High-frequency hearing loss: management and recommendations?
- Koorosh Nejad
- Apr 19
- 8 min read
Updated: 5 days ago
I had the privilege of helping a patient with high-frequency hearing loss last week. I believe there are many people with this type of hearing loss, and wondering if they should start considering hearing aids or not. So here is this article dedicated to patients with good low and mid-range hearing but only high-frequency hearing loss. Should they consider hearing aids? What model? What fitting strategy works best for high-frequency hearing loss? Shall they use the aids all the time or just occasionally? This article is for you if you have a high-frequency hearing loss and are trying to figure out your hearing loss management options.
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What is a high-frequency hearing loss?
High-frequency hearing loss is a profile in which the patient has no or very little hearing loss in low and mid frequencies, but has moderate or severe hearing loss in the high frequencies, specifically above 2 kHz. Please see the above audiogram.
What are the symptoms of a high-frequency hearing loss?
The deterioration of the human auditory system starts with a decline in the high-frequency range, but that starts when you approach the 50s and 60s. Exposure to loud noise for a prolonged time can cause a high-frequency hearing loss earlier than that. Otitis media, or simply the infection of the middle ear in childhood, can also impact your ability to hear high frequencies.
In a case of high-frequency hearing loss, your hearing thresholds at high frequencies are elevated substantially. You lose the ability to hear certain consonants, including k, t, f, s and th. Here are the signs of a high frequency-hearing loss:
You start losing the ability to hear birds chirping, a stream of water, and other natural sounds that are high-frequency.
You or people around you may notice that the TV is louder than usual.
You ask people to repeat what they said, especially in noisy environments.
What causes the high-frequency hearing loss?
Exposure to loud noise can impact the 3-4 kHz range of your hearing band. Not always, but I learned that often a patient with a high-frequency hearing loss has been exposed to noisy environments such as:
construction,
aviation,
events, gigs, music production, concerts and festivals,
dining (e.g. bars, noisy restaurants),
education (a teacher in kindergarten or primary school)
defence, military
noisy hobbies such as shooting, motorcycles
Otitis media, or simply the infection of the middle ear in childhood, can also impact your ability to hear high frequencies.
At what age do I build a high-frequency hearing loss?
In my career, I have treated patients with high-frequency hearing loss as young as their 30s. As you may know, the hearing loss due to environmental noise is due to a. loudness and b. the period of exposure. So a subject may have been in music gigs since their teens, and if they have never used ear defenders and music earplugs, it is a matter of time to notice a high frequency loss, which usually comes with a tonal tinnitus.
High-frequency hearing loss due to frequent middle ear infection in childhood often goes under the radar, and the patient notices it in adulthood, unless it is due to a prolonged otitis media, which may even impact the subject's linguistic abilities. If your child has gone through a prolonged middle ear infection, there is a good chance that your GP has suggested seeing an ENT specialist to do a comprehensive hearing check during and after the management cycle.
How can I prevent a high-frequency hearing loss?
Just like other health threats, the best way to avoid a high-frequency hearing loss is to avoid it by using earplugs when in a noisy environment. Please remember that any sound above 85 dB is harmful to your ears.
How to manage a high-frequency hearing loss?
A high-frequency hearing loss can be detected through a hearing test. Even a simple online hearing check or screening can detect that. You can do a 2-minute online hearing test here. Just like other hearing losses, hearing aids are the best option for managing a high-frequency hearing loss.
Can hearing aids help with a high-frequency hearing loss? How?
Yes, the hearing aids can help manage a high-frequency hearing loss in 3 ways.
Amplification - The hearing aids amplify the range of your hearing loss frequency selectively, so you can hear the consonants which are in the range of your hearing loss.
Frequency lowering - In a case of a severe, severe to profound or a profound high-frequency hearing loss, the hearing aids can lower the high-frequency range of the sound around you and transpose it over the range of hearing that you can hear. This happens in real time, and although it is not a perfect solution, at least the patient can detect and notice the high-frequency consonants. The side-effect of this technique is that the patient may notice that the s and sh sound very similar. The frequency lowering requires some patience to be optimised. Also, some time for your brain to retrain in hearing high-frequency sound in a lower band.
Tinnitus management - Often, a high-frequency hearing loss comes with a tonal tinnitus which sounds like a high-pitched hissing. For managing tinnitus with hearing aids, please see this article.
How does the frequency lowering work?
Let me explain through the following picture. The following picture shows the gains that the hearing aid is applying to the range of frequencies for the patient who holds the audiogram at the beginning of this article. The shaded area and the red dotted line, with its centre, is the range of frequency over 3 to 8 kHz, which is being lowered and mixed to a lower range so that the patient has a better chance to hear.
What hearing aids are best for a high-frequency hearing loss?
There is no specific model of hearing aids that could help a patient with a high-frequency hearing loss more than the other, in terms of the setting and tuning of the hearing aids, rather than the model or mark of the hearing aid. One piece of advice I have is to choose one with Bluetooth, so your audiologist can support you via telecare if needed, as fitting a high-frequency hearing loss may be a bit tricky and might need some follow-up sessions.
A hearing aid with Bluetooth can also provide a wider range of sound management options to manage your tinnitus.
Another piece of advice is to go with receiver-in-canal or RIC versus in-the-ear models. The reason is that the low to mid frequency hearing range of a patient with high-frequency hearing loss does not require amplification, so the hearing aids would be fitted with open domes. An in-the-canal hearing aid will cause a higher level of occlusion (hearing your voice when you talk) than an RIC.
And last but not least, consider Phonak Activent. More on this in the next Q/A.
What are the challenges of using hearing aids for a high-frequency hearing loss?
In my experience, there are two challenges in fitting hearing aids for patients with severe high-frequency hearing loss. Let me elaborate on them here:
Fitting strategy, i.e. open vs closed - Depends on the level of the hearing loss, I need to balance the sound quality, feedback, occlusion, and speech in noise through the right acoustics of the hearing aids. A closed fitting helps with a high level of amplification required for a higher level of loss, and speech in noise, but it causes the occlusion effect for you. Also, in situations, it can be counterproductive as you won't get much amplification for low frequencies. An open fitting is great for hearing low and mid frequencies naturally, but it could cause a feedback problem and does not help with speech in noise and noise management features, especially the advantage of AI processing in new hearing aids. Using micromoulds can help present the amplified sound deeper in the ear canal. This technique simply controls the risk of the feedback while allowing the patient to hear some low to mid-range sounds through the vent. Not an ideal technique, but it can be a lifesaver.
Frequency lowering - Appreciating the frequency-lowering technique in hearing aids that can help hearing the high frequency range in a lower band requires patience and some fine-tuning. Not all patients have the patience to allow this adjustment period.
So, as a summary, I would highly recommend considering RIC hearing aids fitted with micromoulds for a high-frequency hearing loss.
How can I improve speech in noise with hearing aids for a high-frequency hearing loss?
Linked to the challenges of a balanced fitting strategy, Phonak ActiveVent receivers might be what you are looking for. It does not offer a balanced strategy, but it is a flexible solution that depends on the soundscape, switching between an open and a closed fitting for noisy situations. Let me explain it a bit more.
The receiver has an internal piston that can be positioned to make the receiver an open fitting, i.e. allow the sound to travel through the receiver and a closed position that makes it a closed fitting. The piston is automatically controlled by the hearing aid, depending on the situation that the wearer is in. When you step into a noisy restaurant, the hearing aid switches to a Speech in Noise setting, which also closes the ActiveVent so the aid can do noise management for hearing speech better. When you leave the restaurant and find yourself in a quiet environment, the hearing aid is set in a Quiet setting and signals the ActiveVent receiver to switch to open vent. This way, you would feel less occlusion and receive the low to mid-range of frequencies naturally.
What are the challenges of using Phonak ActiveVent receivers for high-frequency hearing loss?
The only challenge is the cost. The ActiveVent receivers are more expensive to start with, almost double that of the standard receivers. They need to be fitted with titanium micromoulds, which is a cost in addition to the cost of the hearing aids. Also, since they have a mechanical part, they are prone to getting blocked by earwax and skin debris, so they may require replacement frequently, say every 12 months or so, which will be a routine cost (outside the warranty).
You might notice a quiet click in your ears when the Phonak ActiveVent switches its status from open to closed and vice versa, which, in my opinion, is a very small issue compared to the benefits it offers.
A pair of Phonak hearing aids fitted with ActiveVent receivers would be an optimal solution for a high-frequency hearing loss.
References
Simpson, Andrea. "Frequency-lowering devices for managing high-frequency hearing loss: A review." Trends in amplification 13.2 (2009): 87-106.
Beamer, Sharon L., Ken W. Grant, and Brian E. Walden. "Hearing aid benefits in patients with high-frequency hearing loss." Journal of the American Academy of Audiology 11.08 (2000): 429-437.
Glista, Danielle, and Susan Scollie. "The use of frequency-lowering technology in the treatment of severe-to-profound hearing loss: a review of the literature and candidacy considerations for clinical application." Seminars in hearing. Vol. 39. No. 04. Thieme Medical Publishers, 2018.
Glista, Danielle, and Susan Scollie. "The use of frequency-lowering technology in the treatment of severe-to-profound hearing loss: a review of the literature and candidacy considerations for clinical application." Seminars in hearing. Vol. 39. No. 04. Thieme Medical Publishers, 2018.
Support and questions
Please get in touch if you have any questions about fitting hearing aids for a high-frequency hearing loss. Book a free consultation through the following link.
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