Wolmarans Jenique, De Sousa Karina C, Frisby Caitlin, Mahomed-Asmail Faheema, Smits Cas, Moore David R, Swanepoel De Wet
Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa.
Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam, The Netherlands.
J Am Acad Audiol. 2021 May;32(5):315-323. doi: 10.1055/s-0041-1727274. Epub 2021 Aug 10.
Digits-in-noise (DIN) tests have become popular for hearing screening over the past 15 years. Several recent studies have highlighted the potential utility of DIN as a school-aged hearing test. However, age may influence test performance in children due to maturation. In addition, a new antiphasic stimulus paradigm has been introduced, allowing binaural intelligibility level difference (BILD) to be measured by using a combination of conventional diotic and antiphasic DIN.
This study determined age-specific normative data for diotic and antiphasic DIN, and a derived measure, BILD, in children. A secondary aim evaluated the validity of DIN as a smartphone self-test in a subgroup of young children.
A cross-sectional, quantitative design was used. Participants with confirmed normal audiometric hearing were tested with a diotic and antiphasic DIN. During the test, arrangements of three spoken digits were presented in noise via headphones at varying signal-to-noise ratio (SNR). Researchers entered each three-digit spoken sequence repeated by the participant on a smartphone keypad.
Overall, 621 (428 male and 193 female) normal hearing children (bilateral pure tone threshold of ≤ 20 dB hearing level at 1, 2, and 4 kHz) ranging between the ages of 6 and 13 years were recruited. A subgroup of 7-year-olds ( = 30), complying with the same selection criteria, was selected to determine the validity of self-testing.
DIN testing was completed via headphones coupled to a smartphone. Diotic and antiphasic DIN speech recognition thresholds (SRTs) were analyzed and compared for each age group. BILD was calculated through subtraction of antiphasic from diotic SRTs. Multiple linear regressions were run to determine the effect of age on SRT and BILD. In addition, piecewise linear regressions were fit across different age groups. Wilcoxon signed-rank tests were used to determine differences between self- and facilitated tests.
Age was a significant predictor, of both diotic and antiphasic DIN SRTs ( < 0.05). SRTs improved by 0.15 dB and 0.35 dB SNR per year for diotic and antiphasic SRTs, respectively. However, age effects were only significant up to 10 and 12 years for antiphasic and diotic SRTs, respectively. Age significantly ( < 0.001) predicted BILD, which increased by 0.18 dB per year. A small SRT advantage for facilitated over self-testing was seen but was not significant ( > 0.05).
Increasing age was significantly associated with improved SRT and BILD using diotic and antiphasic DINs. DIN could be used as a smartphone self-test in young children from 7 years of age with appropriate quality control measures to avoid potential false positives.
在过去15年中，数字噪声（DIN）测试在听力筛查中变得很流行。最近的几项研究强调了DIN作为学龄儿童听力测试的潜在效用。然而，由于成熟度的原因，年龄可能会影响儿童的测试表现。此外，一种新的反相刺激范式已经被引入，使得双耳清晰度水平差异（BILD）可以通过结合传统的双耳和反相DIN来测量。
本研究确定了儿童双耳和反相DIN以及衍生指标BILD的年龄特异性规范数据。第二个目的是评估DIN作为智能手机自我测试在一小部分幼儿中的有效性。
采用横断面定量设计。对经确认听力正常的参与者进行双耳和反相DIN测试。在测试过程中，通过耳机以不同的信噪比（SNR）在噪声中呈现三个口语数字的排列。研究人员将参与者重复的每个三位口语序列输入智能手机键盘。
总共招募了621名（428名男性和193名女性）听力正常的儿童（1、2和4kHz时双侧纯音阈值≤20dB听力级），年龄在6至13岁之间。选择一组符合相同选择标准的7岁儿童（n = 30）来确定自我测试的有效性。
DIN测试通过连接到智能手机的耳机完成。分析并比较每个年龄组的双耳和反相DIN言语识别阈值（SRT）。通过从双耳SRT中减去反相SRT来计算BILD。进行多元线性回归以确定年龄对SRT和BILD的影响。此外，对不同年龄组进行分段线性回归。使用Wilcoxon符号秩检验来确定自我测试和辅助测试之间的差异。
年龄是双耳和反相DIN SRT的显著预测因素（P < 0.05）。双耳和反相SRT每年分别提高0.15dB和0.35dB SNR。然而，反相和双耳SRT的年龄效应分别仅在10岁和12岁之前显著。年龄显著（P < 0.001）预测BILD，BILD每年增加0.18dB。观察到辅助测试比自我测试有小的SRT优势，但不显著（P > 0.05）。
年龄增长与使用双耳和反相DIN时SRT和BILD的改善显著相关。DIN可以在7岁及以上的幼儿中用作智能手机自我测试，但需要采取适当的质量控制措施以避免潜在的假阳性。
