Extended High-Frequency Audiometry Outcomes in Generation Z With Electronic Noise Exposure

Article information

J Audiol Otol. 2026;30(2):114-118

Publication date (electronic) : 2026 April 20

doi : https://doi.org/10.7874/jao.2025.00640

Merve Mutlu Çekim^,1, Doğukan Özdemir¹, Esra Yılmaz¹, Samet Aydemir², Hande Arslan², Dursun Mehmet Mehel³, Ayşe Çeçen¹

¹Department of Otorhinolaryngology, Samsun University, Samsun, Türkiye

²Department of Otorhinolaryngology, Samsun Education and Research Hospital, Samsun, Türkiye

³Department of Otorhinolaryngology, University of Health Sciences, Samsun, Türkiye

Address for correspondence Merve Mutlu Çekim, MD Department of Otorhinolaryngology, Samsun University, 199 Barış Street, Kadıköy Neighborhood 55090 İlkadım, Samsun, Türkiye Tel +90-553-343-82-33 E-mail mervemutlu1995@hotmail.com

Received 2025 October 14; Revised 2025 December 2; Accepted 2025 December 26.

Abstract

Introduction

Noise-induced hearing loss (NIHL), increasingly observed due to occupational and social noise exposure associated with technological advancements, has become a prevalent public health problem affecting a wide segment of society [1]. In children and young adults known as Generation Z, the rising use of electronic devices is considered a major source of noise exposure that may elevate the risk of hearing loss [2,3]. Although conventional audiometry results may remain within normal limits in the early stages of NIHL, a deterioration in extended high-frequency audiometry (EHFA) thresholds may occur. Acoustic trauma leads to damage in cochlear hair cells and vascular structures, and such damage is more pronounced at high-frequency tones represented in the basal turn of the cochlea [4]. EHFA is utilized in individuals with high-frequency sloping hearing loss, in cases of suspected noise exposure, and for monitoring ototoxicity [5]. Numerous studies in the literature have demonstrated the effects of noise exposure on extended-high frequencies (EHFs). The aim of our study is to evaluate hearing loss potentially associated with the use of modern technological devices among members of Generation Z using EHFA.

Subjects and Methods

This cross-sectional descriptive study was conducted between January 15, 2023, and January 15, 2024, following approval by the Ethics Committee of Samsun University (Approval number: SÜKAEK-2023 9/11). Individuals aged 10–22 years who presented to the otorhinolaryngology outpatient clinic with any complaint and were scheduled for routine hearing testing were included. Written informed consent was obtained from all participants and their families.

Inclusion criteria were: no history of ototoxic medication use or acoustic trauma exposure; absence of external or middle ear pathologies such as chronic otitis, serous otitis, mastoiditis, or ossicular chain abnormalities; no history of otologic surgery; and a type A tympanogram. All individuals were thoroughly evaluated, and symptoms such as tinnitus, hearing loss, and vertigo were recorded. Weekly personal listening device (PLD) usage time was also documented to assess the degree of noise exposure. Conventional audiometry (250, 500, 1,000, 2,000, 4,000, 8,000 Hz) and EHFA (10, 12, 14, 16, 18 kHz) were performed on all participants. Audiometric measurements were conducted in a sound-treated booth using an AC40 clinical audiometer (Interacoustics). Calibration of the audiometer and related equipment was performed in accordance with ISO 389 standards. Bone conduction thresholds were measured when air conduction thresholds exceeded 25 dB at any frequency to determine the presence of conductive hearing loss. A hearing threshold exceeding 15 dB at any frequency was considered pathological.

Sample size estimation was performed using G*Power 3.1.9.7 (Heinrich-Heine-Universität Düsseldorf). Based on Cohen’s effect size conventions, with an effect size of d=0.30, α=0.05, and power=0.80 (β=0.20), the minimum required sample size was calculated as 72 participants. Participants were divided into two groups according to weekly PLD use: <10 hours and ≥10 hours. Differences between the two groups in standard and EHFA were statistically analyzed. All data were analyzed using SPSS for Windows (version 21.0; IBM Corp.). Descriptive statistics (mean, percentage, standard deviation, minimum–maximum values) were used to summarize the variables. The normality of data distribution was tested using the Kolmogorov–Smirnov test. For normally distributed variables, comparisons between groups were performed using the Student’s t-test. The Mann–Whitney U test was used for non-normally distributed variables. Categorical variables were analyzed using the chi-square test or Fisher’s exact test. A p-value less than 0.05 was considered statistically significant.

Results

Of the 72 participants included in the study, 38 were female (52.8%) and 34 were male (47.2%), with a mean age of 18.25± 3.35 years. In the group with weekly PLD use of less than 10 hours (n=36), the mean duration of PLD use was 2.81±2.64 hours (0.0–9.0), whereas in the group with weekly PLD use of 10 hours or more (n=36), the mean duration was 28.14±17.78 hours (10.0–84.0) (p<0.001). Regarding weekly PLD use, the two groups demonstrated similar rates of symptom presence, vertigo, tinnitus, and hearing loss; no statistically significant differences were identified (p>0.05) (Table 1).

Table 1.

Relationship between weekly PLD usage time and demographic and clinical characteristics

Weekly PLD usage–based comparisons were made by calculating threshold levels at standard frequencies of 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz in both groups. Among participants who used PLDs for 10 hours or more per week, the mean (±standard deviation) hearing thresholds were 10.86± 6.34 dB in the right ear and 9.58±4.43 dB in the left ear. In those who used PLDs for less than 10 hours per week, the corresponding mean thresholds were 9.03±3.66 dB in the right ear and 8.28±3.73 dB in the left ear. There was no statistically significant difference between the groups in terms of mean standard frequency thresholds in either ear (p=0.53 and p=0.38, respectively).

In EHFA, thresholds at 10, 12, 14, 16, and 18 kHz were evaluated. At 10 kHz, the mean threshold in the right ear of participants using PLDs less than 10 hours per week was 7.50± 7.70 dB, which was higher than the mean 10 kHz threshold in the right ear of those using PLDs 10 hours or more per week (5.0±10.8 dB) (p=0.02). At all other frequencies in both the right and left ears, the mean threshold values were higher in participants with ≥10 hours of weekly PLD use compared with those with <10 hours of use; however, these differences did not reach statistical significance (p>0.05) (Table 2).

Table 2.

Conventional frequency averages and extended high-frequency thresholds in relation to weekly PLD usage time

Discussion

Hearing loss associated with prolonged use of PLDs has raised concern in the popular media [6]. A recent systematic review demonstrated that up to 58.2% of adolescents and young adults exceed the recommended maximum daily noise dose [7]. In NIHL, acoustic trauma leads to damage in cochlear hair cells and vascular structures. Although these changes are often temporary, continued exposure may result in permanent injury. Hair cells responsible for transmitting highfrequency sounds are located in the basal region of the cochlea and are the most vulnerable to noise-related damage. Therefore, early NIHL typically manifests as a notch on the audiogram or high-frequency hearing impairment [8]. Because noise exposure initially affects frequencies above 8 kHz, EHFA can be predictive of early cochlear damage. Numerous studies have evaluated the impact of noise exposure on EHFs [9]. In their study, Ahmed, et al. [10] identified age and noise exposure as the first and second predictive factors for highfrequency hearing loss. Sataloff, et al. [11] reported significant differences in mean thresholds at 10, 12, and 14 kHz in individuals exposed to noise. Morton and Reynolds [12] demonstrated statistically significant threshold differences at frequencies above 14 kHz in two noise-exposed young adult groups (ages 10–19 and 20–29 years). Shargorodsky, et al. [13] showed that adolescent hearing loss increased by 30% over an 8-year period (1994–2006). The term adolescent generally refers to individuals aged 10–19 years in the pediatric literature [14]. Generation Z refers to individuals born between 2001 and 2013 who share similar sociocultural characteristics [3]. Although many studies have been conducted on NIHL in adolescents, individuals belonging to the same generation experience similar social transitions, economic conditions, and historical events. Thus, although previous studies have examined similar age groups, those cohorts represented different generations. Our study stands out as the first to specifically investigate Generation Z. Unlike some previous studies, thresholds at 10, 12, 14, 16, and 18 kHz were included as EHFs.

In the study by Weichbold, et al. [15], involving 1,296 participants aged 14–15 years, noise exposure was evaluated based on the frequency and duration of visits to discos and bars, exposure to high-intensity sound, and weekly PLD use, categorized as 1, 2, 3, and 4 hours or more. Because exposure to recreational noise, such as discos or bars, was uncommon among our participants, only PLD-related noise exposure was assessed. Gottfriedová, et al. [16] demonstrated significant differences in conventional frequencies based on frequency of PLD use (daily vs. less frequent), durations longer than 30 minutes per session, and total weekly listening time ≥7 hours; however, no differences were found in EHFs. Their study also emphasized that only the highest test frequency was affected by loud-volume listening. In two national studies from Korea, Hong, et al. [17] reported unilateral and bilateral high-frequency hearing loss (>20 dB) in 5% and 1.9% of 1,658 adolescents, respectively, while Rhee, et al. [18] showed that approximately 17% of Korean adolescents had mild hearing loss. Although the review by Elmazoska, et al. [19] indicated that certain recreational noise exposures may be potentially harmful, the relationship between exposure and outcomes remains unclear. Some findings have shown threshold shifts or decreased otoacoustic emission amplitudes following recreational noise exposure; however, most changes were temporary and occurred primarily at EHFs.

In our study, participants’ reports of loud-volume PLD use were subjective; therefore, groups were formed solely based on weekly usage time (<10 hours vs. ≥10 hours), independent of loudness. EHFs were higher in individuals with ≥10 hours of weekly PLD use; however, these differences were not statistically significant. We believe that ongoing electronic noise exposure may contribute to future hearing loss in this generation. The isolated significant finding at 10 kHz in the right ear likely reflects inter-individual variability rather than a dosedependent effect, and therefore does not support a consistent exposure–response relationship. Hearing loss in adolescents can negatively affect psychosocial well-being, including academic performance, social participation, language development, and self-esteem. Therefore, predicting and preventing hearing loss that may become permanent with continued noise exposure is crucial [20].

One of the main limitations of our study is that noise exposure was assessed based on weekly headphone usage duration, and the intensity of noise exposure could not be standardized due to the lack of consideration of headphone type. In addition, a subjective method, high-frequency audiometry, was used to evaluate noise exposure. The use of objective measures such as otoacoustic emissions and auditory brainstem responses could provide more reliable and meaningful results.

Acoustic trauma can lead to early high-frequency hearing loss. Although EHFs tended to be higher in individuals who used PLDs for ≥10 hours per week, the differences were not statistically significant for most frequencies. A significant difference was observed only at the 10 kHz threshold in the right ear, which may reflect interindividual variability rather than a consistent exposure effect. To clarify the potential high-frequency effects of electronic noise exposure in Generation Z, larger and better-controlled studies incorporating objective noise-dose measurements are needed.

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