The applicability of a speech-in-noise screening test in occupational hearing conservation

A Critique of the National Academies of Sciences, Engineering, and Medicine Report (2021) and the Diagnostic Accuracy of Measurements of Functional Hearing Ability

PURPOSE

The Social Security Administration (SSA) asked the National Academies of Sciences, Engineering, and Medicine (NASEM, 2021) to make recommendations for tests of functional hearing ability. These tests include speech perception measures administered in quiet and in background noise. Such tests are required to make disability determinations for adults and children following cochlear implantation. The test review required an evaluation of the diagnostic accuracy of the speech perception measures. Following a review of the literature, NASEM wrote that the evidence needed to support such a recommendation was lacking. They resorted to "professional judgment" and recommended a monosyllabic word recognition test, presumably in quiet, along with a measure of self-report or parent report. The primary purpose of this article was to critically review the committee's report. The secondary purpose was to critique the committee's recommendation of a monosyllabic word test as a measure of functional hearing ability for disability determinations. The third purpose was to provide a review of diagnostic accuracy studies not included in NASEM (2021) with an emphasis on speech recognition in noise (SRN) tests.

CONCLUSIONS

In contrast to the committee's recommendation, studies have shown that a monosyllabic word test is a poor predictor of SRN ability. Contrary to the conclusion of NASEM (2021), diagnostic accuracy studies have been conducted for a few SRN tests. The Hearing in Noise Test and the AzBio SRN test have published data demonstrating their ability to correctly identify the presence and absence of an SRN disorder.

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.

Accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss: incorporating automatic conditional rescreening

Purpose

To validate the accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss (HFHL) ‘Occupational Earcheck (OEC)’ incorporating an automatic conditional rescreening, in an occupationally noise-exposed population. Secondary objectives were to assess the effects of age on test accuracy measures, and to assess the test accuracy for different degrees of HFHL.

Methods

A study was conducted on cross-sectional data of occupational audiometric examinations, including the index test OEC and reference standard pure-tone air conduction audiometry, of 80 noise-exposed workers. Sensitivity, specificity, and likelihood ratios were calculated for the OEC, after automatic conditional rescreening, for a younger and an older age group, and for two degrees of HFHL (HFHL₂₅: PTA3,4,6 ≥ 25 dB HL, and HFHL₃₅: PTA3,4,6 ≥ 35 dB HL, both for at least one ear).

Results

Test specificity for HFHL₂₅ after a single test was 63%, and improved to 93% after the automatic conditional rescreen. Test sensitivity for HFHL₂₅ decreased from 65% to 59%. Test sensitivity and specificity including automatic conditional rescreening for HFHL₃₅ was 94% and 90%, respectively. The positive likelihood ratio for HFHL₂₅ was 8.4, and for HFHL₃₅ 9.4. The negative likelihood ratio for HFHL₃₅ was below 0.1.

Conclusions

The OEC is an appropriate screening test, especially for HFHL₃₅. Normal-hearing workers who obtained a positive test result for the first test for one or two ears, benefit from having an automatic rescreen, resulting in an improvement of the test specificity, and hence prevent unnecessary referral.

Contact dermatitis is an unrecognized problem in the construction industry: Comparison of four different assessment methods

BACKGROUND

A high contact dermatitis symptoms prevalence has been observed in Dutch construction workers.

METHODS

Contact dermatitis was diagnosed by an expert panel using questionnaire data and photographs of 751 subjects' hands. A subset was evaluated by two occupational physicians. Their diagnoses were compared to those of the expert panel. In addition, two self-reported questionnaire-based assessment methods were compared to the expert panel evaluation. Associations between contact dermatitis and determinants were assessed using log-binomial regression analysis.

RESULTS

Contact dermatitis prevalence was high: 61.4% (expert panel's diagnosis) and 32.9% (self-reported). Agreement between occupational physicians and the expert panel was low but increased after training. Washing hands with solvents and performing job-related tasks at home were related to contact dermatitis.

CONCLUSIONS

Contact dermatitis prevalence among construction workers is high. Recognition of contact dermatitis by occupational physicians is poor but can be improved by training. Awareness of skin disorders should be raised.

Application of the online hearing screening test "Earcheck": Speech intelligibility in noise in teenagers and young adults

Objective:

The objective was to describe the speech intelligibility in noise test results among Dutch teenagers and young adults aged 12–24 years, using a national online speech reception threshold (SRT) test, the Earcheck. A secondary objective was to assess the effect of age and gender on speech intelligibility in noise.

Design:

Cross-sectional SRT data were collected over a 5-year period (2010–2014), from participants of Earcheck. Regression analyses were performed, with SRT as the dependent variable, and age and gender as explaining variables. To cross-validate the model, data from 12- to 24-year olds from the same test distributed by a hearing aid dispenser (Hoorscan) were used.

Results:

In total, 96,803 valid test results were analyzed. The mean SRT score was −18.3 dB signal-to-noise ratio (SNR) (standard deviation (SD) = 3.7). Twenty-five percent of the scores was rated as insufficient or poor. SRT performance significantly improved with increasing age for teenagers aged 12–18 years by 0.49 dB SNR per age-year. A smaller age-effect (0.09 dB SNR per age-year) was found for young adults aged 19–24 years. Small differences between male and female users were found.

Conclusion:

Earcheck generated large quantities of national SRT data. The data implied that a substantial number of users of Earcheck may have some difficulty in understanding speech in noise. Furthermore, the results of this study showed an effect of gender and age on SRT performance, suggesting an ongoing maturation of speech-in-noise performance into late adolescence. This suggests the use of age-dependent reference values, but for this purpose, more research is required.

A user-operated test of suprathreshold acuity in noise for adult hearing screening: The SUN (Speech Understanding in Noise) test

A novel, user-operated test of suprathreshold acuity in noise for use in adult hearing screening (AHS) was developed. The Speech Understanding in Noise test (SUN) is a speech-in-noise test that makes use of a list of vowel-consonant-vowel (VCV) stimuli in background noise presented in a three-alternative forced choice (3AFC) paradigm by means of a touch sensitive screen. The test is automated, easy-to-use, and provides self-explanatory results (i.e., 'no hearing difficulties', or 'a hearing check would be advisable', or 'a hearing check is recommended'). The test was developed from its building blocks (VCVs and speech-shaped noise) through two main steps: (i) development of the test list through equalization of the intelligibility of test stimuli across the set and (ii) optimization of the test results through maximization of the test sensitivity and specificity. The test had 82.9% sensitivity and 85.9% specificity compared to conventional pure-tone screening, and 83.8% sensitivity and 83.9% specificity to identify individuals with disabling hearing impairment. Results obtained so far showed that the test could be easily performed by adults and older adults in less than one minute per ear and that its results were not influenced by ambient noise (up to 65dBA), suggesting that the test might be a viable method for AHS in clinical as well as non-clinical settings.