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

Abstract

ObjectivesHearing 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.DesignUS-English digits 0-9, homogenized for audibility, were binaurally presented in different noise maskers including one broadband and three low-pass (cut-off at 2, 4, 8 kHz) filtered speech-shaped noises. DIN-Speech reception thresholds (SRTs) were obtained from 60 normal hearing (NH), and 40 mildly hearing impaired (HI) listeners with bilateral symmetric sensorineural hearing-loss. Standard and extended high frequency audiometric pure tone averages (PTAs) were compared with the DIN-SRTs.ResultsNarrower masking noise bandwidth generally produced better (more sensitive) mean DIN-SRTs. There were strong and significant correlations between SRT and PTA in the HI group. Lower frequency, PTALF 0.5,1, 2, 4 kHz had the highest correlation and 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.ConclusionsOf 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.

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

“…The lab-DIN test was administered using Sennheiser 215 headphones connected to an iPad in a double-walled sound booth meeting criteria of ANSI S3.1. No test-retest was done for the lab testing since the reliability of lab procedures has already been established (Motlagh-Zadeh et al, 2020).…”

“…A speech reception threshold (SRT) is the usual outcome measure, the speech (digit) signal-tonoise ratio at which three successive digits are all correctly recognized on 50% of presentations (Vlaming et al 2014). During the past 10 years, the efficacy and sensitivity of the standard DIN test have been substantially increased using various test modifications such as low-pass filtering of the noise (Vlaming et al 2014;Motlagh Zadeh et al 2019;Motlagh Zadeh et al 2020) and antiphasic presentation of the digits (De Sousa et al 2018;De Sousa et al 2020). For example, De Sousa et al (2018) showed that presenting digits that are phase inverted (antiphasic) between the ears, while leaving the masking noise interaurally in-phase, significantly improves sensitivity of DIN test to asymmetric or unilateral sensorineural hearing loss (area under the receiver operating characteristic curve, AUROC = 0.94).…”

“…Advances in mobile technology and global connectivity through the internet have allowed development of sensitized web-and app-based screening and diagnostic tools that can improve assessment of auditory function in several ways. For example, smartphone deliverable variants of the digits-in-noise test (DIN) can reliably detect and differentiate sensorineural and conductive hearing loss (Smits et al 2005;Potgieter et al 2018;Motlagh Zadeh et al 2020;De Sousa et al 2018. DIN is a relatively undemanding speech-in-noise test that measures speech recognition abilities objectively, reliably and quickly, in addition to having a strong correlation with audiometric thresholds (Smits et al 2006;Ozimek et al 2009;Leensen et al 2011;Vlaming et al 2014;Folmer et al 2017;Motlagh Zadeh et al 2019.…”

“…For example, De Sousa et al (2018) showed that presenting digits that are phase inverted (antiphasic) between the ears, while leaving the masking noise interaurally in-phase, significantly improves sensitivity of DIN test to asymmetric or unilateral sensorineural hearing loss (area under the receiver operating characteristic curve, AUROC = 0.94). Using low-pass filtering of the noise, Motlagh Zadeh et al (2020) sensitized the DIN test (92% sensitivity and 90% specificity) to high-frequency hearing loss as low as 20 dB from 2-14 kHz.…”