High-Frequency Vulnerability and Sex Differences in Age-Related Hearing Loss:A Cross-Sectional Audiometric Analysis of Older Chinese Otolaryngology OutpatientsOA

Objective:To determine the prevalence,severity,and audiometric characteristics of age-related hearing loss(ARHL)in older Chinese adults attending a tertiary otolaryngology clinic,with emphasis on age-and sex-specific patterns based on the updated World Health Organization(WHO 2020)cri-teria.Methods:In this cross-sectional study,1,000 adults aged≥60 years underwent otologic examination,tympanometry,and pure-tone audiometry at a tertiary medical center between March 2022 and January 2023.Individuals with abnormal tympanograms or evidence of middle ear disease were excluded.Pure-tone averages(0.5,1,2,and 4 kHz)from the better ear were used to define and grade ARHL.Age-and sex-related differences in hearing thresholds were assessed using chi-square tests,t-tests,and two-way ANOVA.Results:Within this tertiary-care outpatient cohort,the prevalence of hearing loss according to WHO 2020 criteria was 84.1%,rising from 78.3%in the 60s to 100%in those aged over 90 years.Hearing thresholds showed a consistent high-frequency-sloping configuration,with high-frequency(8,000 Hz)thresholds declining at nearly double the rate of low-to-mid frequencies(11.7 dB vs.4.5-6.3 dB per decade).The steepest decadal deterioration occurred between the 70s and 80s,characterized by a transition from high-frequency sensory loss to generalized cochlear decline.A sex-dependent"crossover"was observed:females exhibited superior hearing in their 60s and 70s but experienced more rapid deterioration in late life,resulting in comparable or poorer thresholds than males by their 80s and 90s.Conclusion:In this tertiary-care outpatient cohort of older Chinese adults,ARHL demonstrated distinct age-and sex-specific trajectories,including disproportionate high-frequency vulnerability and a late-life sex crossover effect.Adoption of WHO 2020 criteria substantially increased hearing-loss identification,particularly among adults in their 60s and 70s.