Improving sensitivity of the digits-in-noise test using antiphasic stimuli
Ear and Hearing, 2020•journals.lww.com
Objectives: 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 (ie, diotic noise and speech, N o S o).
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). After an earlier finding of enhanced sensitivity in …
based method to screen for hearing loss. Current versions of all DINs either test ears
monaurally or present identical stimuli binaurally (ie, diotic noise and speech, N o S o).
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). After an earlier finding of enhanced sensitivity in …
Abstract
Objectives:
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 (ie, diotic noise and speech, N o S o). 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). After an earlier finding of enhanced sensitivity in normally hearing listeners, this study tested the hypothesis that interaural antiphasic digit presentation (N o S π) would improve sensitivity to hearing loss caused by unilateral or asymmetric SNHL, symmetric SNHL, or CHL.
Design:
This cross-sectional study recruited adults (18 to 84 years) with various levels of hearing based on a 4-frequency pure-tone average (PTA) at 0.5, 1, 2, and 4 kHz. 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 (intraclass correlation coefficient r> 0.89). Area under the receiver operating characteristics 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 (r partial [96]= 0.69) than diotic (r partial= 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 (r partial [62]= 0.92) than diotic SRTs (r partial [62]= 0.64). Slope of the regression line with PTA was also significantly steeper for antiphasic than diotic DIN. The 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.
Conclusions:
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