Occupational noise exposure and age correction: The problem of selection bias

Selection bias often invalidates conclusions about populations based on clinical convenience samples. A recent paper in this journal [1] makes two surprising assertions about noise-induced permanent threshold shift (NIPTS): first, that there is more NIPTS at 2 kHz than at higher frequencies; second, that NIPTS declines with advancing age. Neither assertion can be supported with the data presented, which were obtained from a clinical sample; both are consistent with the hypothesis that people who choose to attend an audiology clinic have worse hearing, especially at 2 kHz, than people of the same age and gender who choose not to attend.