{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T19:09:35Z","timestamp":1794510575258,"version":"4.9.1"},"reference-count":27,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiol. Res.","Audiology Research"],"abstract":"<jats:p>Background\/Objectives: The four-frequency better-ear pure-tone average (PTA4; 0.5\u20134 kHz) is the dominant population definition of hearing impairment but underweights frequencies above 4 kHz and ignores interaural asymmetry. We quantified, in two independent adult samples, the proportion of PTA4-normal adults with elevated high-frequency or asymmetric profiles and whether this has a self-report correlate. Methods: Cross-sectional secondary analysis of two public datasets: the German H\u00d6RSTAT\/Aalen sample (2008\u20132012; N = 3105) and pooled US NHANES (2011\u2013March 2020; N = 10,575; adults \u2265 20 years). The primary outcome, PTA4-discordant high-frequency loss, was defined a priori as better-ear PTA4 \u2264 25 dB HL with a better-ear 6\u20138 kHz mean (PTA68) &gt; 25 dB HL, reported as the conditional proportion among PTA4-normal adults. Secondary outcomes were interaural asymmetry \u2265 15 dB and self-rated hearing trouble (NHANES AUQ054 \u2265 3). Results: Among PTA4-normal adults, 34.3% (95% CI 32.5\u201336.2) of the German sample and a survey-weighted 28.2% (25.9\u201330.5) of the NHANES sample had PTA68 &gt; 25 dB HL. Prevalence rose with age (\u2248three-fold odds per decade; two-fold for male sex; all p &lt; 0.001). Of those with PTA68 asymmetry \u2265 15 dB, 75\u201385% remained PTA4-normal, although the more stringent unilateral-like pattern was rare (1.5\u20131.7%). Self-reported trouble was elevated in PTA4-discordant mild (OR 2.56) and strong (OR 3.50) groups (OR 1.43 per 10 dB PTA68). Conclusions: Although disagreement between the two classifications is arithmetically expected, since they cover different frequencies, its magnitude is substantial and reproducible: roughly a quarter to a third of PTA4-normal adults (28\u201334%) carry an elevated PTA68, with a graded self-report correlate consistent with early high-frequency presbyacusis, and the same age structure emerges in two samples measured with different equipment and procedures. Because the 25 dB HL criterion is not age-referenced, an increasing share of the discordance at older ages represents expected presbyacusis rather than pathology, so the older-age figures should be read as counts above a fixed public-health threshold. Reporting a high-frequency companion metric (PTA68 or PTA346) alongside PTA4 would make this information visible without displacing the existing system.<\/jats:p>","DOI":"10.3390\/audiolres16040111","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:23:20Z","timestamp":1785504200000},"page":"111","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Quantifying What Better-Ear PTA4 Does Not Capture: High-Frequency and Asymmetric Classification Discordance in Two Independent Adult Population Samples from Germany and the United States"],"prefix":"10.3390","volume":"16","author":[{"given":"Peizheng","family":"Wang","sequence":"first","affiliation":[{"name":"School of Artificial Intelligence, Shenzhen Technology University, Shenzhen 518118, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changgeng","family":"Mo","sequence":"additional","affiliation":[{"name":"Orka Health Limited, Hong Kong SAR, China"},{"name":"Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6356-9604","authenticated-orcid":false,"given":"Shangqiguo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China"},{"name":"Faculty of Education, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). 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