13 dBHL of hearing loss. Continue using IEMs and headphones?

[D!sco]

I can’t see why there is any speculation at all about an audiologist’s diagnosis.

Losing upwards of 12dB represents serious long term damage. Or maybe someone magdumped a handgun next to your face. Losing that kind of sensitivity leads to further increased volume use and further ear degradation. It will be impossible to listen “loud” without dramatically increasing power. It’s time to start listening quietly. Sorry, dude.

The only sidestep I can think of has already been mentioned. I use AirPod Pros and the effect of noise canceling has completely changed my listening perspective. Lower noise floor and lower volumes feel great. I hardly use my Moondrop Blessing 2’s anymore because of the effect silence has on listening quality and my overall calmness. I live in a busy, loud walking city. I could never leave home without them anymore. As mentioned, Apple will attempt to define your average listening volumes by SPL and I’m quite certain about its accuracy.

 

[goliardo]

Yes, this seems to be the standard. At my last test the generator could not create frequencies above 8 kHz. May be because above that it's too difficult to produce calibrated headphones.

It is true that most audiologists still test only up to 8 kHz because of common practice and HF limitations of most transducers. There are however transducers that can be calibrated and used for testing frequencies up to 16 kHz. Testing so-called “extended high frequencies” (EHFs, 9-16 kHz), in addition to convetional frequencies (250-8000 Hz) is becoming more widespread in audiology practice. One reason is that testing EHFs might be a possible way to test for hidden hearing loss (evidence is stiil preliminary though).

About restorer-john’s question: estimating pure tone thresholds behaviourally takes up valuable time, even using the relatively quick procedures used by clinical audiologists. Hence the focus on octave frequencies within the 250-8000 Hz.

 

[goliardo]

I can’t see why there is any speculation at all about an audiologist’s diagnosis.

Losing upwards of 12dB represents serious long term damage. Or maybe someone magdumped a handgun next to your face. Losing that kind of sensitivity leads to further increased volume use and further ear degradation. It will be impossible to listen “loud” without dramatically increasing power. It’s time to start listening quietly. Sorry, dude.

The only sidestep I can think of has already been mentioned. I use AirPod Pros and the effect of noise canceling has completely changed my listening perspective. Lower noise floor and lower volumes feel great. I hardly use my Moondrop Blessing 2’s anymore because of the effect silence has on listening quality and my overall calmness. I live in a busy, loud walking city. I could never leave home without them anymore. As mentioned, Apple will attempt to define your average listening volumes by SPL and I’m quite certain about its accuracy.

The OP does not have a diagnosis of hearing loss, not even a “mild” one given the audiogram they posted and the current most conservative definition of a mild loss (15 dB HL or higher average of 500, 1000, and 2000 Hz thresholds).
Not using any equipment close to the ears (e.g. headphones) does seem a bit extreme IMO. What counts is the level. Hence the advice to ensure that one listens at lower volumes is a sound one.

 

[Andysu]

i drink orange juice improves high frequency range

high end orange juice THX approved

 

[jae]

Your audiogram is perfectly normal.

 

[LTig]

Your audiogram is perfectly normal.

Where did you find this graph?

 

[jae]

Where did you find this graph?

Just did a quick google image search for "hearing threshold age". But, a normal age-appropriate audiogram does not necessarily mean there is not any hidden hearing loss.

 

[LTig]

Just did a quick google image search for "hearing threshold age". But, a normal age-appropriate audiogram does not necessarily mean there is not any hidden hearing loss.

Thanks, found it at ResearchGate and the full paper can be downloaded.

 

[DRMLFL]

These results are superimposed from the PTA audiogram test I had and it looks like I have low-frequency hearing loss in both ears (13dBHL right ear and 12dBHL left ear), and my right ear has lost some high frequencies.

Hello,
I am a hearing care professional and student at the Technical University of Luebeck in the field of hearing science and acoustics. I can tell your hearing is absolutely fine (please compare to the diagram below) as far I can read from your audiogram and assuming that no measuring errors were made. Your left ear is more sensitive at higher frequencies than the the right ear (X is left ear, O is right ear). The hearing threshold for both ears from 250-1000 Hz is @ +15 dB HL (HL stands for hearing level - in short, a calibrated representation of fletcher munson curve).
Interesting would also be the bone conduction measurement, especially for the 8 kHz tone. Hearing measurements are (in most cases) not made with 1 dB increments, but instead in 5 dB steps. It has to do with the sound pressure level, a duplication of SPL means +6 dB, but for simplification +5 dB was chosen. And it is easier to read from the chart/audiogram in 5 dB steps. This is mainly done to save time. Always remember, TIME IS MONEY! And a hearing measurement can also be very exhausting for patients and the ENT or hearing care professional if all measurements are done avoiding measuring errors, including air and bone conduction + all the different speech tests. Depending on how accurate you perform these measurements with your patient/client it can take up to 30-45 minutes, in some cases also longer. There might be differences in the performance of hearing measurements depending on the country and the language. I am talking about the standard measurement in Germany.

Here is a diagram (I made this for my english speaking clients for easier assessment) which highlights the different degrees of hearing loss.

A mild hearing loss starts @ 25 dB HL and goes to 40 dB HL, but many people are not aware of it because the signs or "problems" that occur are not really obvious (main sign from my experience is problems with directional hearing). Most people start to realise hearing loss only from a moderate degree (40 dB HL) where speech in a quiet environment can become difficult to understand correctly, especially monosyllabic words (sun-fun / sin-thin etc.). At a moderate hearing loss speech intelligibility can already be challenging without or very little background noise @ +/- 40 dB. Important to understand ist that the transition from one degree to another is very fluid and the perception and the suffering can vary drastically from person to person.
Not only the high frequencies between 4 kHz and 8 kHz cause problems (mix up of "s" and "f" sounds) but also frequencies at 1,5 kHz are problematic and important (dependent on the language). In german for example there is a big difference between "sch" which is equivalent to the english "sh"-sound (like shine or shoe and english) and "ch" which is pronounced totally different than in english. The english "ch" is pronounced "tsh" (like channel, chance or chart) whereas the german "ch" sound is mostly pronounced (depending on the area you live) like the word drache which means dragon (it sounds like when collecting spit - *chhhh thuuuuuhhhh*) and is produced with the back of your throat. In english problematic words could be for example chunk (the very hard "tsh"-sound) and jump (a more soft "dsh"-sound).
The reason why hearing tests are made from (125 Hz to 8 kHz) is the so called "speech main area" (250 Hz up to 4 kHz), hearing aids have the purpose to increase speech intelligibility and those are the frequencies we need for spoken communication. Hearing "tests" (from a psychological view I prefer the word hearing measurement, as this does not put the patient/client under pressure) are made in octaves - 125, 250, 500, 1, 2, 4, 8 Hz/kHz - otherwise it would take to long to measure every single frequency. And this is not the way our ears work to be honest (bark scale is one concept). Personally, I also measure the tertian frequencies @ 750, 1.5, 3 and 6 kHz, just to have a more detailed representation of the audiogram which allows a more accurate fitting of hearing aids imho.
Here is the so called "speech banana" which indicates the link between letters and frequencies. Sorry for the bad quality of the picture.

I apologize for the long text, but I just wanted to clarify some things. I am new to this forum and I have already read many false assumptions/conceptions about the sense of hearing and the perception. I just want to contribute and educate people because hearing has become, besides producing music, my passion.

I hope this helps. All the best to you.

Stay focused!

 

[ns156]

Welcome to ASR!

This is from Dr. Toole (source: AVSForum post). Our ears are most fragile at their most sensitive frequency band of around 1 kHz - 8 kHz. Outside of that range, they seem to be able to take a bit more "abuse".

One thing we need to be extra careful about is the "hidden hearing loss". It is called "hidden" because the typical audiometry test will not detect it. Hidden hearing loss was discovered relatively recently, and it is currently a very active area of research. Below is from:

How We Hear: The Perception and Neural Coding of Sound

Auditory perception is our main gateway to communication with others via speech and music, and it also plays an important role in alerting and orienting us to new events. This review provides an overview of selected topics pertaining to the perception ...

www.ncbi.nlm.nih.gov

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Hidden Hearing Loss​

Most of us have experienced temporary threshold shift (TTS) at some time or other, such as after a very loud sporting event or rock concert. The phenomenon is often accompanied by a feeling of wooliness and, possibly, a sensation of ringing, but it usually resolves itself within 24 to 48 hours. However, recent physiological studies have suggested that the long-term consequences of TTS may not be as benign as previously thought. A landmark study by Kujawa & Liberman (2009) in mice revealed that noise exposure sufficient to cause TTS, but not sufficient to cause permanent threshold shifts, can result in a significant loss of the synapses between the inner hair cells in the cochlea and the auditory nerve. These synapses effectively connect the ear to the brain, so a 50% loss of synapses (as reported in many recent animal studies; e.g., Kujawa & Liberman 2009) is likely to have some important perceptual consequences. The surprising aspect of these results is that a 50% loss of synapses does not produce a measurable change in absolute thresholds, meaning that it would not be detected in a clinical hearing test, leading to the term hidden hearing loss (Schaette & McAlpine 2011).​

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The questions currently in need of urgent answers are: (a) Do humans suffer from hidden hearing loss? (b) If so, how prevalent is it? (c) What are the perceptual consequences in everyday life? Finally, (d) how can it best be diagnosed? A number of studies are currently under way to provide answers to these questions. Indeed, studies have already suggested that some of the difficulties encountered by middle-aged and older people in understanding speech in noise may be related to hidden hearing loss (Bharadwaj et al. 2015, Ruggles et al. 2011). In addition, some consideration has gone into developing either behavioral or noninvasive physiological tests as indirect diagnostic tools to detect hidden hearing loss (Liberman et al. 2016, Plack et al. 2016, Stamper & Johnson 2015). Although it seems likely that people with more noise exposure would suffer from greater hidden hearing loss, the results from the first study with a larger sample of younger listeners (>100) have not yet revealed clear associations (Prendergast et al. 2017).​

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It may appear puzzling that a 50% loss of fibers leads to no measurable change in absolute thresholds for sound. There are at least three possible reasons for this, which are not mutually exclusive. First, further physiological studies have shown that the synapses most affected are those that connect to auditory nerve fibers with high thresholds and low spontaneous firing rates (Furman et al. 2013). These fibers are thought to be responsible for coding the features of sound that are well above absolute threshold, so a loss of these fibers may not affect sensitivity to very quiet sounds near absolute threshold. Second, higher levels of auditory processing, from the brainstem to the cortex, may compensate for the loss of stimulation by increasing neural gain (Chambers et al. 2016, Schaette & McAlpine 2011). Third, theoretical considerations based on signal detection theory have suggested that the perceptual consequences of synaptic loss may not be very dramatic until a large proportion of the synapses are lost (Oxenham 2016). In fact, with fairly simple and reasonable assumptions, it can be predicted that a 50% loss of synapses would result in only a 1.5-dB worsening of thresholds, which would be unmeasurable. Taken further, a 90% loss of fibers would be required to produce a 5-dB worsening of thresholds—still well below the 20-dB loss required for a diagnosis of hearing loss (Oxenham 2016). However, if the loss of fibers is concentrated in the small population of fibers with high thresholds and low spontaneous rates, then a loss of 90% or more is feasible, and may result in severe deficits for the processing of sounds that are well above absolute threshold—precisely the deficits that cause middle-aged and elderly people to have difficulty understanding speech in noisy backgrounds. In summary, hidden hearing loss remains a topic of considerable interest that has the potential to dramatically change the way hearing loss is diagnosed and treated.​

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I've always wondered about this. Absolutely, the NIHL notch at 4-6KHz is very noticeable, but audiograms rarely ever test above 8KHz and it stands to reason that the very fragile hairs in the EHF (10-20KHz) region at the very outer edges of the cochlea would be impacted heavily by noise exposure, just not visible because it is rarely tested for as standard.