Speech-in-noise screening tests by internet, Part 1: Test evaluation for noise-induced hearing loss identification

Simplified cochlear frequency selectivity measure for sensorineural hearing loss screening: comparison with digit triplet test (DTT) and shortened speech, spatial and qualities of hearing scale (SSQ) questionnaire

PURPOSE

Pure-tone audiometry (PTA) is the gold standard for screening and diagnosis of hearing loss but is not always accessible. This study evaluated a simplified cochlear frequency selectivity (FS) measure as an alternative option to screen for early frequency-specific sensorineural hearing loss (SNHL).

METHODS

FS measures at 1 and 4 kHz center frequencies were obtained using a custom-made software in normal-hearing (NH), slight SNHL and mild-to-moderate SNHL subjects. For comparison, subjects were also assessed with the Malay Digit Triplet Test (DTT) and the shortened Malay Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire.

RESULTS

Compared to DTT and SSQ, the FS measure at 4 kHz was able to distinguish NH from slight and mild-to-moderate SNHL subjects, and was strongly correlated with their thresholds in quiet determined separately in 1-dB step sizes at the similar test frequency. Further analysis with receiver operating characteristic (ROC) curves indicated area under the curve (AUC) of 0.77 and 0.83 for the FS measure at 4 kHz when PTA thresholds of NH subjects were taken as ≤ 15 dB HL and ≤ 20 dB HL, respectively. At the optimal FS cut-off point for 4 kHz, the FS measure had 77.8% sensitivity and 86.7% specificity to detect 20 dB HL hearing loss.

CONCLUSION

FS measure was superior to DTT and SSQ questionnaire in detecting early frequency-specific threshold shifts in SNHL subjects, particularly at 4 kHz. This method could be used for screening subjects at risk of noise-induced hearing loss.

The relationship between hearing status, listening effort, and the need for recovery in employees of a manufacturing company

OBJECTIVE

Hearing screening can be used to detect hearing loss, but its value for identifying employees with work functioning difficulties is unclear. The objective of this study was to assess the association between the hearing status measured with an occupational hearing-in-noise screening test, Listening Effort (LE), and Need For Recovery (NFR) in employees of a manufacturing company, and to examine whether these associations depend on the perceived noise level at the workplace.

METHODS

Employees of coatings and paints manufacturing company were included. Their hearing status was assessed with an occupational hearing-in-noise screening test. An online survey was used to assess their LE, NFR, and the perceived noise level at the workplace. Responses from 143 employees were analyzed (mean age = 53 years) using hierarchical multiple regression analysis with the outcomes LE and NFR.

RESULTS

Regression analysis-with adjustments for gender, age, educational level, health status, pace/amount of work, job variety, and work pleasure-revealed that hearing status was significantly associated with LE, but the interaction between hearing status and the perceived noise level was not. Hearing status nor the interaction between hearing status and the perceived noise level was significantly associated with NFR.

CONCLUSION

The results confirm that poorer hearing is associated with higher LE, but not with higher NFR. These associations were unrelated to the perceived noise level at the workplace. Therefore, the value of occupational hearing screening appears to be early identification of hearing loss in employees, but not identification of work functioning difficulties.

Characterization of Synthetic Health Data Using Rule-Based Artificial Intelligence Models

The aim of this study is to apply and characterize eXplainable AI (XAI) to assess the quality of synthetic health data generated using a data augmentation algorithm. In this exploratory study, several synthetic datasets are generated using various configurations of a conditional Generative Adversarial Network (GAN) from a set of 156 observations related to adult hearing screening. A rule-based native XAI algorithm, the Logic Learning Machine, is used in combination with conventional utility metrics. The classification performance in different conditions is assessed: models trained and tested on synthetic data, models trained on synthetic data and tested on real data, and models trained on real data and tested on synthetic data. The rules extracted from real and synthetic data are then compared using a rule similarity metric. The results indicate that XAI may be used to assess the quality of synthetic data by (i) the analysis of classification performance and (ii) the analysis of the rules extracted on real and synthetic data (number, covering, structure, cut-off values, and similarity). These results suggest that XAI can be used in an original way to assess synthetic health data and extract knowledge about the mechanisms underlying the generated data.

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.

Speech-in-noise testing: Innovative applications for pediatric patients, underrepresented populations, fitness for duty, clinical trials, and remote services

Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.

Evaluation of Machine Learning Algorithms and Explainability Techniques to Detect Hearing Loss From a Speech-in-Noise Screening Test

PURPOSE

The aim of this study was to analyze the performance of multivariate machine learning (ML) models applied to a speech-in-noise hearing screening test and investigate the contribution of the measured features toward hearing loss detection using explainability techniques.

METHOD

Seven different ML techniques, including transparent (i.e., decision tree and logistic regression) and opaque (e.g., random forest) models, were trained and evaluated on a data set including 215 tested ears (99 with hearing loss of mild degree or higher and 116 with no hearing loss). Post hoc explainability techniques were applied to highlight the role of each feature in predicting hearing loss.

RESULTS

Random forest (accuracy = .85, sensitivity = .86, specificity = .85, precision = .84) performed, on average, better than decision tree (accuracy = .82, sensitivity = .84, specificity = .80, precision = .79). Support vector machine, logistic regression, and gradient boosting had similar performance as random forest. According to post hoc explainability analysis on models generated using random forest, the features with the highest relevance in predicting hearing loss were age, number and percentage of correct responses, and average reaction time, whereas the total test time had the lowest relevance.

CONCLUSIONS

This study demonstrates that a multivariate approach can help detect hearing loss with satisfactory performance. Further research on a bigger sample and using more complex ML algorithms and explainability techniques is needed to fully investigate the role of input features (including additional features such as risk factors and individual responses to low-/high-frequency stimuli) in predicting hearing loss.

Listening Effort Measured Using a Dual-task Paradigm in Adults With Different Amounts of Noise Exposure

OBJECTIVES

Excessive noise levels can result in hearing damage and/or hearing-related symptoms, thereby leading to impaired communication and, eventually a decrease in the quality of life. Moreover, in daily practice, subjects often indicate that listening in noisy situations is a challenging and often exhausting experience, even in the absence of a clinically significant hearing loss. Hence, a person's perceived difficulty of the listening situation will also be important to consider. It has been suggested that beyond the peripheral factors, there are some central cognitive correlates of speech understanding that are essential for communication abilities. The aim of the present study was to evaluate the effect of the amount of noise exposure on hearing as measured by pure-tone audiometry and otoacoustic emissions (OAEs) on the one hand and listening effort measured using a dual-task paradigm on the other hand.

DESIGN

The study included 152 adults between 18 and 40 years of age. First, participants completed a self-administered questionnaire regarding the amount of noise exposure. Second, hearing status was evaluated using pure-tone audiometry and transient evoked OAEs (TEOAEs) as well as distortion product OAEs (DPOAEs). Finally, listening effort was evaluated using a dual-task paradigm, which consisted of a primary speech-recognition task in different listening conditions and a secondary visual memory task that were performed both separately and simultaneously. Based on the quartiles of their subjective estimation of noise exposure, the participants were categorized into a group with low noise exposure (lower quartile), moderate noise exposure (two middle quartiles), and high noise exposure (upper quartile).

RESULTS

There was no significant difference in hearing thresholds between the participants with low, moderate, and high noise exposure for each frequency of the pure-tone audiometry. In contrast, more absent TEOAEs and DPOAEs were found in the high noise exposed group. Regarding the primary speech-recognition task of the dual-task paradigm, no significant difference in speech recognition was found between the different groups of noise exposure. For the amount of listening effort, it was found that across all listening conditions subjects with high noise exposure expend significantly more listening effort compared with subjects with low and moderate noise exposure.

CONCLUSIONS

This study is a first exploration of the effects of different amounts of noise exposure on listening effort showing that, listening effort is increased in subjects with high noise exposure compared with subjects with low and medium noise exposure. The most plausible hypothesis pertains to an effect of noise exposure on the peripheral and central auditory system, or a combination of effects on both the auditory system and the high-level cognitive functions necessary for speech understanding in the subjects with high levels of noise exposure. As such, a test for listening effort would be useful as part of a comprehensive test battery within the assessment of subjects exposed to noise.

The digit triplet test: a scoping review

OBJECTIVE

This review article presents an overview of all Digit Triplet Tests (DTT) and digits-in-noise tests (DIN) and their variations in language, speech material, masking noise, test procedures, and targeted population. The effects on aspects of validity, reliability, and feasibility are investigated.

DESIGN

Scoping review.

STUDY SAMPLE

All studies referring to the DTT and DIN were collected from Pubmed and Embase. Search terms "digit triplet test" and "digits in noise" were used. Citations of selected articles were scanned backwards in time (the bibliography of the already selected research article) and forward in time (articles that cited the already selected research article). The search terms yielded 95 results in total. Eventually, 39 papers were selected.

RESULTS

Analyses showed psychometric reference-curves with steep slopes and speech reception thresholds with high measurement precision which are strongly associated with pure tone audiometry. High sensitivity and specificity to detect elevated pure tone thresholds were noted for test variants. Certain procedural modifications of the DTT and DIN can further improve the test. Additionally, large-scale application of the DTT and DIN is feasible.

CONCLUSION

The DTT and DIN are a very valuable tool for screening and diagnostics for a wide variety of populations.

Improved Sensitivity of Digits-in-Noise Test to High-Frequency Hearing Loss

OBJECTIVES

Hearing loss is most commonly observed at high frequencies. High-frequency hearing loss (HFHL) precedes and predicts hearing loss at lower frequencies. It was previously shown that an automated, self-administered digits-in-noise (DIN) test can be sensitized for detection of HFHL by low-pass filtering the speech-shaped masking noise at 1.5 kHz. This study was designed to investigate whether sensitivity of the DIN to HFHL can be enhanced further using low-pass noise filters with higher cutoff frequencies.

DESIGN

The US-English digits 0 to 9, homogenized for audibility, were binaurally presented in different noise maskers including one broadband and three low-pass (cutoff at 2, 4, and 8 kHz) filtered speech-shaped noises. DIN-speech reception thresholds (SRTs) were obtained from 60 normal hearing (NH), and 40 mildly hearing impaired listeners with bilateral symmetric sensorineural hearing loss. Standard and extended high-frequency audiometric pure-tone averages (PTAs) were compared with the DIN-SRTs.

RESULTS

Narrower masking noise bandwidth generally produced better (more sensitive) mean DIN-SRTs. There were strong and significant correlations between SRT and PTA in the hearing impaired group. Lower frequency PTALF 0.5,1, 2, 4 kHz had the highest correlation and the steepest slope with SRTs obtained from the 2-kHz filter. Higher frequency PTAHF 4,8,10,12.5 kHz correlated best with SRTs obtained from 4- and 8-kHz filtered noise. The 4-kHz low-pass filter also had the highest sensitivity (92%) and equally highest (with the 8-kHz filter) specificity (90%) for detecting an average PTAHF of 20 dB or more.

CONCLUSIONS

Of the filters used, DIN sensitivity to higher frequency hearing loss was greatest using the 4-kHz low-pass filter. These results suggest that low-pass filtered noise may be usefully substituted for broadband noise to improve earlier detection of HFHL using DIN.

An Automated Speech-in-Noise Test for Remote Testing: Development and Preliminary Evaluation

Purpose The aim of this study was to develop and evaluate a novel, automated speech-in-noise test viable for widespread in situ and remote screening. Method Vowel-consonant-vowel sounds in a multiple-choice consonant discrimination task were used. Recordings from a professional male native English speaker were used. A novel adaptive staircase procedure was developed, based on the estimated intelligibility of stimuli rather than on theoretical binomial models. Test performance was assessed in a population of 26 young adults (YAs) with normal hearing and in 72 unscreened adults (UAs), including native and nonnative English listeners. Results The proposed test provided accurate estimates of the speech recognition threshold (SRT) compared to a conventional adaptive procedure. Consistent outcomes were observed in YAs in test/retest and in controlled/uncontrolled conditions and in UAs in native and nonnative listeners. The SRT increased with increasing age, hearing loss, and self-reported hearing handicap in UAs. Test duration was similar in YAs and UAs irrespective of age and hearing loss. The test-retest repeatability of SRTs was high (Pearson correlation coefficient = .84), and the pass/fail outcomes of the test were reliable in repeated measures (Cohen's κ = .8). The test was accurate in identifying ears with pure-tone thresholds > 25 dB HL (accuracy = 0.82). Conclusion This study demonstrated the viability of the proposed test in subjects of varying language in terms of accuracy, reliability, and short test time. Further research is needed to validate the test in a larger population across a wider range of languages and hearing loss and to identify optimal classification criteria for screening purposes.

No Reliable Association Between Recreational Noise Exposure and Threshold Sensitivity, Distortion Product Otoacoustic Emission Amplitude, or Word-in-Noise Performance in a College Student Population

OBJECTIVES

The purpose of this study was to evaluate the relationship between recreational sound exposure and potentially undiagnosed or subclinical hearing loss by assessing sound exposure history, threshold sensitivity, distortion product otoacoustic emission (DPOAE) amplitudes, and performance on the words-in-noise (WIN) test.

DESIGN

Survey data were collected from 74 adult participants (14 male and 60 female), 18 to 27 years of age, recruited via advertisements posted throughout the University of Florida campus. Of these participants, 70 completed both the survey and the additional functional test battery, and their preferred listening level was measured in a laboratory setting.

RESULTS

There were statistically significant relationships between hearing thresholds and DPOAE amplitude. In contrast, performance on the WIN was not reliably related to threshold sensitivity within this cohort with largely normal hearing. The two most common exposures included bars or dance clubs, followed by music player use. There were no statistically significant relationships between individual or composite measures of recreational sound exposure, including preferred listening level, years of music player use, number of reported sound exposures, previous impulse noise exposure, or previous noise-induced change in hearing, and functional measures including threshold, DPOAE amplitude, and WIN measures. Some subjects were highly consistent in listening level preferences, while others were more variable from song to song.

CONCLUSIONS

No reliable relationships between common recreational sound exposure or previous noise-induced changes in hearing were found during analysis of threshold sensitivity, DPOAE amplitude, or WIN performance in this cohort. However, the study sample was predominantly female and Caucasian, which limits generalizability of the results.

Development and evaluation of the British English coordinate response measure speech-in-noise test as an occupational hearing assessment tool

OBJECTIVE

The studies described in this article outline the design and development of a British English version of the coordinate response measure (CRM) speech-in-noise (SiN) test. Our interest in the CRM is as a SiN test with high face validity for occupational auditory fitness for duty (AFFD) assessment.

DESIGN

Study 1 used the method of constant stimuli to measure and adjust the psychometric functions of each target word, producing a speech corpus with equal intelligibility. After ensuring all the target words had similar intelligibility, for Studies 2 and 3, the CRM was presented in an adaptive procedure in stationary speech-spectrum noise to measure speech reception thresholds and evaluate the test-retest reliability of the CRM SiN test.

STUDY SAMPLE

Studies 1 (n = 20) and 2 (n = 30) were completed by normal-hearing civilians. Study 3 (n = 22) was completed by hearing impaired military personnel.

RESULTS

The results display good test-retest reliability (95% confidence interval (CI) < 2.1 dB) and concurrent validity when compared to the triple-digit test (r ≤ 0.65), and the CRM is sensitive to hearing impairment.

CONCLUSION

The British English CRM using stationary speech-spectrum noise is a "ready to use" SiN test, suitable for investigation as an AFFD assessment tool for military personnel.

Simulated Critical Differences for Speech Reception Thresholds

PURPOSE

Critical differences state by how much 2 test results have to differ in order to be significantly different. Critical differences for discrimination scores have been available for several decades, but they do not exist for speech reception thresholds (SRTs). This study presents and discusses how critical differences for SRTs can be estimated by Monte Carlo simulations. As an application of this method, critical differences are proposed for a 5-word sentences test (a matrix test) using 2 widely implemented adaptive test procedures.

METHOD

For each procedure, simulations were performed for different parameters: the number of test sentences, the j factor, the distribution of the subjects' true SRTs, and the slope of the discrimination function. For 1 procedure and 1 parameter setting, simulation data are compared with results found by listening tests (experimental data).

RESULTS

The critical differences were found to depend on the parameters tested, including interactive effects. The critical differences found by simulation agree with data found experimentally.

CONCLUSIONS

As the critical differences for SRTs rely on multiple parameters, they must be determined for each parameter setting individually. However, with knowledge of the test setup, rules of thumb can be derived.

Effects of noise on speech recognition: Challenges for communication by service members

Speech communication often takes place in noisy environments; this is an urgent issue for military personnel who must communicate in high-noise environments. The effects of noise on speech recognition vary significantly according to the sources of noise, the number and types of talkers, and the listener's hearing ability. In this review, speech communication is first described as it relates to current standards of hearing assessment for military and civilian populations. The next section categorizes types of noise (also called maskers) according to their temporal characteristics (steady or fluctuating) and perceptive effects (energetic or informational masking). Next, speech recognition difficulties experienced by listeners with hearing loss and by older listeners are summarized, and questions on the possible causes of speech-in-noise difficulty are discussed, including recent suggestions of "hidden hearing loss". The final section describes tests used by military and civilian researchers, audiologists, and hearing technicians to assess performance of an individual in recognizing speech in background noise, as well as metrics that predict performance based on a listener and background noise profile. This article provides readers with an overview of the challenges associated with speech communication in noisy backgrounds, as well as its assessment and potential impact on functional performance, and provides guidance for important new research directions relevant not only to military personnel, but also to employees who work in high noise environments.

The Cost-Effectiveness of Different Hearing Screening Strategies for 50- to 70-Year-Old Adults: A Markov Model

OBJECTIVE

To assess the cost-effectiveness of screening 50- to 70-year-old adults for hearing loss in The Netherlands. We compared no screening, telephone screening, Internet screening, screening with a handheld screening device, and audiometric screening for various starting ages and a varying number of repeated screenings.

METHODS

The costs per quality-adjusted life-year (QALY) for no screening and for 76 screening strategies were analyzed using a Markov model with cohort simulation for the year 2011. Screening was deemed to be cost-effective if the costs were less than €20,000/QALY.

RESULTS

Screening with a handheld screening device and audiometric screening were generally more costly but less effective than telephone and Internet screening. Internet screening strategies were slightly better than telephone screening strategies. Internet screening at age 50 years, repeated at ages 55, 60, 65, and 70 years, was the most cost-effective strategy, costing €3699/QALY. At a threshold of €20,000/QALY, this strategy was with 100% certainty cost-effective compared with current practice and with 69% certainty the most cost-effective strategy among all strategies.

CONCLUSIONS

This study suggests that Internet screening at age 50 years, repeated at ages 55, 60, 65, and 70 years, is the optimal strategy to screen for hearing loss and might be considered for nationwide implementation.

Characterizing the Speech Reception Threshold in hearing-impaired listeners in relation to masker type and masker level

The Speech Reception Threshold [SRT, (dB SNR)] is often used as an outcome measure to quantify the acuity for speech perception in noise. The majority of studies observe speech intelligibility in noise at a fixed noise level. However, the observed SNR might be an ambiguous outcome measure because it is dependent on the sensation level (SL) of the noise in the case of a non-stationary noise. Due to their higher thresholds, hearing-impaired listeners are usually tested at a different SL compared to normal-hearing listeners. Therefore, the observed SNR "itself" might not be a robust outcome measure to characterize the differences in performance between normal-hearing and hearing-impaired listeners, within and between different studies. In this paper, the SRTs are measured at a fixed absolute noise level (80 dBA) and at a fixed SL (25 dB). The results are discussed and described with an extension to the SRT model of Plomp [(1986). "A signal-to-noise ratio model for the speech-receptionthreshold of the hearing-impaired," J. Speech Hear. Res. 29, 146-154] and the Extended Speech Intelligibility Index. In addition, two alternative outcome measures are proposed which are, in contrast to the SNR, independent of the noise level. These outcome measures are able to characterize the SRT performance in fluctuating noise in a more uniform and unambiguous way.

Biological calibration for web-based hearing tests: evaluation of the methods

Background

Online hearing tests conducted in home settings on a personal computer (PC) require prior calibration. Biological calibration consists of approximating the reference sound level via the hearing threshold of a person with normal hearing.

Objective

The objective of this study was to identify the error of the proposed methods of biological calibration, their duration, and the subjective difficulty in conducting these tests via PC.

Methods

Seven methods have been proposed for measuring the calibration coefficients. All measurements were performed in reference to the hearing threshold of a normal-hearing person. Three methods were proposed for determining the reference sound level on the basis of these calibration coefficients. Methods were compared for the estimated error, duration, and difficulty of the calibration. Web-based self-assessed measurements of the calibration coefficients were carried out in 3 series: (1) at a otolaryngology clinic, (2) at the participant’s home, and (3) again at the clinic. Additionally, in series 1 and 3, pure-tone audiometry was conducted and series 3 was followed by an offline questionnaire concerning the difficulty of the calibration. Participants were recruited offline from coworkers of the Department and Clinic of Otolaryngology, Wroclaw Medical University, Poland.

Results

All 25 participants, aged 22-35 years (median 27) completed all tests and filled in the questionnaire. The smallest standard deviation of the calibration coefficient in the test-retest measurement was obtained at the level of 3.87 dB (95% CI 3.52-4.29) for the modulated signal presented in accordance with the rules of Bekesy’s audiometry. The method is characterized by moderate duration time and a relatively simple procedure. The simplest and shortest method was the method of self-adjustment of the sound volume to the barely audible level. In the test-retest measurement, the deviation of this method equaled 4.97 dB (95% CI 4.53-5.51). Among methods determining the reference sound level, the levels determined independently for each frequency revealed the smallest error. The estimated standard deviations of the difference in the hearing threshold between the examination conducted on a biologically calibrated PC and pure-tone audiometry varied from 7.27 dB (95% CI 6.71-7.93) to 10.38 dB (95% CI 9.11-12.03), depending on the calibration method.

Conclusions

In this study, an analysis of biological calibration was performed and the presented results included calibration error, calibration time, and calibration difficulty. These values determine potential applications of Web-based hearing tests conducted in home settings and are decisive factors when selecting the calibration method. If there are no substantial time limitations, it is advisable to use Bekesy method and determine the reference sound level independently at each frequency because this approach is characterized by the lowest error.

Internet-based hearing screening using speech-in-noise: validation and comparisons of self-reported hearing problems, quality of life and phonological representation

OBJECTIVES

For the last decade a host of different projects have been launched to allow persons who are concerned about their hearing status to quickly and at a low cost test their hearing ability. Most often, this is carried out without collecting complementary information that could be correlated with hearing impairment. In this two-part study we first, present the development and validation of a novel Internet-based hearing test, and second, report on the associations between this test and phonological representation, quality of life and self-reported hearing difficulties.

DESIGN

Cross-sectional study.

SETTING

An opportunity sample of participants was recruited at the Stockholm central station for the first study. All parts of the second study were conducted via the Internet, with testing and self-report forms adapted for online use.

PARTICIPANTS

The first part of the study was carried out in direct contact with the participants, and participants from the second study were recruited by means of advertisements in newspapers and on webpages. The only exclusion criterion was that participants had to be over 18 years old. Most participants were between 60 and 69 years old. There were almost an equal number of men and women (total n=316).

OUTCOME MEASURES

48 participants failed the Internet-based hearing screening test. The group failing the test reported more problems on the Amsterdam Inventory of Auditory Disability. In addition, they were found to have diminished phonological representational skills. However, no difference in quality of life was found.

CONCLUSIONS

Almost one in five participants was in need of contacting their local hearing clinic. This group had more complaints regarding tinnitus and hyperacusis, rated their own hearing as worse than those who passed, and had a poorer capability of generating accurate phonological representations. This study suggests that it is feasible to screen for hearing status online, and obtain valid data.

Using the Speech Understanding in Noise (SUN) Test for Adult Hearing Screening1

Purpose

To develop a novel speech-in-noise test for adult hearing screening—the Speech Understanding in Noise (SUN) test. The goal was to design a fast, automated, easy-to-use test to identify difficulties in speech communication.

Method

The SUN test consists of a short list of intervocalic consonants in noise presented in a forced-choice paradigm by means of a touch screen. The SUN test was developed and evaluated in an overall population of >6,000 participants. The test is available in various languages (i.e., English, French, German, and Italian) and continues to be developed in others (e.g., Spanish, Portuguese, and Mandarin).

Results

Test time was <1 min/ear. Test–retest reliability was very good. The test showed good agreement with conventional clinical measures (e.g., pure-tone testing, speech-in-noise testing, and self-reported hearing handicap). The test's sensitivity and specificity to identify disabling hearing impairment were 84% and 75%, respectively. The same results were obtained in low and high ambient noise.

Conclusion

The SUN test is fast, repeatable, easy to use, self-explanatory, specific to the impairment, and robust to ambient noise. It may be a viable approach for adult hearing screening in clinical as well as nonclinical settings.

Self-test web-based pure-tone audiometry: validity evaluation and measurement error analysis

Background

Potential methods of application of self-administered Web-based pure-tone audiometry conducted at home on a PC with a sound card and ordinary headphones depend on the value of measurement error in such tests.

Objective

The aim of this research was to determine the measurement error of the hearing threshold determined in the way described above and to identify and analyze factors influencing its value.

Methods

The evaluation of the hearing threshold was made in three series: (1) tests on a clinical audiometer, (2) self-tests done on a specially calibrated computer under the supervision of an audiologist, and (3) self-tests conducted at home. The research was carried out on the group of 51 participants selected from patients of an audiology outpatient clinic. From the group of 51 patients examined in the first two series, the third series was self-administered at home by 37 subjects (73%).

Results

The average difference between the value of the hearing threshold determined in series 1 and in series 2 was -1.54dB with standard deviation of 7.88dB and a Pearson correlation coefficient of .90. Between the first and third series, these values were -1.35dB±10.66dB and .84, respectively. In series 3, the standard deviation was most influenced by the error connected with the procedure of hearing threshold identification (6.64dB), calibration error (6.19dB), and additionally at the frequency of 250Hz by frequency nonlinearity error (7.28dB).

Conclusions

The obtained results confirm the possibility of applying Web-based pure-tone audiometry in screening tests. In the future, modifications of the method leading to the decrease in measurement error can broaden the scope of Web-based pure-tone audiometry application.