Standard Audiograms Should Range 20 Hz - 20 kHz (!?)

Is there any legitimate reason that standard audiograms administered around the U.S. (and apparently in many countries around the world) only run until 8 khz? This has definitely come up many times on this site, but I haven't seen a thread dedicated to it and I wanted to discuss it.

There have absolutely been many, many brilliant people who have worked to bring medical science to where it is today, and that must include the field of audiology. On the other hand, I think most would agree that there is tons of BS in medicine due to doctors' apathy, pharma lobbying and common lack of a true free market. And of course there must ultimately be a financial motivation for all but the truly altruistic to do anything at all. Finally, in the grand scheme of things modern medicine is really very young.

So my question is, why are audiograms so apparently primitive? Is medical science up to par here, or is it simply not? If not, then why? It doesn't seem that complicated!
I am absolutely only a layman but it strikes me as beyond absurd to think that playing forty or so percent of the total human hearing range measures the entire human auditory system. I mean, a five year old could tell you that if the average human hearing ranges until 16-20 khz, only measuring up to 8 khz is only testing half the system!! It's like 2 + 2 = 4! Perhaps tests for synaptic "hidden" hearing loss (ugh I hate this whole nomenclature) have not yet been developed, but at least the standard simple audiogram could go until 20 khz, or at the very least 16 khz?? So this is the question: what is the real reason that the audiogram is generally only given until 8 khz? Does anyone here know?

 

They need to test atleast up to 16,000hz and speech/tones in background noise scenarios across the spectrum.

It's a pathetic excuse not to test for this.

0-5000hz is the human voice range and they only test up to 8000hz in tonal noises in silence.

Science comes in and tells them they are doing it wrong but most audiology practioners/ENT's don't keep up to date.

 

There's nothing too complicated about testing for hidden hearing loss. it's literally just testing background noise discrimination, hidden hearing loss isn't even hidden. Mine is blatantly obvious!

 

Agreed. I guess I mean somewhat more subtle stuff, e.g. perceived decrease in timbre quality of an instrument, or a general "full" feeling. But you're absolutely right.

 

Not exactly. Hearing isn't linear when it comes to perception of frequencies.
8 kHz to 16 kHz is one octave. 125 Hz to 8 kHz represents 6 octaves.

You are correct that we do miss a significant amount of hearing bandwidth by limiting ourselves to 8 kHz, but it's nowhere near half of the range: that one upper octave covers a large band of frequencies!

There's a couple of reasons that I know of:

1. audiologists generally perform hearing tests in order to fit you with a hearing aid, and hearing aids more often than not don't amplify high frequencies (ie above 8 kHz - there are exceptions, but the vast majority of hearing aids' gain falls off before 8 kHz), because they are usually designed to help the patient hear voices, which roughly peak one octave below 8 kHz for women and one more octave below for men. In other words, if the audiologist gave you a graph up to 20 kHz, it would not be actionable, so they feel there is no point in doing so (it costs money and cannot lead to any treatment).
2. equipment (in particular headphones) need to be calibrated for a flat response in the high frequency ranges - and these are either too expensive or difficult to come by apparently. It's a bit surprising, but that's what one of the audiologists I saw told me.

If you feel you want an extended hearing test, you should be able to find an audiologist that will have the right equipment to do it (I did). You may have a better chance at success with audiologists who also perform tinnitus matching (both pitch & volume) work: they seem to be better equipped to do these "out of the ordinary" tests.

I do agree with your sentiment, though.
Good luck.

 

#ABOVE-8K-MATTERS

 

@GregCA agree with a lot of this; good points.

Forgot about this. You are right. And it's kind of a relief too.

You see, I understand; but this is what I find most frustrating. Yes, audiograms appear to be designed primarily for hearing aid facilitation. But therein kinda lies the problem. People with a normal 125 - 8000 hz audiogram who underwent acoustic trauma etc and experience other hearing loss or tinnitus are now summarily dismissed without steroids or HBOT recommendation because their hearing is "perfect". (I know that steroids and HBOT don't possess the best evidence of efficacy but I think for this horrific condition people should at least be informed of anything that has a chance of helping.)
I also have a feeling that general progress regarding an eventual cure for "hidden" hearing loss is impeded because this loss has now been "hidden" by the diagnostic methodology and nomenclature and is kind of "out of sight".

Basically yes the audiograms appear to have been designed primarily for hearing aid facilitation BUT have just sort of been adopted for general diagnosis, instead of a unique and comprehensive diagnostic tool. And for general diagnosis they appear to be horrifically inadequate.

Okay. I hear that, but it raises real sticky utilitarian-esque questions about how health resources should be allocated. Also to what degree medical practitioners should perhaps inform their patients of limitations of their technology as it may affect treatment (I'm referring to steroids/HBOT again).
Of course, to be honest, I can't exactly be subjective about this. Not that I blame myself for that either. I still think the current state of affairs is downright wretched.

Thanks for the dialogue, and best of luck to you too!

 

It's also a good question why it's not uncommon to just test the range 250hz-8khz. Even though most male voices have fundamental frequency below 250hz, and it's not uncommon to have it below 125hz. Maybe they just rely that brain will fill in that missing fundamental frequency.

 

They only test up to 8 khz in audiologist's office...

 

Yes I agree it's painful that you can "ace the hearing test" even if you have a damaged hearing apparatus, but remember that "hidden hearing loss" (aread Liberman's & Schaette's) refers to hearing damage that is not visible on an audiogram, regardless of the range of the audiogram (even if you were to be tested up to 22 kHz for example).

There is, however, a set of people whose losses would be clearly visible on extended audiograms, but that do not get to see it because the standard tests just go up to 8 kHz. You could call it "hidden losses", but it would have a different meaning from the meaning typically associated with this naming.

Dealing with higher frequencies is difficult because of the high variability across individuals, since that's the part of the hearing that "goes first". You can have perfectly healthy individuals who will show signs of loss in that range, simply due to aging (presbycusis).

Yes it's true that it's a high level tool that lacks detail, but remember that before you get to do an audiogram you often have to go through an even coarser tool: the tuning fork tests! It behooves the patient to keep digging deeper when all the tests seem to come back "perfect". We have to be persistent! Nobody has our best interest in mind more than ourselves.

 

Depends on the audiologist. I had an above 8k test conducted by an audiologist, I also saw other audiologists who conducted higher frequency tests on patients receiving cancer treatments.

 

Very true and very sad imho.

 

I could understand the 8khz limit back in the 60s, 70s or 80s, and maybe even 90s when technology was more primitive and much more expensive but there really is no excuse for the audiologists and ENT's to still be limiting hearing tests in this manner anymore with how easy it is to test up to 20khz.

I once had an ENT tell me "nothing above 8khz matters" - what a load of nonsense. Take an piece of music and use a low pass filter to take out all frequencies above 8khz and the difference is drastic.

It's insane to me to think that most studies conducted in regards to hearing disorders are still using hearing tests limited to 8khz. It's 2018, let that sink in. Imagine how much critical information we've missed out on.

 

I will agree that from the technical point of view there is no excuse in 2018. I pointed out this to an audiologist at the Stanford Hearing Center, and he said that they can not do anything about very high frequency loss, and that very high frequency scans are difficult to interpret because everybody has age induced hearing loss. He said that they only do those scans to patients going through cancer treatment because it is known that some of the drugs are ototoxic and the effects start to show in the very high frequency range first.
I got my audiogram to 16 kHz at a tinnitus specialized audiologist.

 

My audiologist works within the office of an ENT (Board Certified Otolaryngology/Neurotology).

My hearing test went up to 15kHz (I recall, not looking at it now) but the graph paper she logged on was pre printed only to 8kHz. All she did was extend the chart lines with her pen. But the equipment went higher.

Guess they don't have a need to exceed 8k or they would redesign the pre printed graph charts.

Also, when she tests the loudness of your T, I think they stop at 85dB. Maybe because they don't want to cause anymore discomfort?

 

I’ve had my hearing tested to 16khz a few times in the past, the results were surprisingly bad. My last test done about 2 years ago shows my hearing drop off like a ski slope after about 7khz, by 12khz I was down to almost no hearing.

Recently noise trauma (mri machine) I seem to have lost additional hearing, it’s pretty easy to tell just in day to day life, but still need to have another audiogram done.

In the mean time I checked out a couple of sweep tests online, I’ve posted this one below for others to try. I start to seriously fade to almost nothing by 6khz, I’m sure this isn’t normal for a 44 year old.

If you are interested, post your age, and how high you hear. At the beginning of the video, adjust to comfortable volume (not loud) and do not turn louder if you can not hear as you climb the spectrum. Headphones best results

Thanks

Hearing Test

 

What treatment are those cancer patients given if they do have any hearing loss?