European Archives of Oto-Rhino-Laryngology (2023) 280:565–572

https://doi.org/10.1007/s00405-022-07498-1

OTOLOGY

Extended high‑frequency audiometry: hearing thresholds in adults

Michaela Škerková1 · Martina Kovalová1 · Tomáš Rychlý1 · Hana Tomášková1 · Hana Šlachtová1 · Zdeněk Čada3 ·
Rastislav Maďar1 · Eva Mrázková1,2,4

Received: 1 March 2022 / Accepted: 7 June 2022 / Published online: 28 June 2022
© The Author(s) 2022

Abstract
Purpose This study aimed to determine hearing thresholds in an otologically normal population without occupational noise
exposure aged 18 to 64 years using extended high-frequency audiometry (EHFA).
Methods Individuals from the general population who have never had hearing problems and whose job was not associated
with noise exposure were included in the study and classified by age into 5 categories: 18–24 and, further, by 10 years of
age. Each of these groups was further divided according to gender. All subjects underwent tympanometry, conventional
pure-tone audiometry within the 0.125–8 kHz range, and extended high-frequency audiometry within the 9–16 kHz range,
performed according to the standards. The significance level for statistical testing was set at 5%.
Results Here, we established hearing thresholds in an otologically healthy population within the extended high-frequency
(EHF) range (9–16 kHz). We found the EHFA to be a highly sensitive method for early detection of hearing loss, with hear-
ing thresholds decreasing as soon as 35 years of age. In males, the hearing thresholds grew with age more rapidly than in
women. The ability to respond at EHF gradually decreased with age and increasing frequency.
Conclusion Our results can help improve the knowledge of EHF hearing thresholds for individual sexes and age groups. So
far, the standard 7029:2017 is not binding and, moreover, it only reaches up to the frequency of 12.5 kHz. EHFA is a highly
sensitive method for the evaluation of hearing loss depending on age and sex.

Keywords Hearing loss · Audiometry · Hearing test · Extended high-frequency audiometry · Hearing threshold ·
Audiogram

Abbreviations Introduction
EHF Extended high-frequency
EHFA Extended high-frequency audiometry Hearing impairment is globally a highly topical issue. Nearly
WHO World Health Organization 2.5 billion people worldwide will be living with some degree
of hearing loss by 2050, warns the World Health Organiza-
tion’s (WHO) first World Report on Hearing. At least 700
million of these people will require access to ear and hearing
care and other rehabilitation services unless action is taken
* Michaela Škerková [1]. Hearing impairment, if not identified and addressed,
[email protected] can have far-reaching consequences, adversely affecting lan-
guage development, psychosocial well-being, quality of life,
1
Department of Epidemiology and Public Health, Faculty educational attainment, and economic independence at vari-
of Medicine, University of Ostrava, 703 00 Ostrava,
Czech Republic
ous stages of life [2, 3]. Unaddressed, hearing loss imposes
2
a global annual cost of more than $980 billion. Causes of
Hospital Center for Hearing and Balance Disorders,
708 00 Ostrava, Czech Republic
hearing impairment and hearing loss are multifactorial,
3
including genetic causes, complications at birth, infectious
Department of Otorhinolaryngology and Head and Neck
Surgery, 1st Faculty of Medicine Charles University
diseases, the use of ototoxic medications, sex, exposure to
in Prague and Motol University Hospital, Postgraduate noise, aging, etc. Among this variety of factors involved in
Medical School, 150 06 Prague 5, Czech Republic hearing loss, aging is one of the most widely recognized [2,
4
Department of ENT, Regional Hospital Havirov, 4]. Hearing loss also comes with consequences, for example,
736 01 Havirov, Czech Republic

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566 European Archives of Oto-Rhino-Laryngology (2023) 280:565–572

it has been proven to be the most significant risk factor for ENT outpatient clinic, which was a part of a multidiscipli-
dementia development in middle-aged people (45–65 years nary facility. Only individuals who have never had any hear-
of age) [5]. Hearing impairment should be revealed as soon ing problems, self-assessed their hearing as “normal” and
as possible; this is, however, typically not the case as adults neither otoscopy nor tympanometry revealed any abnormali-
typically underestimate the seriousness and implications of ties were included in the study. The study group consisted of
any hearing problems, thus delaying treatment. Hearing aids individuals aged 18–64 years who worked in a job without
are, therefore, predominantly reaching the older population. professional noise exposure (A-weighted equivalent sound
The COVID-19 pandemic has underlined the importance of pressure level ­LAeq,8 h < 80 dB), randomly selected from the
hearing. As we have struggled to maintain social contact database of the facility who were not previously patients of
and remain connected to family, friends, and colleagues, we the ENT clinic were offered participation. The study group
have relied on being able to hear them more than ever before. was drawn from the socially consistent general population
Covering mouths with face masks made lip-reading also living in the same industrial region burdened also with traf-
impossible, which made many people with impaired hearing fic noise. Statistical evaluation was then limited only to data
who might have not even been aware of this problem start from participants whose tympanic membrane was assessed
to take interest in their hearing [2]. Preventing and treating to be normal during otoscopic examination, whose immit-
diseases and disabilities of all kinds should not be perceived tance test of the middle ear (type A tympanometry curve)
as a cost but rather as an investment in a safer, fairer, and was normal and hearing loss at frequencies of 0.5; 1; 2; and
more prosperous world for all people [2]. As early diagnosis 4 kHz was lower than 25 dB. The history of noise exposure
is the key to the treatment of practically any disease, find- in public areas and leisure activities was not investigated
ing a method capable of diagnosing hearing disorders at an in this work; however, professional exposure to workplace
early stage is of great importance. Extended high-frequency noise was an exclusion criterion. The recruited individuals
(EHFA), a method used to examine hearing thresholds in were divided into age categories of 18–24, 25–34, 35–44,
the frequency range of 8–20 kHz, could be valuable in this 45–54, 55–64 years. The exclusion criteria were as follows:
context as the damage to hearing thresholds can typically be disagreement with inclusion in the study or with signing
first observed at these frequencies [6]. EHFA is, therefore, informed consent, age outside the range of 18–64 years, pro-
a very useful test, which can detect hearing loss early, i.e., fessional noise exposure, pathological result of an otoscopic
before it starts involving the medium and low frequencies examination, type B or C tympanometric curve, or hearing
that significantly affect hearing capacity [7]. EHFA has been threshold of more than 25 dB at 0.5, 1, 2, or 4 kHz.
studied for several decades but the lack of commercially
available equipment (adapted audiometers capable of gen- Hearing measurement
erating tones with frequencies of up to 20 kHz are used for
the test) and the standardization of calibration recommen- Participants had been advised in the invitation that 24 h
dations have been limiting its use for a long time [8]. The before the examination, they should not use personal audio
EN ISO 7029 standard valid for frequencies of 0.125–8 kHz devices and they should avoid exposure to excessive noise.
in individuals with normal hearing was under development Before beginning the examination, the participants were
for decades [9]. The current version, EN ISO 7029:2017, briefed about the process and the principle of the audio-
remains only informative for hearing thresholds at frequen- metric measurements. Data collection began with taking
cies from 9 to 12.5 kHz and no hearing thresholds have been a brief personal history and other data needed for further
established for higher frequencies [9]. The presented study processing. This was followed by tympanometry (Madsen
aimed to determine hearing thresholds at high frequencies Zodiac Diagnostic, type 1096), conventional pure-tone audi-
(9–16 kHz) in an otologically normal population aged 18–64 ometry, and high-frequency audiometry (Madsen Astera 2,
without professional noise exposure using EHFA. Headset Sennheiser HDA300), performed according to the
standards EN ISO 8253-1:2010 Acoustics—Audiometric
test methods and EN ISO 266:1997 Acoustics—Preferred
Methods frequencies [10, 11]. These standards were last reviewed
and confirmed in 2018 and 2021, respectively; as such, these
Study population versions can be considered current. All instruments were
calibrated before the beginning of the measurement. The
This study was performed in accordance with the Declara- examination was performed always by the same personnel
tion of Helsinki and approved by the Ethics Committee of in an acoustic chamber. The respondents were equipped
the University of Ostrava. All individuals completed and with headphones, through which tones of different inten-
signed an informed consent form prior to inclusion in the sities and frequencies were played, first into one ear, then
study. The data were collected between 2020 and 2021 at the into the other. The measurement started with the ear that

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European Archives of Oto-Rhino-Laryngology (2023) 280:565–572 567

the participant identified as the one with better hearing. If Comparison of left and right ears
the participant did not perceive a subjective difference of
hearing between the ears, the measurement began in the left A statistical analysis of hearing thresholds between the right
ear. The hearing threshold was measured at conventional and left ears for each sex and age group was performed. No
(0.125, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8 kHz), as well as statistically significant difference was found and for this rea-
extended high frequencies (EHF; 9, 10, 11.25, 12.5, 14, and son, further analyses do not distinguish the laterality.
16 kHz). The result was plotted as an audiogram in which
the hearing thresholds was expressed in dB (decibel hearing Comparison of hearing threshold medians
level, dB HL) for each frequency and separately for each ear. between sexes
The average values of hearing loss for individual frequencies
were calculated, the average threshold curves for individual Table 2 details median hearing thresholds at frequencies
age categories were compiled and statistically compared 0.125–16 kHz in men and women. The hearing thresholds
to determine the differences in hearing thresholds (in dB) generally increased with age and frequency; this observa-
among groups. tion was more pronounced in men. The biggest differences
in hearing thresholds between sexes were observed in the
Statistical analyses 35–44 years age group at the high frequency of 11.25 kHz
(12.5 dB), 45–54 years age group at 9, 11.25, and 12.5 kHz
The study results were exported to Microsoft Office Excel (15 dB), 55–64 years at 8 kHz (15 dB), 9 kHz (12.5 dB),
2017 (MS Excel; Microsoft Corporation, Washington, DC, and 10 kHz (17.5 dB). In the younger age groups below
USA) for calculation of basic descriptive statistics and to 44 years of age, the differences did not exceed 5 dB (except
create tables and graphs. Data were analyzed using basic for frequencies of 11.25 and 12.5 kHz in the age groups of
descriptive statistics, Pearson’s chi-squared test and the non- 35–44 years).
parametric Mann–Whitney U test. Statistical significance
was analyzed using the Stata version 13 software (Data Comparison of median hearing thresholds
Analysis and Statistical Software; StataCorp LP, CollegeS- among age groups
tation, TX, USA). The significance level for testing was set
at 5%. The general trends for men and women were similar both
for conventional and high frequencies (see Table 2). In men,
there were generally no differences in hearing thresholds
Results in the two youngest age groups; after that, however (i.e.,
from the age group of 35–44 onwards), hearing thresholds
Study population in all age groups mutually differed, with hearing thresh-
olds increasing with increasing age. In women, no statisti-
In all, 316 participants (i.e., 632 ears) aged 18–64 were cally significant differences were observed between the age
included in the study, of which 68% were women and 32% groups of 35–44 and 45–54; however, apart from these, all
men, respectively. There was no difference in the sex distri- other groups (in general) mutually differed, with thresholds
bution among age groups (p = 0.928; Table 1). increasing with increasing age. Hearing loss of > 25 dB was
The average threshold curves for individual age cat- observed at some high frequencies in the age groups 35–44,
egories in men and women are shown in Fig. 1A, B. It is 45–54 and 55–64. In men over 45 years of age, hearing
obvious that with increasing age, a gradual deterioration losses of > 25 dB were observed at all EHF frequencies with
of the hearing threshold, especially at high frequencies, is the exception of 9 kHz; in the 55 + years group, this included
observed in both sexes. Compared to women, the increase the 9 kHz as well. In women, the hearing loss > 25 dB was
in hearing thresholds was more pronounced in men aged recorded in women of 35 years and older, especially at fre-
45–54 and 54–64 years for both conventional as well as high quencies of 14 and 16 kHz. In the 55–64 age group, hearing
frequencies. thresholds were increased at all EHF. The ability to respond

Table 1  Number of ears and Age groups 18–24 25–34 35–44 45–54 55–64 Total
the percentage representation of
men and women in individual Men's ears 32 (15.8%) 62 (30.7%) 30 (14.9%) 38 (18.8%) 40 (19.8%) 202 (100%)
age categories
Women's ears 76 (17.7%) 124 (28.8%) 78 (18.1%) 76 (17.7%) 76 (17.7%) 430 (100%)
Total ears 108 (17.1%) 186(29.4%) 108 (17.1%) 114 (18.0%) 116 (18.4%) 632 (100%)

*Chi-squared test; data are presented as N (% in the respective age group)

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568 European Archives of Oto-Rhino-Laryngology (2023) 280:565–572

Fig. 1  Median hearing thresh-

olds for individual ages and
frequencies in men (A) and
women (B)

in % in all measured frequencies by age groups is shown in 7029:2017 has only informative value for this range with a
Table 3. maximum of 12.5 kHz [9]. As the standard gradually devel-
ops taking into account new studies, the presented one has
the ambition to contribute to establishing the normative
Discussion values of hearing thresholds at extended high frequencies.
Previously published studies monitoring high-frequency
The presented study aimed to establish normal hearing lev- hearing loss in individuals professionally unexposed to noise
els at extended high frequencies in an otologically healthy reported an increase in hearing thresholds with an increas-
population of 5 age categories (18–64) for both sexes. The ing frequency as well as increasing age, while the ability to
results of this work can significantly contribute to the cur- respond to higher frequencies declined with age [12–17],
rent knowledge at EHFas at present, the standard EN ISO which is in accordance with our study. Hearing thresholds

13
 Table 2  Hearing thresholds and significant differences by age group and sex
Hearing threshold [dB] in medians (Q1;Q2)

Men (total 202 ears) Women (total 430 ears)

Number of ears 32 62 30 38 40 76 124 78 76 76

Age groups 18–24 years 25–34 years 35–44 years 45–54 years 55–64 years 18–24 years 25–34 years 35–44 years 45–54 years 55–64 years
Frequency [kHz]
0.125 15 (10;15) 10 (10;15) 15 (10;15) 15 (15;20) ⁑● 15 (13.75;20) ⁑● 15 (10;15) 15 (10;15) 15 (10;20) ⁑● 15 (10;20) ⁑● 20 (15;21.25) ⁑●▲
0.25 5 (0;10) 5 (5;10) ♀ 5 (5;10) 10 (5;15) ⁑●▲ 10 (5;15) ⁑●▲ 5 (5;10) 5 (3.75;10) 10 (5;10) ⁑● 10 (5;15) ⁑● 10 (8.75;15) ⁑●▲○
0.5 7,5 (5;10) ♀ 5 (5;10) ♀ 10 (6.25;10) 10 (5;18.75) ⁑● 10 (10;20) ⁑●▲ 10 (5;10) 10 (5;11.25) ⁑ 10 (10;15) ⁑● 10 (5;15) ⁑● 10 (10;15) ⁑●
0.75 5 (0;10) 5 (5;10) ♀ 5 (5;10) 10 (5;15) ⁑●▲ 10 (5;16.25) ⁑●▲ 5 (0;10) 5 (5;10) ⁑ 10 (5;15) ⁑● 10 (5;15) ⁑● 10 (8.75;15) ⁑●
1 5 (0;6.25) ♀ 5 (0;5) ♀ 5 (5;10) ● 10 (5;10) ⁑●▲ 10 (5;20) ⁑●▲ 5 (0;5) 5 (5;10) ⁑ 7.5 (5;10) ⁑● 5 (5;10) ⁑● 10 (5;15) ⁑●▲○
1.5 0 (0;5) ♀ 0 (0;5) ♂ 0 (0;5) 5 (2.5;10) ⁑●▲ 10 (5;15) ⁑●▲ 0 (0;5) 5 (0;5) 15 (0;10) ⁑ 5 (0;10) ⁑ 5 (5;10) ⁑●
2 0 (0;5) 5 (0;5) ♂ 5 (0;5) 10 (5;15) ⁑●▲ ♂ 10 (5;20) ⁑●▲ 0 (0;5) 5 (0;10) ⁑ 5 (5;15) ⁑● 5 (5;10) ⁑● 10 (5;15) ⁑●
3 5 (3.75;10) 10 (5;10) 10 (5;15) ⁑ ♂ 20 (15;25) ⁑●▲ ♂ 22.5 (15;35) 5 (0;10) 5 (5;10) 10 (10;15) ⁑● 10 (5;15) ⁑● 15 (10;20) ⁑●▲○
European Archives of Oto-Rhino-Laryngology (2023) 280:565–572

⁑●▲
4 5 (0;5) 12,5 (5;13.75) ⁑ 10 (5;20) ⁑● ♂ 22.5 (20;35) ♂ 25 (15;36.25) 5 (0; 10) 10 (5;10) ⁑ 10 (6.25;15) ⁑● 10 (5;20) ⁑● 15 (10;20) ⁑●▲○
⁑●▲ ⁑●▲
6 2.5 (0;10) 10 (5;10) ⁑ 7.5 (5;15) ⁑ ♂ 20 (15;33.75) ♂ 20 (20;35) ⁑●▲ 0 (0;5) 5 (0;10) ⁑ 10 (5;15) ⁑● 15 (10;20) ⁑●▲ 15 (10;25) ⁑●▲
⁑●▲
8 0 (0;5) 5 (0;8.75) 5 (0;10) ⁑● ♂ 20 (10;28.75) ♂ 30 (13.75;40) 5 (0;10) 5 (0;10) 10 (5;15) ⁑● 10 (5;16.25) ⁑● 15 (10;25) ⁑●▲○
⁑●▲ ⁑●▲○
9 ♂ 5 (0;10) 10 (0;5) 7.5 (5;10) ● ♂ 25 (10;35) ⁑●▲ ♂ 32.5 (20;51.25) 0 (0;5) 5 (0;10) ⁑ 10 (5;20) ⁑● 10 (5;25) ⁑● 20 (10;36.25)
⁑●▲○ ⁑●▲○
10 5 (0;15) 10 (5;15) 12.5 (5;15) ⁑ ♂ 30 (15;47.5) ♂ 47.5 5 (0;10) 7.5 (5;10) ⁑ 17.5 (10;28.75) 20 (10;30) ⁑● 30 (20;55) ⁑●▲○
⁑●▲ (33.75;61.25) ⁑●
⁑●▲○
11.25 0 (0;10) 7.5 (0;10) ♀ 7.5 (0;15) ⁑● ♂ 35 (16.25;55) 50 (38.75;61.25) 0 (0;5) 5 (0;10) ⁑ 20 (6.25;33.75) 20 (10;40) ⁑● 40 (30;60) ⁑●▲○
⁑●▲ ⁑●▲○ ⁑●
12.5 0 (0;10) 5 (0;15) ♀ 15 (5; 28.75) ⁑● ♂ 45 (26.25;65) 60 (55;75) ⁑●▲○ 0 (0;6.25) 5 (0;10) ⁑ 22.5 (10;45) ⁑● 30 (15;46.25) ⁑● 57.5 (40;70) ⁑●▲○
⁑●▲
14 7.5 (0;21.25) 15 (10;25) 40 (25; 48.75) ⁑● 60 (46.25;73.75) 75 (65;85) ⁑●▲○ 5 (0;15) 15 (5;25) ⁑ 45 (30;63.75) ⁑● 55 (45;65) ⁑● 70 (65;80) ⁑●▲○
⁑●▲
16 7.5 (0;20) 25 (15;30) ⁑ 50 (40; 58.75) ⁑● 55 (55;65) ⁑●▲ 70 (55;70) ⁑●▲○ 15 (0;25) 22.5 (15;40) ⁑ 55 (45;60) ⁑● 55 (45;60) ⁑● 65 (55;70) ⁑●▲○

Q1 25th empirical quartile; Q2 75th empirical quartile

⁑Significant difference (p < 0.05) from the group of the 18–24 years; ● significant difference (p < 0.05) from the group of the 25–34 years; ▲ significant difference (p < 0.05) from the group of
the 35–44 years; ○ significant difference (p < 0.05) from the group of the 45–54 years
♀ significant difference (p < 0.05) between sex and the age same group (higher hearing threshold in women); ♂ significant difference (p < 0.05) between sex and the age same group (higher
hearing threshold in men)

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570 European Archives of Oto-Rhino-Laryngology (2023) 280:565–572

at the extended high frequencies (9 to 20 kHz) are more

55–64 years
sensitive to aging than frequencies of up to 8 kHz [16, 18].

76 ears
Our results imply that it is important to distinguish

100%

53%
93%
99%
between sexes but not between the right and left ears as the
results for both sides are similar. This is in agreement with
the study by Barbosa de Sá who reported that the thresholds

45–54 years
were similar in the left ear and right ear, with significant
76 ears

100%
differences between the ears only being observed at 11 kHz

75%
96%
99%
and 12 kHz, at which the right ear performed worse [12].
Another study, however, reported different hearing thresh-
35–44 years

olds between ears in the same individuals, with the right ear
performing generally worse [14].
78 ears

100%

87%
Valiente et al. analyzed a group aged 5–90 with groups of
97%
99%

5–19 and, afterward, groups of 10 years of age. The mean

hearing thresholds at each frequency (11.2 to 20 kHz) were
25–34 years

lower in women than in men [15]. This agrees with our

124 ears

results as in our study, in which this difference has been

100%
100%
100%
100%

observed as soon as in the youngest age category. However,

other studies showed that the hearing thresholds for men
and women were similar [12, 16]. Barbosa et al. analyzed
18–24 years

high-frequency hearing thresholds in individuals aged

Women

76 ears

18–29 years and found no significant differences in hear-

100%
100%
100%

99%

ing thresholds between men and women [12]. This, how-

ever, also agrees with our study as in the age category of
18–25 years, we found no significant differences in hear-
55–64 years

ing thresholds between sexes, either. Similarly, Wang et al.

40 ears

did not find any significant difference in hearing thresholds

100%

48%
85%
98%

between sexes within each age group at most of the frequen-

cies from 0.25 to 20 kHz, (differences between men and
women were detected only at frequencies of 4, 6, 8, and
45–54 years

9 kHz in the 41–50 year group) [16]. This could, however,

38 ears

100%
100%

be associated with a relatively smaller number of partici-

79%
97%
Table 3  The ability to respond (%) in all measured frequencies by age groups

pants in their study (162) compared to ours, which might

have resulted in insufficient power to detect any differences
35–44 years

between sexes. Besides, the differences in hearing thresholds

between sexes might have been masked due to multifactorial
30 ears

100%
100%
100%

causes, including, e.g., smoking or abnormal BMI.

97%

Wang et al. showed that hearing at EHF started to degen-

erate in subjects at their 30 s and the degeneration inten-
25–34 years

sified in their 50 s and older age. The hearing thresholds

of EHF were less than 26 dB before 30 years of age; with
62 ears

100%
100%
100%

98%

aging, however, the mean threshold values increased up to

75 dB [16]. In our group, the hearing thresholds of EHF
in both sexes were higher than 26 dB in the age categories
18–24 years

from 35 years onwards; this was initially observed only at

32 ears

the highest frequencies (14 and 16 kHz) but with increas-

100%
100%
100%
100%
Men

ing age, this extended to the lower frequencies as well. In

men, we registered a notable deterioration of hearing in
the 45–54 years age group at all EHF. In women, this was
Frequency [kHz]

observed, especially at frequencies of 12.5, 14, and 16 kHz,

0.125–11.2

as soon as in the 35–44 years category.

The ability to respond at EHF gradually decreased with
12.5

age and increasing frequency up to 48% and 53% at 16 kHz

16
14

13
European Archives of Oto-Rhino-Laryngology (2023) 280:565–572 571

in men and women in the age category of 55–64 years, Availability of data and materials The raw datasets generated and ana-
respectively. However, at the frequency of 12 kHz, this lyzed during the current study are available from the corresponding
author on reasonable request.
parameter remained high even at the highest age group (99%
women and 98% men). Our results indicate a higher ability
Declarations
to respond to EHF than the aforementioned Chinese [16]
and Spanish [15] studies. When looking for explanations, Conflict of interest The authors declare that they have no competing
we can also consider the environmental settings (air pol- interests.
lution, smoking, exposure to background noise, etc.). The
poorer ability to respond might have been caused in those Ethics approval and consent to participate The study was conducted
according to the guidelines of the Declaration of Helsinki, and
studies, among other things, also by older instrumentation approved by the Ethics Committee of the University of Ostrava (pro-
or, as suggested above, long-term exposure to different levels tocol code 12/2020 and date of approval 6 June 2020).
of background noise; while our study was performed in an
agglomeration of about 500,000 population, Valiente et al. Consent for publication N/A.
performed the study in Madrid with 3.5 million population
and Wang in Jinan with about 9.2 million population. In both Open Access This article is licensed under a Creative Commons Attri-
those agglomerations, the long-term background noise expo- bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
sure is likely much higher than in our study area [15, 16]. as you give appropriate credit to the original author(s) and the source,
Only a few published studies have used EHF to determine provide a link to the Creative Commons licence, and indicate if changes
hearing thresholds in a professionally unexposed population. were made. The images or other third party material in this article are
The comparison between studies is, however, often diffi- included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
cult due to differences in age groups, sex representation, the article's Creative Commons licence and your intended use is not
evaluation of risk factors, or, possibly, used audiometers permitted by statutory regulation or exceeds the permitted use, you will
and their accessories (papers originate from 2001 to 2021) need to obtain permission directly from the copyright holder. To view a
[19, 20]. Study limitations include relatively small numbers copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/.
of individuals in individual age/sex groups. As otitis media
can also affect hearing [21], the fact that we did not col-
lect anamnestic data about otitis in the history of individual
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Author contributions Data curation: MŠ; formal analysis: HŠ; inves-
43(3):219–224. https://​doi.​org/​10.​1016/j.​ejr.​2021.​02.​006
tigation: EM; methodology: MK and TR; project administration: TR;
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resources: MK; supervision: EM, HT; writing original draft: MŠ; edit-
Switzerland https://​www.​who.​int/​occup​ation​al_​health/​publi​catio​
ing: RM. All authors read and approved the final manuscript.
ns/​noise8.​pdf. Accessed 28 Feb 2022
9. European Committee for Standardization (2017) Acoustics—
Funding This research was funded by Technology Agency of the statistical distribution of hearing thresholds related to age and
Czech Republic, grant number TJ04000059.

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