Improving Sensitivity of the Digits-in-Noise Test using Antiphasic Stimuli

Abstract

Objective: The digits-in-noise test (DIN) has become increasingly popular as a consumer-based method to screen for hearing loss. Current versions of all DINs either test ears monaurally or present identical stimuli binaurally (i.e., diotic noise and speech, NoSo). Unfortunately, presentation of identical stimuli to each ear inhibits detection of unilateral sensorineural hearing loss (SNHL), and neither diotic nor monaural presentation sensitively detects conductive hearing loss (CHL). Following an earlier finding of enhanced sensitivity in normally hearing listeners, this study tested the hypothesis that interaural antiphasic digit presentation (NoSπ) would improve sensitivity to hearing loss caused by unilateral or asymmetric SNHL, symmetric SNHL, or CHL. Design:This cross-sectional study, recruited adults (18-84 years) with various levels of hearing, based on a four-frequency pure tone average (PTA) at 0.5, 1, 2 and 4kHz.The study sample was comprised of listeners with normal hearing (n=41; PTA ≤ 25 dB HL in both ears), symmetric SNHL (n=57; PTA > 25 dB HL), unilateral or asymmetric SNHL (n=24; PTA > 25 dB HL in the poorer ear) and CHL (n=23; PTA > 25 dB HL and PTA air-bone gap ≥ 20 dB HL in the poorer ear). Antiphasic and diotic speech reception thresholds (SRTs) were compared using a repeated-measures design.Results: Antiphasic DIN was significantly more sensitive to all three forms of hearing loss than the diotic DIN. SRT test-retest reliability was high for all tests (ICC r > 0.89).Area under the receiver operating characteristics (ROC) curve for detection of hearing loss (> 25 dB HL) was higher for antiphasic DIN (0.94) than for diotic DIN (0.77) presentation. After correcting for age, PTA of listeners with normal hearing or symmetric SNHL was more strongly correlated with antiphasic (rpartial[96]=0.69) than diotic (rpartial=0.54) SRTs. Slope of fitted regression lines predicting SRT from PTA was significantly steeper for antiphasic than diotic DIN. For listeners with normal hearing or CHL, antiphasic SRTs were more strongly correlated with PTA (rpartial[62]=0.92) than diotic SRTs (rpartial[62]=0.64). Slope of regression line with PTA was also significantly steeper for antiphasic than diotic DIN. Severity of asymmetric hearing loss (poorer ear PTA) was unrelated to SRT. No effect of self-reported English competence on either antiphasic or diotic DIN among the mixed first-language participants was observed 3 Conclusions: Antiphasic digit presentation markedly improved the sensitivity of the DIN test to detect SNHL, either symmetric or asymmetric, while keeping test duration to a minimum by testing binaurally. In addition, the antiphasic DIN was able to detect CHL, a shortcoming of previous monaural or binaurally diotic DIN versions. The antiphasic DIN is thus a powerful tool for population-based screening. This enhanced functionality combined with smartphone delivery could make the antiphasic DIN suitable as a primary screen that is accessible to a large global audience.

Reward Enhances Online Participants’ Engagement With a Demanding Auditory Task

“…Participants are instructed to attend to the target sentence while ignoring a masker. The CRM is part of a family of adaptive speech reception in noise tests (see also digit-in-noise test commonly used in audiology practice; De Sousa et al., 2019). These paradigms have been shown to be powerful tests of listening in complex environments because of their sensitivity to small intelligibility changes in highly noisy backgrounds, their applicability to testing with different maskers, and their relative independence from semantic/syntactic cues (Brungart, 2001; De Sousa et al., 2020; Eddins & Liu, 2012; Humes et al., 2017).…”

“…Outcomes are therefore less affected by calibration of equipment compared with other tasks that rely on absolute sound level. These considerations make the CRM, as well as other similar speech-in-noise tasks (De Sousa et al., 2019, 2020), particularly attractive for estimating auditory abilities in online settings.…”

Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL)

“…One of these apps enables the patient to perform a speech-in-noise audiometry test using an adaptive procedure. It is validated by increments of 2 dB and does not call on mental substitution as it uses series of digits triplets [8] . Its special feature is to enable the detection of asymmetrical or conductive hearing impairments thanks to an antiphasic presentation between the two ears which invokes the principle of binaural unmasking.…”

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

“…The relation between SRTs with lower-frequency (PTALF) and higher-frequency (PTAHF) better ear audiometric averages for the listeners with HI are shown in Figure 3 (filled symbols). The reasons for choosing better ear PTA were, first, the assumption that listeners will preferentially use that ear when they can and, second, typical binaural speech-in-noise tests usually empasize better ear performance (Potgieter et al, 2018;De Sousa et al, 2019).…”