The Audiogram

The Equal Temperament

Chapter 8: The Audiogram

Three months had passed since the first audiogram, and the season had turned from October's gray-gold to January's unbroken gray, the Portland winter that was not cold so much as constant, a temperature in the low forties that did not vary, a rain that did not storm or clear but persisted, day after day, week after week, the city under a ceiling of cloud that was less weather than climate, less event than condition, and Clara had tuned approximately two hundred and forty pianos in those three months and had noticed, in the tuning of approximately the last sixty of them, a change.

The change was subtle. It was not a loss of ability — she could still tune, could still set a temperament, could still match octaves and unisons, could still do the work — but a loss of certainty, a narrowing of the margin between what she heard and what she needed to hear, the gap between perception and requirement closing, the clearance shrinking, the way the clearance between a piston and a cylinder shrinks as the engine wears, the machine still functional but the tolerance tighter, the room for error smaller, the risk of failure not imminent but approaching.

She had compensated. She had begun, without making a conscious decision to do so, to spend more time on the upper treble, to listen longer to each note above C7, to strike the keys harder so that the fundamentals were louder and the partials more prominent, to lean closer to the strings so that the sound traveled a shorter distance to her ears, and these compensations were effective — the tunings were good, the clients were satisfied, no one had noticed any change — but the compensations themselves were evidence of the change, were symptoms of the disease, were the adjustments you make when the thing you are adjusting for is real.

She had also begun, without telling anyone, to use the Korg tuner as a check on the top octave. Not as a primary tool — she still tuned by ear, still set the intervals by listening for beats, still did the work the way she had always done it — but as a verification, a second opinion, a way to confirm that what her ear told her was correct. She would tune the top octave by ear and then, when the tuning was complete, she would turn on the Korg and check the top notes, one by one, comparing the ear's judgment to the device's measurement, and in most cases the ear and the device agreed, the notes within a cent or two of the target, the tuning correct, and Clara would turn off the Korg and feel reassured and pack her tools and leave.

But in some cases — four times in the last sixty tunings, she had counted — the Korg showed a discrepancy. A note in the top octave that was three cents sharp, or four cents flat, a deviation that was beyond the tolerance Clara would have accepted if she had heard it but that she had not heard, had not detected, had missed because the beats that would have revealed the error were in the frequency range where her hearing was diminished, where the audiogram showed the drop, where the hair cells were dying or dead.

Four times in sixty tunings. Once every fifteen tunings. A failure rate of approximately seven percent.

Clara had corrected the errors each time, had adjusted the pins, had brought the notes to the correct pitch as the Korg confirmed, and no client had heard the errors, because the errors were in the top octave where the notes sustained for less than a second and where most listeners — most pianists, most music teachers, most recreational players — could not hear a deviation of three or four cents, could not distinguish a slightly sharp C8 from a correct C8, could not hear what Clara could no longer hear.

But Clara could have heard it, once. Clara's ear, at its best, would have caught a three-cent deviation in the top octave without effort, would have heard the wrongness the way a carpenter sees a crooked line, instantly, automatically, without needing to look twice. And the fact that she now needed the Korg to catch what her ear had once caught alone was — Clara searched for a word that was not "decline" and could not find one — was a decline, was a diminishment, was a step down from the standard she had maintained for twenty-eight years.

She had made a follow-up appointment with Dr. Chau. The appointment was today, January 15th, at ten in the morning, and Clara was driving to the audiologist's office through the rain, through the January gray, through the streets of Portland that she knew by sound as well as by sight — the pitch of each bridge, the frequency of each intersection's traffic signal, the low hum of the power lines on Division Street, the particular acoustic signature of each neighborhood, each block, each corner — and she was thinking about the four errors in sixty tunings and about what the follow-up audiogram would show and about whether the drop at 6,000 hertz had deepened, whether the curve had descended further, whether the territory she was losing had expanded.

Dr. Chau's office was on the fourth floor of a medical building on Morrison Street, a building that smelled of antiseptic and new carpet and the particular odorless air of a building with a mechanical ventilation system, air that had been filtered and conditioned and delivered through ducts at a constant temperature and humidity, air that was the opposite of the air in the houses where Clara tuned, where the air carried the smell of cooking and pets and laundry and the particular smell of each family's life, the smell that Clara associated with each piano, the olfactory context that accompanied the auditory context, each piano existing not just in a sound environment but in a smell environment, each piano's sound colored by the associations Clara's brain made between what she heard and what she smelled, the synaesthetic linking of senses that made each tuning not just a job but a visit, not just a task but an experience.

The waiting room was quiet. Clara sat in a chair with a magazine she did not read and waited for her name to be called, and while she waited she listened to the sounds of the waiting room — the receptionist's keyboard, the ventilation system's hiss, the muffled conversation from a room down the hall, the faint buzz of the fluorescent lights at 120 hertz, the second harmonic of the electrical supply — and she catalogued the sounds by frequency and amplitude and source, as she always did, the automatic inventory of an ear that had been trained to categorize sound the way a somelier's palate categorizes taste, and the catalogue was complete, was accurate, was the work of an ear that functioned well in the frequencies below 4,000 hertz, and the irony of this — that Clara's ear worked brilliantly in the frequencies that the waiting room provided and poorly in the frequencies that her work demanded — was not lost on her.

"Clara Resnikoff."

She followed the technician — a young man in scrubs who spoke quietly and moved with the efficiency of someone who performed the same procedure many times a day — to the booth, the soundproof room, and the room was small, perhaps four feet by four feet, with a chair and a pair of headphones mounted on a hook and a window through which the technician would observe her from the control room, and the room was lined with acoustic foam that absorbed all reflections, that made the room anechoic, that removed from the air every sound except the sounds the headphones would produce, and Clara put on the headphones and sat in the chair and the technician closed the door and the silence was total, was absolute, was the purest silence Clara had ever experienced, a silence so complete that she could hear her own blood circulating, her own heart beating, the tiny internal sounds of a living body that are normally masked by the ambient noise of the world.

The test began.

The first tone was at 250 hertz — a low hum, easy to hear, well within the range of normal hearing for a person of any age — and Clara pressed the button and the tone stopped and another tone began at 500 hertz, and she pressed the button, and 1,000 hertz, and she pressed the button, and the tones climbed the frequency scale, each one higher than the last, each one tested at different volume levels to determine the threshold — the quietest level at which Clara could detect the tone — and Clara pressed the button each time, hearing each tone clearly, the button-pressing automatic, effortless, the sounds obvious, unambiguous, present.

At 2,000 hertz, clear. At 3,000, clear. At 4,000, clear. The tones were well within her hearing, the thresholds low, the ear performing as it should, as the first audiogram had shown it would, the lower frequencies undiminished, intact, normal.

At 6,000 hertz, the tone was present but softer. Clara heard it, pressed the button. The technician reduced the volume. Clara heard it, pressed the button. The volume reduced again. Clara listened. She heard — something. A whisper of tone. She pressed the button. The volume reduced again. Silence. She waited. Nothing. She did not press the button.

At 8,000 hertz, the tone was fainter. She heard it at the louder presentation, pressed the button. At the reduced level, she heard it — barely, at the edge. She pressed the button. At the next reduction, silence. She waited, leaning forward slightly, as though leaning could help the ear hear, which it could not, which was irrational, but the body did it anyway, the way the body leans into a conversation when the speaker is quiet, the instinctive attempt to close the distance between the sound and the ear.

Nothing.

The test continued at higher frequencies. 10,000 hertz. Clara heard the louder presentation, but the tone had a quality she had not experienced before — not faint but strange, distorted, as though the tone were being transmitted through a medium that altered it, that added artifacts, that changed the clean sinusoidal wave into something rougher, less pure, and she pressed the button because she heard something but she was not confident that what she heard was the tone, was not sure whether she was hearing the signal or hearing her own ear's attempt to produce a signal, the neural noise that the auditory system generated when it searched for a sound at the edge of its range.

At 12,000 hertz, she heard the loudest presentation only — a faint, metallic whisper, more sensation than sound, more pressure than pitch — and at the lower levels, nothing. At 14,000 hertz, she heard nothing at any level. The button remained unpressed. The frequency existed — the headphones were producing it, the air in the booth was vibrating at 14,000 cycles per second — but Clara could not detect it, could not transduce it, could not convert it from vibration into perception, and the vibration passed through the air of the booth and struck the tympanic membrane and traveled through the ossicles to the cochlea and the basilar membrane displaced at the position corresponding to 14,000 hertz and the hair cells at that position were — absent. Dead. Gone. The cells that would have bent, that would have opened their ion channels, that would have generated the electrical signal that would have traveled the auditory nerve to the cortex and been interpreted as a tone — those cells no longer existed. The frequency was present. The ear was not.

The test ended. Clara removed the headphones and sat in the booth for a moment, in the anechoic silence, and the silence was different now than it had been at the beginning of the test, was not pure but populated, was filled with the frequencies she could not hear, the 14,000 hertz and the 12,000 hertz and the frequencies between that existed in the world but not in her perception, and the silence was not the absence of sound but the absence of hearing, which was a different thing, a distinction that most people never needed to make but that Clara, sitting in the booth with the headphones in her lap, understood with a clarity that was itself a kind of hearing.

Dr. Chau met her in the consultation room, a small office with a desk and two chairs and a computer monitor on which the audiogram was displayed, the graph that showed frequency on one axis and hearing level on the other, the same format as the first audiogram, the same coordinates, the same convention of good news at the top and bad news at the bottom.

The new curve was lower than the old curve.

Clara saw this immediately, before Dr. Chau spoke, before the numbers were discussed, before the clinical vocabulary was deployed — she saw that the symbols at 6,000 hertz were lower than they had been in October, and the symbols at 8,000 hertz were lower still, and there were new symbols at 10,000 and 12,000 hertz that the first test had not included, and these symbols were deep on the graph, low on the vertical axis, in the territory that the audiogram designated as moderate to severe loss.

"The loss has progressed," Dr. Chau said. "More rapidly than I would have expected for a three-month interval."

Clara looked at the numbers. Right ear: 30 decibels at 6,000 hertz, up from 25. 45 decibels at 8,000, up from 35. Left ear: 35 at 6,000, up from 30. 50 at 8,000, up from 40.

"The rate of progression is unusual," Dr. Chau said. "Presbycusis typically progresses slowly — a few decibels per year. Your loss has progressed ten decibels in three months at 8,000 hertz. I'd like to rule out other causes."

"What other causes."

"Noise exposure, ototoxic medications, autoimmune inner ear disease, acoustic neuroma — though the bilateral symmetry makes neuroma unlikely. Have you had any noise exposure. Concerts, power tools, firearms."

"I tune pianos," Clara said. "The loudest sound I encounter is a fortissimo on a concert grand. Maybe 95 decibels. For a few seconds at a time."

"That shouldn't be a factor. Medications. Are you taking anything."

"Ibuprofen. For my back."

"How often."

"Several times a week. Sometimes daily."

Dr. Chau made a note. "NSAIDs — ibuprofen, aspirin, naproxen — can be ototoxic at high doses or with prolonged use. The ototoxicity is usually reversible if the medication is discontinued. I'd recommend switching to acetaminophen for pain management and seeing whether the progression slows."

Clara heard the word "reversible" and felt something move in her chest, not hope exactly but the precursor of hope, the chemical change that precedes the emotion, the body preparing for good news that the mind had not yet processed. "Reversible."

"Potentially. The NSAID-related component, if there is one. The age-related component is not reversible. It may be that your loss is a combination of presbycusis and NSAID ototoxicity, and by removing the NSAID component, we can slow the progression or partially restore the function at the affected frequencies."

"How much restoration."

"I can't predict. It would depend on whether the NSAID damage has been to the hair cells directly or to the stria vascularis — the blood supply to the cochlea. If it's the blood supply, recovery is more likely. If it's the hair cells, less so."

Clara looked at the audiogram on the screen. The curve. The drop. The numbers that were worse than three months ago. The territory that was shrinking.

"I'd like to see you again in three months," Dr. Chau said. "In the meantime, discontinue the ibuprofen, use acetaminophen instead, wear hearing protection in noisy environments, and — I want to ask you something, if you don't mind."

"Go ahead."

"Have you noticed any functional impact. On your work."

Clara looked at Dr. Chau. The audiologist's face was composed, attentive, the face of a clinician asking a clinical question, but the question was not clinical, was personal, was the question that Clara had been asking herself for three months and that she had been answering with the qualified honesty of a person who is not ready to admit the full truth.

"I've noticed some difficulty in the top octave," Clara said. "Above C7. The beats between the intervals are harder to hear. I can still hear them, but I have to listen harder. I have to concentrate more."

This was true but incomplete. It did not mention the Korg. It did not mention the four errors in sixty tunings. It did not mention the compensations — the harder striking, the leaning closer, the extra time — that Clara had adopted. It did not mention the uncertainty, the doubt, the erosion of the confidence that had been the foundation of her work for twenty-eight years. It was a clinical summary of a lived experience, and the clinical summary captured the data but not the meaning, the measurements but not the weight.

"The top octave," Dr. Chau said. "The fundamentals up there are between approximately 2,100 and 4,200 hertz. Your hearing is normal at those frequencies."

"The fundamentals, yes. But the beats — the interactions between the notes — the relevant frequencies are higher. The second and third partials of the top octave notes are above 6,000 hertz. That's where I'm losing."

Dr. Chau nodded. "I understand. The functional impact is in the partials, not the fundamentals. Your ear's frequency resolution at the partial level is being compromised."

"Yes."

"Have you considered — and I ask this with full understanding of what your work means to you — have you considered whether there are alternative methods. Electronic tools. Software. Ways to supplement what the ear is losing."

"There are electronic tuners," Clara said. "I carry one. I've started using it to check the top octave."

"And."

"And it works. It measures the frequencies accurately. It tells me whether the notes are at the correct pitch. But it doesn't —" Clara stopped. She looked at the audiogram. She looked at the curve. She looked at the numbers. "It doesn't hear the piano. It measures frequencies. I hear the piano. Or I used to hear the piano. The distinction —"

She stopped again.

"The distinction matters," Dr. Chau said.

"The distinction is the only thing that matters."

They sat in silence for a moment, the audiologist and the piano tuner, two women in a small office on the fourth floor of a medical building on Morrison Street, and the silence was not the anechoic silence of the booth but the ordinary silence of a room where two people are sitting with a truth between them, a truth that has been stated but not fully absorbed, a truth that would require time to absorb, weeks and months and perhaps years, the way a soundboard absorbs moisture — slowly, incrementally, the wood changing without visible change, the dimensions shifting by fractions of a millimeter, the whole structure adjusting to a new condition.

Clara left the office with a new audiogram folded in her bag, next to the lever and the mutes and the fork. She drove home through the rain. She sat at the kitchen table and unfolded the audiogram and looked at it and then folded it and put it in the filing cabinet, in the folder labeled MEDICAL, next to the first audiogram, and the two audiograms lay in the folder like pages of a story, chapter one and chapter two, the narrative of decline told in graphs and numbers, the story of an ear losing the territory it needed.

She picked up the fork and held it and did not strike it.

She held it for a long time, the steel cool in her hand, the weight familiar, the A stamped on the tine facing upward, and she thought about the numbers — 30 decibels at 6,000 hertz, 45 at 8,000, 50 in the left ear — and she thought about the ibuprofen, about the possibility that some of the loss was reversible, about the word "potentially" that Dr. Chau had used, a word that was not a promise but an opening, not a guarantee but a possibility, and she held the possibility the way she held the fork, carefully, attentively, feeling its weight, not striking it, not testing it, not yet, because the possibility was like the fork at rest — it contained a potential that had not yet been released, a vibration that had not yet begun, and Clara wanted to hold it a moment longer before she released it into the air, where it would either sustain or decay, where it would either be confirmed or denied, where it would either be the beginning of recovery or the middle of decline.

She set the fork on the table.

She opened her appointment book and looked at tomorrow's schedule. Four pianos. Four houses. Four rooms. Four instruments waiting for her ear, her hands, her attention.

She would give them what she had.

She closed the book and went to bed and lay in the dark and listened to the house, to the rain, to the city, to the frequencies she could hear and the frequencies she could not, and somewhere in the space between hearing and not-hearing, between the audiogram's curve and the tuning fork's certainty, between what was lost and what remained, Clara found something that was not sleep but was close to sleep, a resting, a quieting, a settling of the mind into the body the way a piano settles into its tuning, not all at once but gradually, note by note, string by string, the whole instrument coming to rest in the grid of equal temperament, the grid that was not perfect but was functional, the compromise that made all keys equally playable by making all intervals equally impure.

She slept.

In her sleep, she heard nothing, and the nothing was neither silence nor loss but rest, the ear closing for the night the way the fallboard closed over the keys, protecting the instrument from the world, preserving the mechanism for another day of use, and the nothing lasted until morning, when Clara woke and struck the fork and heard the A and began again.