Development and validation of a smartphone-based digits-in-noise hearing test in South African English

Potgieter, Jenni-Marí; Swanepoel, De Wet; Myburgh, Hermanus Carel; Hopper, Thomas Christopher; Smits, Cas

doi:10.3109/14992027.2016.1172269

Cited by 83 publications

(146 citation statements)

References 23 publications

(56 reference statements)

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“…The DIN application was designed in Android Studio version 2.3.0 and written in Java version 1.8.0, consistent with the original hearZA App. The application stored a list of 120 different digit-triplets, randomly selected for presentation at the beginning of each test (Potgieter et al 2016). Randomized triplet selection was done with replacement, meaning that the same triplet could occur more than once in one test.…”

Section: Procedures and Equipmentmentioning

confidence: 99%

“…Successive digits were separated by 200 ms of silence with 100 ms of jitter (Potgieter et al 2016). The test used a fixed noise level and variable speech level when triplets with negative SNRs were presented.…”

Section: Procedures and Equipmentmentioning

confidence: 99%

“…Compared to pure tone audiometry or speech recognition in quiet, speech recognition in noise has the advantage of being more characteristic of a person's hearing ability in real-life situations (Grant et al 2013). Furthermore, DIN assessment of sensorineural hearing loss (SNHL) correlates highly with pure tone audiometry and eliminates the need for a soundproof booth, calibrated equipment and a test administrator (Smits et al 2004;Jansen et al 2010;Potgieter et al 2016Potgieter et al , 2018Koole et al 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Whereas mobile phone penetration is much higher, the cost to complete the test via a mobile phone call could be more expensive. An alternative is to offer the DIN as a downloadable smartphone application, allowing access to high fidelity broadband signals as opposed to bandwidth signals used in standard telephone networks (Potgieter et al 2016), and removing the need for cellular connectivity once uploaded. While applicable worldwide, using a mobile platform could potentially address the mostly nonexistent access to hearing screening in low-and-middle income countries.…”

Section: Introductionmentioning

confidence: 99%

“…In sub-Saharan Africa, for instance, there is only one audiologist for every million people (Mulwafu et al 2017). As a result, the South African English DIN was developed and released as the national hearing screening application in 2016, downloadable on iOS and Android smartphones, called hearZA TM (Potgieter et al 2016;De Sousa et al 2018). This binaural test version allows for testing under 3 minutes, with high sensitivity (> 80%) to detect SNHL (Potgieter et al 2016;Potgieter et al 2018).…”

Section: Introductionmentioning

confidence: 99%

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

Sousa

Swanepoel

Moore

et al. 2019

Preprint

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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.

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Section: Procedures and Equipmentmentioning

confidence: 99%

Section: Procedures and Equipmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Sousa

Swanepoel

Moore

et al. 2019

Preprint

Self Cite

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Effectiveness of an Over-the-Counter Self-fitting Hearing Aid Compared With an Audiologist-Fitted Hearing Aid

Sousa

Manchaiah

Moore

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHearing loss is a highly prevalent condition, with numerous debilitating consequences when left untreated. However, less than 20% of US adults with hearing loss use hearing aids. Over-the-counter (OTC) hearing aids became available in October 2022 to improve access and affordability. However, clinical effectiveness studies of available OTC hearing aids using the existing devices in the market are limited.ObjectiveTo compare the clinical effectiveness of a self-fitting OTC hearing aid with remote support and a hearing aid fitted using audiologist-fitted best practices.Design, Setting, and ParticipantsThis randomized clinical effectiveness trial was conducted between April 14 and August 29, 2022. Sixty-eight adults with self-perceived mild to moderate hearing loss were recruited and randomly assigned to either the self-fitting or the audiologist-fitted group. Following bilateral hearing aid fitting, participants first completed a 2-week, take-home field trial without any support. Access to fine-tuning for both groups was only available after the 2-week trial. Support and adjustment were provided remotely for the self-fitting group per request and by the audiologist for the audiologist-fitted group. Participants were then reassessed after an additional 4-week take-home trial.InterventionsA commercially available self-fitting OTC hearing aid was provided to participants in the self-fitting group who were expected to set up the hearing aids using the commercially supplied instructional material and accompanying smartphone application. In the audiologist-fitted group, audiologists fitted the same hearing aid according to the National Acoustics Laboratories nonlinear version 2 algorithm for prescriptive gain target using real-ear verification with hearing aid use instruction.Main Outcomes and MeasuresThe primary outcome measure was self-reported hearing aid benefit, measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB). Secondary measures included the International Outcome Inventory for Hearing Aids (IOI-HA) and speech recognition in noise measured using an abbreviated speech-in-noise test and a digits-in-noise test. All measures were completed at baseline and at 2 intervals following hearing aid fitting (2 and 6 weeks).ResultsSixty-four participants were included in the analytic sample (33 men [51.6%]; mean [SD] age, 63.6 [14.1] years), with equal numbers of participants (n = 32) randomized into each group. The groups did not differ significantly in age (effect size r = −0.2 [95% CI, −0.3 to 0.2]) or 4-frequency pure-tone average (effect size r = 0.2 [95% CI, −0.1 to 0.4]). After the 2-week field trial, the self-fitting group had an initial advantage compared with the audiologist-fitted group on the self-reported APHAB (Cohen d = −0.5 [95% CI, −1.0 to 0]) and IOI-HA (effect size r = 0.3 [95% CI, 0.0-0.5]) but not speech recognition in noise. At the end of the 6-week trial, no meaningful differences were evident between the groups on any outcome measures.Conclusion and relevanceIn this randomized clinical effectiveness trial, self-fitting OTC hearing aids with remote support yielded outcomes at 6 weeks post fitting comparable to those of hearing aids fitted using audiologist best practices. These findings suggest that self-fitting OTC hearing aids may provide an effective intervention for mild to moderate hearing loss.Trial RegistrationClinicalTrials.gov Identifier: NCT05337748

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