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The Importance of Extended High-Frequency Testing with Dr. Melissa Fling

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Are you aware of the sounds your ears can’t hear? This episode dives deep into extended high-frequency hearing, a vital but often overlooked component of audiology. Join us to uncover how testing ranges above 8,000 Hz can reveal significant insights into your auditory health.

Dr. Melissa Fling shares her expertise and personal experiences as an audiologist. She explains the science behind high-frequency hearing loss and challenges the traditional limitations of standard audiometric tests. Discover why failing to assess these extended ranges may lead to unseen communication struggles that many individuals face, even while passing regular hearing tests. 

Through case studies from Dr. Fling’s practice, we explore how patients often present with "normal" thresholds yet experience complications related to high frequencies. Learn about the patient-centered approach that seeks not only to confirm hearing loss but to enhance quality of life through personalized treatment. 

This episode isn't just for audiologists; it’s for anyone who’s ever wondered about the complexities hidden within our hearing capabilities. Engage with us as we discuss the urgent need for a shift in audiological practices and how we can make strides toward comprehensive assessments for everyone. Want to be proactive about your hearing health? Tune in, and let’s start the conversation! Be sure to subscribe and share your thoughts on this crucial topic.

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Blaise M. Delfino, M.S. - HIS:

Thank you. You to our partners. Cycle, built for the entire hearing care practice. Redux, the best dryer, hands down Caption call by Sorenson. Life is calling CareCredit, here today to help more people hear tomorrow. Faderplugs the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host, blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters Podcast, and today I'm here with my guest, Dr Melissa Fling. She is a clinical audiologist and owner and founder of Custom Ear Solutions, a small private practice in Denver, Colorado. Through Custom Ear Solutions, Dr Fling specializes in hearing conservation and custom fitted ear molds for hearing protection and other uses. She is a graduate of Central Michigan University, one of my favorite old schools, and she has been practicing audiology for almost 10 years in many different settings. Dr Fling is certified through the American Speech-Language Hearing Association and she is licensed in many states, including Colorado, California, Arizona, Utah and New Mexico, so that means you can go almost anywhere. Anyway, thank you for joining me.

Dr. Melissa Fling:

Thank you, Dr Beck. I'm so excited to be here.

Dr. Douglas L. Beck:

Our topic for the day is extended high-frequency hearing and hearing loss and hearing aids and everything else that could have an extended high frequency but doesn't in general. So I want to start by asking you to tell me what is extended high-frequency hearing.

Dr. Melissa Fling:

As audiologists, we all know that humans can hear between 20 hertz and 20,000 hertz and historically it's been standard to test from about 250 hertz up to 8,000 hertz, because the research, I suppose, in the past has shown that that's where we pick up the most speech information, which is what we're most interested in knowing if somebody can hear. But then we're missing out on all this information between 8,000 and 20,000 hertz and that's what we refer to as extended high frequency or ultra high frequency hearing.

Dr. Douglas L. Beck:

Right. And this is so interesting to me because the reason I think that we do 250 to 8,000 is because that aligns very well with medical diagnosis. So you know, if I look between 250 and 8000 hertz I can see patterns like presbycusis, like noise induced hearing loss, like a car heart notch, like air bone gap, things like that. So so it's very, very useful to look there for medical reasons. But I think what we've learned over the decades and I do mean decades since World War Two we've learned that there's so much information to be had above 8000 hertz and I really think we're overdue to be testing that. So what does the literature say about extended high frequencies as far as the sensitivity to that?

Dr. Melissa Fling:

Well, it seems like when people start to lose sensitivity in the extended high frequency range it can potentially affect their localization. It's definitely affecting their speech perception, particularly in complex listening environments. It can affect the perception of music quality. So obviously with musicians they might start to notice something early on that might not show on a standard audiogram. So those are the three main things that I've come across localization, music perception and speech perception in complicated listening environments.

Dr. Douglas L. Beck:

And you know.

Dr. Douglas L. Beck:

The thing about this is, when you're looking above 8,000 hertz, you know there's so much literature that shows the topographic organization of the eighth nerve and the cochlea, and so when you start to have damage at 8, 10, 12, 14, 16, 18, 20,000 hertz, that could be an early warning sign of hearing loss yet to show up on the standard audiogram. And I want to point out that all you need is about 50% of those fibers intact in order to press the button when you hear a beep and have normal responses when somebody says they have a normal audiogram but they can't understand speech and noise, which is at least 26 million people. Jeff Danauer and I wrote a paper on that that was peer reviewed in 2019. And we identified 26 million. So now it's six years later. So I would I would guess it's 28 or maybe 30 million people if we were to redo all that work, but but I think that the point is that if you're looking above 8,000 Hertz, it could be a precursor to what's about to happen below 8,000 Hertz. What are your thoughts on that?

Dr. Melissa Fling:

I agree and I think just in my experience now I see that it can validate somebody's concerns about it when in the past they've been told that they have normal hearing. I've seen huge asymmetries between 8 and 20,000 hertz. I've seen significant hearing loss in that range. That could point to why someone has tinnitus or that could point to why someone perceives their tinnitus as being louder in one ear, why someone perceives their tinnitus as being louder in one ear. I was just actually messaging back and forth with someone on LinkedIn the other day who has seen a case where there was a significant extended high frequency asymmetry and it turned out that person had a vestibular schwannoma on the side that was worse. So they probably detected that way earlier than would have been detected.

Dr. Douglas L. Beck:

I mean, symptoms may have shown up, but yeah, I mean when you go back through the literature, you know, in 1977, 1978, weldon Seltzer and Daryl Brackman looked at the sensitivity of ABR, using ABR to detect acoustic neuromas or vestibular schwannomas, and what they found was very interesting, right, they found an elongation between wave one and wave five, which typically should be 4.0 milliseconds, but it would be maybe five or six or seven or nothing, no response at all. And that turned out to be very, very important in detecting acoustic tumors. And I think that the thing here is that an ABR click is essentially a square wave and most of the energy, if I recall, is going to be around 2,000 hertz, 4,000 hertz. So what you're saying is well, if you looked higher up in the spectral range, you might see damage sooner, which might make sense, because if an acoustic neuroma is touching an auditory nerve, it's mostly impinging on those high fibers first.

Dr. Melissa Fling:

So I agree with you.

Dr. Douglas L. Beck:

And I don't know that anybody's really looked at this.

Dr. Melissa Fling:

I don't know that they have either, because really nobody's testing extended high frequency. So there's so much research that is still that still needs to be done on it.

Dr. Douglas L. Beck:

Absolutely so. Tell me, have you seen any interesting patterns that you've seen through EHF testing? Do you have any data you can show us? I know you work with veterans and you work with active military now and then, but I know you mentioned to me that you had some interesting case studies. Can you show us one?

Dr. Melissa Fling:

Yeah. So this first one is a young man, Air Force veteran, who is a right-handed shooter. He worked in water and fuel system maintenance, which I don't know if that's as relevant to the hearing loss as being a right-handed shooter is. He perceived worse hearing in his left ear, but he essentially shows normal hearing in both ears up to 6,000 hertz. I'm going to show you what the audiogram looks like. So I tested up to 16,000 Hertz.

Dr. Melissa Fling:

That day was my capacity, and I've circled 6,000 Hertz, which is where the military technicians that test hearing would typically stop for hearing conservation purposes. And you can see how it drops way down from. I'd have to look. This is 30 is his threshold at 6,000 Hertz. So he has mild hearing loss there, but it drops down to that.

Dr. Douglas L. Beck:

Probably looks like about 60 dB and stays there, and then it looks like you've got five or six data points that go beyond 8,000 Hertz there. So if you're looking at the fellow's left ear there is a clear asymmetry, but it wouldn't show up in normal audiometry because they're only testing out to 6K. In the military and in the regular audiology and hearing aid dispensing world they test out to 8k, but this really wouldn't show up.

Dr. Melissa Fling:

And a little difference at 8 000 hertz everybody would just say is relatively insignificant right and so if he, if he was referred to for a diagnostic with a military audiologist, then they would see the drop at 8 000 hertz. But if, if not, if he didn't show a, then they would see the drop at 8,000 Hertz. Um, but if, if not, if he didn't show a significant shift, they would not necessarily refer him for a full diagnostic. So that would have been, the 8,000 Hertz would have been missed out. So I'm hoping that in the future um the hearing conservation for you know, the department of defense they will change their protocol to start including not only 8,000 hertz but extended high frequency, Because I mean that changes the entire story for him when we see that.

Dr. Douglas L. Beck:

Yeah, it really does and it also tells us. You'll see that pattern every now and then in tinnitus patients, where everything will be absolutely normal through 8K, but they'll have an asymmetry or they'll have a high frequency loss. That's bilateral, that would not show up below 8K.

Dr. Melissa Fling:

Right, and then I've got several others that show hearing loss above 8K. So here's another 59-year-old Navy veteran who worked in construction for the Navy, normal hearing at 8,000 hertz, which I'm going to circle here. We're close to it anyway in both ears. So I circled the 8,000 hertz threshold so he's got mild loss in the left ear at eight. But then you can see this huge drop off in the extended high frequency range.

Dr. Douglas L. Beck:

What was his primary complaint when he came in to see you?

Dr. Melissa Fling:

You know, honestly I don't remember, because it was over a year ago that I saw him and I didn't make notes on that, so he may not have perceived any problem. I'm not sure.

Dr. Douglas L. Beck:

Some of these people do, and some don't have any perception of it, which is another interesting thing to look at, but that's what his hearing looks like you as an Air Force veteran, which I am the changes that you can expect, you know, through the military are very, very slow to happen, unless there's an immediate need, in a crisis or something you know that says you must act now. I wonder have you had any contact with Military Academy of Audiology to speak with them or share ideas to see what they're, because they're a great group and I want to give a shout out to them. I worked with them many ideas to see what they're, because they're a great group and um I, I want to give a shout out to them. I worked with them many, many years ago. But the military academy of audiology would be a great place to bring this and to start discussing it, because if they say, hey, listen, we need to do this, um, you know it could get done the the.

Dr. Douglas L. Beck:

The interesting thing to me also is that you know we we rarely we're taught that we don't need to test the mid-tones unless the difference between the octaves is 20 dB or greater, and I've always thought that that's an absolute nonsensical state of affairs. That may be true for medical purposes Again looking for medical patterns of the etiology of hearing loss but I think there's so much information to get at 750, 1500, 3k and 6K and when you think about it in the military, if they do 255, 124 and 6, that's six data points. That's all they've got. If they add in the mid-tones, now they've got 10. If they add in, let's say, four spots above 8,000, or five or six spots, you know now you're going, you know up to 14, 15, 16 data points. That gives you a much clearer impression of what's actually going on in that ear than six data points. So I wonder why is it that AAA and ASHA and audiologists and hearing aid dispensers, why is it they don't do this?

Dr. Melissa Fling:

Well, I don't know for sure what everybody's reasoning is, but my guess is, from the places that I've worked, my guess is time the perception that it will take significantly more time to include six more data points, let alone 750 and 1500. So time, you know, we talked about this a little bit before but in an ear, nose and throat office that's extremely fast paced and busy, you have 10 minutes from the second you sit in the room with the patient, get case history and do an audio and, you know, hand them off to the physician and they just have to crank through people. So there's just not time unless they prioritize something like that. But insurance reimbursement is potentially an issue. There is a modifier for extended high frequency testing that's been suggested for the pure tone CPT code, but I don't know how responsive insurance companies are to that, If the re, what the reimbursement is, if it's consistent.

Dr. Melissa Fling:

So it's a time and money issue. And also I think from just discussing it with other audiologists, some might not see the purpose in it when we for. So if somebody has an extended high frequency hearing loss, we can't yet treat it with hearing aids. So that's the other obstacle that's coming up, or the resistance is. Ok, I can diagnose it, but I can't actually treat it. So what's the point of finding that information out?

Dr. Douglas L. Beck:

I'm going to argue that one. Here's the thing. So I wrote a paper in 2018 with 25 co-authors and we talked about what do you do with patients with normal thresholds who have hearing difficulty or speech and noise complaints and things like that. And the essence of the paper is that each person has to be treated as an N of one. Each has a specific complaint. That's your primary task is make sure they're safe and then address that complaint.

Dr. Douglas L. Beck:

But many of the recommendations were to try hearing aids. And, of course, back then in the 2010s is when the British Society of Audiology said that it's totally fine to put hearing aids on people who have normal hearing but they have tinnitus, and so you know, I took that and ran with it. I thought that was brilliant and I've always done that anyway, but I was so glad to see them come out with it, and now it's kind of a common thing in audiology in 2025 in the USA. To you know, with tinnitus patients, even if they have normal hearing, you might try hearing aids and see how that goes, because you know, habituation, masking, improved speech and noise, reduced background noise all of those things that you can get with a good quality hearing aid fitting. So this is my point on extended high frequencies and I have no basis for this at all.

Dr. Douglas L. Beck:

But I think if I had a patient who complained of hearing difficulty and the only thing I could find on them is a difference at 12, 14, 16, 18k, 20, 30, 40 dB you know asymmetry I might try hearing aids and see if that helps. Because in essence, you know, what they're complaining about is lots of things that we can't measure at those high frequencies and I wouldn't be opposed to trying hearing aids and I would probably not do that lightly. I mean, you got to do real your measures to make sure you're not getting too noisy. You have to. Uh, I would absolutely do speech and noise aided and unaided. And if he or she says to me oh my gosh, I'm doing so much better with this hearing aid, um, why wouldn't I suggest that they wear it? You know right, yeah, I mean, I wear hearing aids pretty much full time.

Dr. Douglas L. Beck:

now, you know I have a mild to moderate loss and and I can remember when my hearing loss was only mild every now and then wearing hearing aids and thinking, oh, this is so much better, you know. So you're not trying to fix anything other than their listening ability, their ability to make sense and comprehend the sounds around them. So I, you know, I don't have any proof, I can't offer any proof.

Dr. Douglas L. Beck:

But I think that it's ripe for somebody to do a study looking at extended high frequencies, find those people with losses and with asymmetries and see what they respond to, because you know, I mean, I mean I know it's been done with small pilot studies here and there, but I think it would be a really important study, particularly when we're talking about the military, because you know there are a lot of veterans who will come home from a tour of duty somewhere and they'll play I have difficulty hearing, I don't understand speech noise and they'll wind up with an FM system or a digital remote mic or hearing aids or a pocket talker and they'll tell you that life is much better.

Dr. Douglas L. Beck:

And tinnitus is such a great example because we can't directly measure it. We can use different tools to get a subjective perception of what their tinnitus is like, but we physically can't measure it. And yet we treat it. And my final word on that is there's a difference between treatment and cure, right? I mean, if I can treat it with hearing aid to make the patient's quality of life better, I haven't cured it, I haven't taken it away, I haven't fixed it, but I've given them a tool that allows them to do better with it, to manage with it, and I think that that's very worthwhile.

Dr. Melissa Fling:

Well, and I have a thought about that because actually some of the research has shown that extended high frequency hearing loss can mimic learning disorders in children. So again it's just going back to why wouldn't we want more data points to investigate why somebody is having the difficulty that they are child or adult, More information is better, but I think it comes down to a matter of time and money and cost for adding that module onto an audiometer.

Dr. Douglas L. Beck:

So it seems to me in my read of the literature over these last few weeks prepping for this, it looks like the modules that you need. You need something on your audiometer that can produce those sounds at the right oscillations, and that's an issue, issue but it's doable for many audiographers. And then you need heads, headsets that can reproduce it right, uh, special transducers to accurately, um, deliver that sound. So so that runs what like 1500 bucks, 2000 bucks yeah, that's.

Dr. Melissa Fling:

That's what I paid once on a colleague's GSI 61. It might have been about $1,200 to add the module onto that. And then I also had to buy the DD450 headphones, which were I can't remember. Now I want to say $900. That might be off. So it was an investment, but worth it to me because I'm totally fascinated by extended high-frequency hearing loss and right now I'm not doing any treatment with it because it's mostly veterans that I'm doing this testing on. But it's so fascinating to see the patterns that come up and how they either match or don't match with their perceived difficulties.

Dr. Douglas L. Beck:

Yeah, I'm. I'm really curious. I will try to get in touch. Some of my friends who used to work in San Antonio when I was in San Antonio were taking care of veterans and I'm curious what the main line of thinking is in this situation when you have asymmetries or hearing loss, it extended high frequencies, and perhaps the answer is they don't test it, so they don't know about that. So what are the limits of the application of EHF test results?

Dr. Melissa Fling:

Well, kind of like we already talked about. I think it's a matter of okay. Now we know that you have hearing loss in this range, what do we do about it? Hearing aids receivers can't produce that range of sound. So how do we treat it? And I think, just like you said, if you feel that it's safe and appropriate and it's not going to hurt anything, why not just try hearing aids and see if just having a little bit of a boost will give somebody help? That's no different than what we have done with people with auditory processing disorder who show normal hearing. They're often fit with some kind of ear level device.

Dr. Douglas L. Beck:

Absolutely, and they've been doing that since World War II.

Blaise M. Delfino, M.S. - HIS:

Fm trainers the old headset.

Dr. Douglas L. Beck:

And most of those kids didn't have hearing loss right.

Dr. Douglas L. Beck:

They didn't need things louder, they needed things clearer, and the way to accomplish that was to give them an improved signal-to-noise ratio.

Dr. Douglas L. Beck:

You know, I know that the original audiometers right from 100 years ago the first one out there went up to whatever it was 20,000 hertz right, and then the second one was it Westinghouse, I think it was 20,000 Hertz right, and then the second one was it Westinghouse, I think it was Westinghouse. The second one, wa2 or whatever it was called, only went out to 8,000 Hertz, and so we've known about the value of measuring the entire human hearing spectrum for a hundred years, but commercially it just didn't happen. And so I'm wondering when, when you have so many manufacturers now making audiometers and and you know, pretty small these days and, and you know, usually attached to a computer and all that good stuff. So the question is is there one in particular I mean, I hate to do this because I don't want to get hate mail from the others, but is there one or two that you might mention that you know, offer this, uh, as a regular part of their audiometry packaging?

Dr. Melissa Fling:

yeah, well, there are several. So I have the med recs awrc, which is a computer-based audiometer. Love it, it Interacoustics makes. Ehf testing available. Otometrics GSI Shoebox goes up to 16,000 hertz. So there's plenty of. I mean all the main audiometer manufacturers are offering it.

Dr. Douglas L. Beck:

And so that's great. I'm glad you mentioned that. Now tell me about your personal opinion as somebody who's studied this and been involved with this. When a patient comes in and they say I have difficulty in a cocktail party situation, I have difficulty speech and noise, are you going to test all frequencies or do you just see what you get through 8,000 and then make a decision? I mean, what's your standard protocol is what I'm asking.

Dr. Melissa Fling:

Yes, so what I've been doing. So I would like to do it on everybody, just to see, because I like seeing the patterns and seeing what comes up, no matter what the complaints are. But sometimes, when I'm lower on time, if it's an older person, that's maybe in their sixties, sevents I already know that they have hearing loss between 250 and 8000 or it's likely that they do so. Once I'm doing that testing I see what that looks like. If I have extra time I'll do EHF testing on them. If I don't, then I won't, and it might not be as valuable information with them as it would be with somebody who shows relatively normal hearing between 250 and eight. So I tend to do it. I tend to stick to my guns doing it on younger people that show normal hearing between 250 and eight and less, with older populations that show hearing loss at that range. But if I had all the time I'd do it on yeah, as as at least as the the first time that I test them.

Dr. Douglas L. Beck:

You know this is. It's more of a political statement that I'm happy to make. I'm an old guy. They say whatever they want, I don't care, but we're in this difficult situation where we have best practices right and AAA, ash and IHS. The best practices are brilliant, they're all excellent, they all need to be renewed, but they're all excellent.

Dr. Douglas L. Beck:

And my point is that we don't get paid to do best practices. We get paid to do 92557 and other little things and it's a huge problem. Physicians are in the same boat, nurses are in the same boat, ots, pts, speech, language pathology are in the same boat OTs, pts, speech, language pathology. But it sets us up for failure because we know so much more than what we can bill. We know how to find more important diagnostic information than what we can bill for. And I think you're speaking honestly to the fact that people don't do the work that we can and probably should do because we're limited by reimbursement through crazy insurance companies, you know, won't reimburse for the work you did. You know we all have ICD-10s and CPT codes and it's a shambles, I you know. And and it just gets worse and worse the more you look at it. I wonder if one day we'll go back to fee for service, cause.

Dr. Douglas L. Beck:

If we did, I think everybody could then do the complete best practice protocol, which would be always in the patient's best interest. And that gets us to oh, that's why we do screenings, because it's more efficient. No, it's not. It's not A pure tone screening.

Dr. Douglas L. Beck:

So if I do a pure tone screening on any of your patients 250, 500, 1k, 2k, maybe throwing 3K and 4K at 30 dB or 25, you know all these intricate patterns that you're finding, all of this very valuable high frequency information none of it would be found. If the patient had asymmetries that you know started at 8K and went above, they would never be seen. And you know when patients come in for screenings, we're in this terrible position where we say well, you know your hearing is normal through the screening and nobody tested their speech and noise and their speech and noise might be deplorable, which Rich Wilson made very clear in 2011 that um of the 3,500 veterans he tested um in quiet I think now I'm going to go off the top of my head, but I'm going to be pretty close About 90% of them had normal word recognition scores in quiet and when he tested them with speech and noise, 70% of those failed.

Dr. Douglas L. Beck:

So the point is yeah 70% of them, but they passed all these shortcuts, practices, but they passed because we took all these shortcuts. So I don't know, just my own little rant that I've been on for about 40 years.

Dr. Melissa Fling:

Well, I'm getting into the same headspace. I get angry all the time thinking about how we've allowed insurance to put their hands not only into our money, but the way that we decide how we practice, because they're the boss of how we get reimbursed, which is not the way that it should be. They should not dictate the way that we practice. We should.

Dr. Douglas L. Beck:

Right, and it should be. You know, not maybe each of us as an individual, but if we're going to speak theoretically, you know you have a working group at AAA or ASHA or IHS. They say this is best practice, this is what we recommend. That's what you do, Right, chest. They say this is best practice, this is what we recommend.

Dr. Douglas L. Beck:

That's what you do Right, and then the evidence back, whatever their decisions are. And and that would be great, you know, I I think stuff like extended high frequency um testing would be a part of every test. Um, so would speech and noise. But you know, speech and noise is already in best practices by every major group, yet only 15% of us do it. And you're right. It is time and money, I mean. I don't think anybody says, oh, it's not worth doing. I think it's always time and money, and you know that puts us in a tough spot Anyway. So if listeners were to take away one thing about extra high frequency testing, what would you want that to be?

Dr. Melissa Fling:

I'm going to kind of steal from a hearing journal article that I read recently and at the end they say to steal from a hearing journal article that I read recently and at the end they say there's always got to be the first kid on the block doing it. So start doing it. The more of us that do it, the more this will become the standard. It should be the standard. We should be testing the entire cochlea, not a part of it. And another thing that this makes me think of I want to give a shout out to a former supervisor professor at Central Michigan, shannon Palmer.

Dr. Melissa Fling:

She always said to us in class and in clinic don't be an oddie. Almost. Do it the right way, do it the thorough way. You're getting a doctorate. There's a reason that you're getting a doctorate. There's there's a reason that you you know you're getting a doctorate you need to be performing at a high level. So let's do what we should be doing and and evaluate people comprehensively. And the more we all start doing it and diagnosing it, I wonder if the hearing aid industry will kind of come along and try to catch up with that, because there will be more and more need for hearing aids to be able to amplify in that range. So we've just got to start doing it, that's all.

Dr. Douglas L. Beck:

Well, the industry frequently does follow practice and I can tell you I wrote a paper gosh, I'm going to say 15 years ago on extended bandwidths in hearing aids and at that point the extended bandwidth was going out to 6,000 to 8,000 hertz and that was unusual because hearing aids prior to that only went out really to about 3,000 or 4,000 hertz.

Dr. Douglas L. Beck:

But I do think that the hearing aid industry responds very, very well to clinical needs and I think if we had enough data to show how important this is, I think they could probably you know it's not easy because they don't have the transducers right now, but they could start doing R&D on them out to, you know, 12,000 hertz or maybe 14,000 on a good day, but 10 to 12,000 hertz Now. Some of the hearing aid manufacturers do go out to 10,000 hertz now, but there's just not a lot of gain available there and you know there's so many issues that get involved. But I do think that if the data supports that, audiologists and dispensers are going to start testing on a regular basis five or six data points, like you do, beyond 8,000 hertz, it would be nice to have some products that could reach that.

Dr. Douglas L. Beck:

So I think you're exactly right, all right. Well, listen, melissa, it's been a joy to spend time with you and I'm so happy that we had this discussion, and I will try to follow up with the Military Academy of Audiology. I think this is a great question. I used to have some friends there. I don't know if they're still there, but I'll try and I wish you a joyous afternoon. Thank you so much.

Dr. Melissa Fling:

Thank you, Dr Beck.

Dr. Douglas L. Beck:

My pleasure.

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Blaise M. Delfino, M.S. - HIS

Host
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Dr. Douglas Beck

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