increased medial olivocochlear reflex strength in normal-hearing, noise-exposed humans. PLoS One 2017; 12 (09) e0184036
    CrossrefPubMedGoogle Scholar
  • 6 Bhatt IS, Guthrie O. Analysis of audiometric notch as a noise-induced hearing loss phenotype in US youth: data from the national health and nutrition examination survey, 2005–2010. Int J Audiol 2017; 56 (06) 392-399
    CrossrefPubMedGoogle Scholar
  • 7 British Society of Audiology. Recommended procedure: Pure tone air and bone conduction threshold audiometry with and without masking and determination of uncomfortable loudness levels. Reading: British Society of Audiology. 2011. http://www.thebsa.org.uk/wp-content/uploads/2014/04/BSA_RP_PTA_FINAL_24Sept11_MinorAmend06Feb12.pdf
  • 8 British Standards Institute. BS EN ISO 389-1: 2000 Acoustics-Reference Zero for the Calibration of Audiometric Equipment. Part 1: Reference Equivalent Thresholds for Pure Tones and Supra Aural Headphones. London: British Standards Institute; 2000
    Google Scholar
  • 9 Carter L, Williams W, Black D, Bundy A. The leisure-noise dilemma: hearing loss or hearsay? What does the literature tell us?. Ear Hear 2014; 35 (05) 491-505
    CrossrefPubMedGoogle Scholar
  • 10 Centers for Disease Control. 2017. National health and nutrition examination survey. https://www.cdc.gov/nchs/nhanes/index.htm . Accessed March 14, 2018
    Google Scholar
  • 11 Chen G, Fechter LD. The relationship between noise-induced hearing loss and hair cell loss in rats. Hear Res 2003; 177 (01) 81-90
    CrossrefPubMedGoogle Scholar
  • 12 Cody A, Russell I. Outer hair cells in the mammalian cochlea and noise-induced hearing loss. Nature 1985; 315 (6021): 662-665
    CrossrefPubMedGoogle Scholar
  • 13 Coles RR, Lutman ME, Buffin JT. Guidelines on the diagnosis of noise-induced hearing loss for medicolegal purposes. Clin Otolaryngol Allied Sci 2000; 25 (04) 264-273
    CrossrefPubMedGoogle Scholar
  • 14 Dirks DD, Ahlstrom J, Eisenberg L. Comparison of probe insertion methods on estimates of ear canal SPL. J Am Acad Audiol 1996; 7: 31-38
    PubMedGoogle Scholar
  • 15 Engdahl B, Kemp DT. The effect of noise exposure on the details of distortion product otoacoustic emissions in humans. J Acoust Soc Am 1996; 99 (03) 1573-1587
    CrossrefPubMedGoogle Scholar
  • 16 Flamme GA, Stephenson MR, Deiters KK, Hessenauer A, Van Gessel DK, Geda K, McGregor KD. Short-term variability of pure-tone thresholds obtained with TDH-39P earphones. Int J Audiol 2014; 53 (02) S5-S15
    CrossrefPubMedGoogle Scholar
  • 17 Frank T, Vavrek MJ. Reference threshold levels for an ER-3A insert earphone. J Am Acad Audiol 1992; 03 (01) 51-59
    Google Scholar
  • 18 Henderson E, Testa MA, Hartnick C. Prevalence of noise-induced hearing-threshold shifts and hearing loss among US youths. Pediatrics 2011; 127 (01) e39-e46
    CrossrefPubMedGoogle Scholar
  • 19 International Electrotechnical Commission. Electroacoustics: audiological equipment. Part 1: pure tone audiometers. IEC 60645-1:2001. Geneva: IEC; 2001
    Google Scholar
  • 20 Kirchner DB, Evenson E, Dobie RA, Rabinowitz P, Crawford J, Kopke R, Hudson TW. Occupational noise-induced hearing loss: ACOEM task force on occupational hearing loss. J Occup Environ Med 2012; 54 (01) 106-108
    CrossrefPubMedGoogle Scholar
  • 21 Kummer P, Janssen T, Arnold W. The level and growth behavior of the 2 f1-f2 distortion product otoacoustic emission and its relationship to auditory sensitivity in normal hearing and cochlear hearing loss. J Acoust Soc Am 1998; 103 (06) 3431-3444
    CrossrefPubMedGoogle Scholar
  • 22 Lawton BW. Variation of young normal-hearing thresholds measured using different audiometric earphones: implications for the acoustic coupler and the ear simulator. Int J Audiol 2005; 44 (08) 444-451
    CrossrefPubMedGoogle Scholar
  • 23 Le Prell C, Hensley B, Campbell K, Hall III J, Guire K. Evidence of hearing loss in a ’normally-hearing’ college-student population. Int J Audiol 2011; 50 (01) S21-S31
    CrossrefPubMedGoogle Scholar
  • 24 Lee JS, Choi HG, Jang JH, Sim S, Hong SK, Lee H, Kim H. Analysis of predisposing factors for hearing loss in adults. J Korean Med Sci 2015; 30 (08) 1175-1182
    CrossrefPubMedGoogle Scholar
  • 25 Lee J, Dhar S, Abel R, Banakis R, Grolley E, Lee J, Siegel J. Behavioral hearing thresholds between 0.125 and 20 kHz using depth-compensated ear simulator calibration. Ear Hear 2012; 33 (03) 315-329
    CrossrefPubMedGoogle Scholar
  • 26 Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF. Toward a differential diagnosis of hidden hearing loss in humans. PLoS One 2016; 11 (09) e0162726
    CrossrefPubMedGoogle Scholar
  • 27 Lie A, Skogstad M, Johnsen TS, Engdahl B, Tambs K. The prevalence of notched audiograms in a cross-sectional study of 12,055 railway workers. Ear Hear 2015; 36 (03) e86-e92
    CrossrefPubMedGoogle Scholar
  • 28 Mahboubi H, Zardouz S, Oliaei S, Pan D, Bazargan M, Djalilian HR. Noise-induced hearing threshold shift among US adults and implications for noise-induced hearing loss: national health and nutrition examination surveys. Eur Arch Otorhinolaryngol 2013; 270 (02) 461-467
    CrossrefPubMedGoogle Scholar
  • 29 Marshall L, Lapsley Miller JA, Heller LM. Distortion-product otoacoustic emissions as a screening tool for noise-induced hearing loss. Noise Health 2001; 03 (12) 43-60
    Google Scholar
  • 30 Marshall L, Lapsley Miller JA, Heller LM, Wolgemuth KS, Hughes LM, Smith SD, Kopke RD. Detecting incipient inner-ear damage from impulse noise with otoacoustic emissions. J Acoust Soc Am 2009; 125 (02) 995-1013
    CrossrefPubMedGoogle Scholar
  • 31 McBride DI, Williams S. Audiometric notch as a sign of noise induced hearing loss. Occup Environ Med 2001; 58 (01) 46-51
    CrossrefPubMedGoogle Scholar
  • 32 Megerson SC. Development of a screening tool for identifying young people at risk for noise-induced hearing loss [dissertation]. Lawrence, KS: University of Kansas; 2010
    Google Scholar
  • 33 Munro K, Davis J. Deriving the real-ear SPL ofaudiometric data using the ’’coupler to dial difference” and the “real ear to coupler difference”. Ear Hear 2003; 24 (02) 100-110
    PubMedGoogle Scholar
  • 34 Munro K, Lazenby A. Use of the ’real-ear to dial difference’ to derive real-ear SPL from hearing level obtained with insert earphones. Br J Audiol 2001; 35 (05) 297-306
    CrossrefPubMedGoogle Scholar
  • 35 National Institute on Deafness and other Communication Disorders. 2016. Quick statistics about hearing. https://www.mdcd.nih.gov/health/statistics/quick-statistics-hearing . Accessed March 14, 2018
    Google Scholar
  • 36 Neely ST, Gorga MP. Comparison between intensity and pressure as measures of sound level in the ear canal. J Acoust Soc Am 1998; 104 (05) 2925-2934
    CrossrefPubMedGoogle Scholar
  • 37 Niemitz C, Nibbrig M, Zacher V. Human ears grow throughout the entire lifetime according to complicated and sexually dimorphic patterns-conclusions from a cross-sectional analysis. Anthropol Anz 2007; 65 (04) 391-413
    CrossrefPubMedGoogle Scholar
  • 38 Niskar AS, Kieszak SM, Holmes AE, Esteban E, Rubin C, Brody DJ. Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: the third national health and nutrition examination survey, 1988-1994, United States. Pediatrics 2001; 108 (01) 40-43
    CrossrefPubMedGoogle Scholar
  • 39 Niskar AS, Kieszak SM, Holmes A, Esteban E, Rubin C, Brody DJ. Prevalence of hearing loss among children 6 to 19 years of age: the third national health and nutrition examination survey. JAMA 1998; 279 (14) 1071-1075
    CrossrefPubMedGoogle Scholar
  • 40 Nondahl DM, Shi X, Cruickshanks KJ, Dalton DS, Tweed TS, Wiley TL, Carmichael LL. Notched audiograms and noise exposure history in older adults. Ear Hear 2009; 30 (06) 696-703
    CrossrefPubMedGoogle Scholar
  • 41 Nordmann AS, Bohne BA, Harding GW. Histopathological differences between temporary and permanent threshold shift1. Hear Res 2000; 139 (1-2): 13-30
    CrossrefPubMedGoogle Scholar
  • 42 Pandit R, Sharma N, Shrestha R, Shrestha S, Yadav P. Morphometric study of external ear of medical students in college of medical sciences and teaching hospital, Bharatpur, Chitwan, Nepal. Int J Anat Res 2017; 5 (3.2): 4269-4274
    Google Scholar
  • 43 Phillips SL, Henrich VC, Mace ST. Prevalence of noise-induced hearing loss in student musicians. Int J Audiol 2010; 49 (04) 309-316
    CrossrefPubMedGoogle Scholar
  • 44 Phillips SL, Richter SJ, Teglas SL, Bhatt IS, Morehouse RC, Hauser ER, Henrich VC. Feasibility of a bilateral 4000–6000 Hz notch as a phenotype for genetic association analysis. IntJ Audiol 2015; 54 (10) 645-652
    Google Scholar
  • 45 Poling GL, Siegel JH, Lee J, Lee J, Dhar S. Characteristics of the 2 f 1-f 2 distortion product otoacoustic emission in a normal hearing population. J Acoust Soc Am 2014; 135 (01) 287-299
    CrossrefPubMedGoogle Scholar
  • 46 Scheperle RA, Neely ST, Kopun JG, Gorga MP. Influence of in situ, sound-level calibration on distortion-product otoacoustic emission variability. J Acoust Soc Am 2008; 124 (01) 288-300
    CrossrefPubMedGoogle Scholar
  • 47 Schlauch RS, Carney E. A multinomial model for identifying significant pure-tone threshold shifts. J Speech Lang Hear Res 2007; 50 (06) 1391-1403
    CrossrefPubMedGoogle Scholar
  • 48 Schlauch RS, Carney E. Are false-positive rates leading to an overestimation of noise-induced hearing loss?. J Speech Lang Hear Res 2011; 54 (02) 679-692
    CrossrefPubMedGoogle Scholar
  • 49 Scollie SD, Seeweld R, Cornelisse LE, Miller SM. Procedural considerations in the real-ear measurement of completely-in-the-canal instruments. J Am Acad Audiol 1998; 09: 216-220
    Google Scholar
  • 50 Shargorodsky J, Curhan SG, Curhan GC, Eavey R. Change in prevalence of hearing loss in US adolescents. JAMA 2010; 304 (07) 772-778
    CrossrefPubMedGoogle Scholar
  • 51 Shargorodsky J, Curhan SG, Henderson E, Eavey R, Curhan GC. Heavy metals exposure and hearing loss in US adolescents. Arch Otolaryngol Head Neck Surg 2011; 137 (12) 1183-1189
    CrossrefPubMedGoogle Scholar
  • 52 Siegel J. Ear-canal standing waves and high-frequency sound calibration using otoacoustic emission probes. J Acoust Soc Am 1994; 95 (05) 2589-2597
    CrossrefGoogle Scholar
  • 53 Souza NN, Dhar S, Neely ST, Siegel JH. Comparison of nine methods to estimate ear-canal stimulus levels. J Acoust Soc Am 2014; 136 (04) 1768-1787
    CrossrefPubMedGoogle Scholar
  • 54 Stamper GC, Johnson TA. Auditory function in normalhearing, noise-exposed human ears. Ear Hear 2015; 36 (02) 172-184
    CrossrefPubMedGoogle Scholar
  • 55 Stover L, Gorga MP, Neely ST, Montoya D. Toward optimizing the clinical utility of distortion product otoacoustic emission measurements. J Acoust Soc Am 1996; 100 (02) 956-967
    CrossrefPubMedGoogle Scholar
  • 56 Su BM, Chan DK. Prevalence of hearing loss in US children and adolescents: findings from NHANES 1988-2010. JAMA Otolaryngol Head Neck Surg 2017; 143 (09) 920-927
    CrossrefPubMedGoogle Scholar
  • 57 Subramaniam M, Salvi RJ, Spongr VP, Henderson D, Powers NL. Changes in distortion product otoacoustic emissions and outer hair cells following interrupted noise exposures. Hear Res 1994; 74 (1-2): 204-216
    CrossrefPubMedGoogle Scholar
  • 58 Valente M, Potts LG, Valente LM. Differences and intersubject variability of loudness discomfort levels measured in sound pressure level and hearing level for TDH-50P and ER-3A earphones. J Am Acad Audiol 1997; 08 (01) 59-67
    Google Scholar
  • 59 Valente M, Potts LG, Valente LM, Vass W, Goebel J. Intersubject variability of real-ear sound pressure level: conventional and insert earphones. J Am Acad Audiol 1994; 05 (06) 390-398
    Google Scholar
  • 60 Verma P, Sandhu HK, Verma KG, Goyal S, Sudan M, Ladgotra A. Morphological variations and biometrics of ear: An aid to personal identification. J Clin Diagn Res: JCDR 2016; 10 (05) ZC138
    PubMedGoogle Scholar
  • 61 Wei W, Heinze S, Gerstner DG, Walser SM, Twardella D, Reiter C, Herr CE. Audiometric notch and extended high-frequency hearing threshold shift in relation to total leisure noise exposure: an exploratory analysis. Noise Health 2017; 19 (91) 263
    CrossrefPubMedGoogle Scholar