Remote Monitoring of Adult Cochlear Implant Recipients Using Digits-in-Noise Self-Testing

The multilingual digits-in-noise (DIN) test: development and evaluation

OBJECTIVE

To develop a methodologically uniform digits-in-noise (DIN) test in 17 different languages.

DESIGN

The DIN test was developed for Android devices as an extension to the open-access Hearing Test™ app, available on the Google Play store. It utilised professionally recorded female speech, speech-shaped noise, a digit scoring method and a variable step size. The test was adaptively optimised and evaluated as the results of tests taken online by users of the app became available.

STUDY SAMPLE

Optimisation using 35,534 ears, evaluation using 6012 ears.

RESULTS

Optimisation improved the slopes of the psychometric functions for all languages by an average of 6.8%/dB. Evaluation included calculation of normative speech reception thresholds (SRTs) and estimation of test-retest standard deviations. Normative values for SRTs ranged from -14.2 dB SNR (95% CI -14.3 to -14.0) for Chinese to -11.2 dB SNR (95% CI -11.3 to -11.1) for Japanese, with reliability estimates ranging from 0.48 dB (95% CI 0.36-0.64) for Portuguese to 0.91 dB (95% CI 0.73-1.21) for Romanian.

CONCLUSIONS

The optimisation of each language version was confirmed by the improvement in the slopes of the psychometric functions. The normative values obtained from the test evaluation were in agreement with literature data.

TRIAL REGISTRATION

Science Support Centre of Wroclaw Medical University BW-59/2020.

Remote self-testing for adult cochlear implant users: the effect of wireless streaming on speech recognition in noise

OBJECTIVES

Wireless sound transfer methods for cochlear implant sound processors have become popular for remote self-assessed hearing tests. The aim of this study was to determine (1) spectral differences in stimuli between different wireless sound transfer options and (2) the effect on outcomes of speech recognition tests in noise.

DESIGN

In study 1, the frequency response of different streaming options (Phonak Roger Select, Cochlear Mini Mic 2+, telecoil and Bluetooth connection) was measured by connecting headphones to CI sound processors. Study 2 followed a repeated measures design in which digits-in-noise (DIN) tests were performed using wireless streaming to sound processors from Cochlear, Advanced Bionics, and MED-EL.

STUDY SAMPLE

20 normal hearing participants.

RESULTS

Differences in frequency response between loudspeaker and wireless streaming conditions were minimal. We did not find significant difference in DIN outcome (F4,194 = 1.062, p = 0.376) between the wireless transfer options with the Cochlear Nucleus 7 processor. No significant difference in DIN outcomes was found between Bluetooth streaming and the loudspeaker condition for all of the three tested brands. The mean standard error of measurement was 0.72 dB.

CONCLUSIONS

No significant differences in DIN test outcomes between wireless sound transfer and the reference method were found.

Changing Knowledge, Principles, and Technology in Contemporary Clinical Audiological Practice: A Narrative Review

The field of audiology as a collection of auditory science knowledge, research, and clinical methods, technologies, and practices has seen great changes. A deeper understanding of psychological, cognitive, and behavioural interactions has led to a growing range of variables of interest to measure and track in diagnostic and rehabilitative processes. Technology-led changes to clinical practices, including teleaudiology, have heralded a call to action in order to recognise the role and impact of autonomy and agency on clinical practice, engagement, and outcomes. Advances in and new information on loudness models, tinnitus, psychoacoustics, deep neural networks, machine learning, predictive and adaptive algorithms, and PREMs/PROMs have enabled innovations in technology to revolutionise clinical principles and practices for the following: (i) assessment, (ii) fitting and programming of hearing devices, and (iii) rehabilitation. This narrative review will consider how the rise of teleaudiology as a growing and increasingly fundamental element of contemporary adult audiological practice has affected the principles and practices of audiology based on a new era of knowledge and capability. What areas of knowledge have grown? How has new knowledge shifted the priorities in clinical audiology? What technological innovations have been combined with these to change clinical practices? Above all, where is hearing loss now consequently positioned in its journey as a field of health and medicine?

Can Videoconferencing Be a Viable Method to Measure Speech Perception?

PURPOSE

Telehealth has proven effective for service delivery to remote and rural locations and was helpful during lockdowns when patients were unable to see clinicians in person. To assure the reliability of clinical services, the aim of the present study was to evaluate a telehealth protocol to measure speech perception skills through virtual meeting applications such as Zoom.

METHOD

A total of 20 participants with normal hearing and cognition participated in the study. Participants' speech perception performance was measured in two sessions: one over a Zoom call and one in person in the laboratory. Speech perception was measured using Quick Speech-in-Noise Test, Bamford-Kowal-Bench Speech-in-Noise Test, and Words-in-Noise Test.

RESULTS

Statistical analysis revealed no significant differences between speech perception scores obtained over the Zoom and in-person methodologies for any of the tests. Additionally, our study found no significant difference in the scores obtained between wired and wireless headphones during Zoom calls.

CONCLUSION

These results suggest that Zoom can be used as a reliable method to measure speech perception in young individuals with normal hearing using these three tests in situations where conventional methods cannot be utilized.

Remote self-report and speech-in-noise measures predict clinical audiometric thresholds

Developments in smartphone technology and the COVID-19 pandemic have highlighted the feasibility and need for remote, but reliable hearing tests. Previous studies used remote testing but did not directly compare results in the same listeners with standard lab or clinic testing. This study investigated reliability of remote, self-administered digits-in-noise (remote-DIN) compared with lab-based, supervised (lab-DIN) testing. Predictive validity was further examined in relation to a commonly used self-report, Speech, Spatial, and Qualities of Hearing (SSQ-12), and lab-based, pure tone audiometry. DIN speech reception thresholds (SRTs) of adults (18-64 y/o) with normal-hearing (NH, N=16) and hearing loss (HL, N=18), were measured using English-language digits (0-9), binaurally presented as triplets in one of four speech-shaped noise maskers (broadband, low-pass filtered at 2, 4, 8 kHz) and two digit phases (diotic, antiphasic). High, significant intraclass correlation coefficients indicated strong internal consistency of remote-DIN SRTs, which also correlated significantly with lab-DIN SRTs. There was no significant mean difference between remote- and lab-DIN on any tests. NH listeners had significantly higher SSQ scores, and remote- and lab-DIN SRTs than listeners with HL. All versions of remote-DIN SRTs correlated significantly with pure-tone-average (PTA), with the 2-kHz filtered test the best predictor, explaining 50% of variance in PTA. SSQ total score also significantly and independently predicted PTA (17% of variance) and all test versions of the remote-DIN, except the antiphasic BB test. This study shows that remote SSQ-12 and remote-DIN are sensitive tools for capturing important aspects of auditory function.