Dear Editors,

We appreciate the kind comments of the above team and their endeavours to employ high-frequency pure tone audiometry as an extended audiometric screening tool. Distortion product otoacoustic emissions, whilst representing a potentially useful adjunct test, should never supplant the ‘gold standard' of carefully conducted audiometric testing.

The corresponding author has also had some experience, at Leicester, in using high-frequency pure tone audiometry in patient groups exposed to ototoxic drugs. He agrees that they can enhance the inferential sensitivity of standard pure tone audiometry. However, their routine use is circumscribed by the absence of internationally accepted threshold standards. The recognised sensitivity of high frequencies to various ototrauma means there are other sources of measurement variability that the clinician must account for.

Notwithstanding these limitations, the proposal to conduct repeated measures of high-frequency pure tone audiometry thresholds in specified subject groups is a sensible one. We would certainly be in favour of the systematic deployment and development of high-frequency pure tone audiometry measurement as described by the above correspondents. It will of course be important to complement the psychophysical measurement with the dimensions of any known noise exposure (i.e. frequency range, intensity and duration).