Extended high-frequency audiometry for detecting early hearing effects of personal listening devices: A narrative...

Personal listening devices (PLDs) are widely used among young adults, raising concern about early noise-induced hearing loss (NIHL). Conventional audiometry (≤8kHz) may not detect the earliest signs of cochlear damage. Extended high-frequency audiometry (EHFA, ≥9kHz) has been suggested as a more sensitive approach for identifying early auditory changes. This narrative review examined the potential role of EHFA in detecting PLD-related hearing effects. A structured search of PubMed and Academic Search Ultimate through 30 September 2024 identified nine eligible studies (sample sizes 20-282; ages 13-31 years). Most studies reported significantly elevated thresholds in the 9-16kHz range, particularly at 12-14kHz, among participants with prolonged PLD use (>4-5 years) or higher listening levels (≥75 dBA). These threshold shifts often occurred despite normal conventional audiograms, suggesting that EHFA may capture early changes not identified by standard testing. Two studies, however, found no significant group differences, likely due to small control samples, short exposure duration, or limited statistical power. Considerable heterogeneity in exposure definitions, calibration, and reliance on self-reported listening habits further limits comparability. Current evidence indicates that EHFA may hold promise as an early indicator of NIHL in young adult PLD users, but further methodological refinements, objective exposure monitoring, and longitudinal research are required to establish normative data and clarify its prognostic and clinical utility.