Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa.
Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
Ear Hear. 2022 May/Jun;43(3):1037-1048. doi: 10.1097/AUD.0000000000001160.
The digits-in-noise test (DIN) is a popular self-test measure that has traditionally been used to screen for hearing loss by providing either a pass or refer result. Standard approaches either tested each ear monaurally or used a binaural diotic version where identical digits and noise were presented simultaneously to both ears. Recently, a dichotic, antiphasic version was developed, increasing sensitivity of the DIN to unilateral or asymmetric sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). The purpose of this study was to determine predictors and normative ranges of the antiphasic and diotic DIN and to determine if a combination of diotic and antiphasic DIN could accurately categorize hearing into (1) normal, (2) bilateral SNHL, or (3) unilateral SNHL or CHL.
The analytical sample consisted of 489 participants between the ages of 18 and 92 years with varying types, symmetry, and degrees of hearing loss. Degree and type of hearing loss were determined based on standard clinical four-frequency (0.5-4 kHz) pure-tone air and bone conduction threshold averages. The sample consisted of bilateral normal hearing (n = 293), bilateral SNHL (n = 172), unilateral SNHL (n = 42), and CHL (n = 32). All participants (n = 489) first completed an antiphasic DIN (digit stimuli 180° out-of-phase between ears), while 393 of the sample also completed a diotic DIN. Two procedures were assessed for their ability to categorize hearing into one of the three hearing groups. The first used a fixed antiphasic cutoff combined with a cutoff formed by a linear combination of antiphasic and diotic speech recognition threshold (SRT) or binaural intelligibility-level difference.
Poorer ear pure-tone average was the strongest predictor of antiphasic DIN score, whereas better ear pure-tone average explained more of the variance in diotic SRT. The antiphasic DIN sensitivity and specificity was 90% and 84%, respectively, for detecting hearing loss, with outstanding area under the receiver operating characteristics values exceeding 0.93 to identify hearing loss in the poorer ear. The first fixed SRT cutoff procedure could categorize 75% of all participants correctly, while the second procedure increased correct categorization to 79%. False negative rates for both procedures were below 10%.
A sequential antiphasic and diotic DIN could categorize hearing to a reasonable degree into three groups of (1) normal hearing; (2) bilateral SNHL; and (3) unilateral asymmetric SNHL or CHL. This type of approach could optimize care pathways using remote and contactless testing, by identifying unilateral SNHL and CHL as cases requiring medical referral. In contrast, bilateral SNHL cases could be referred directly to an audiologist, or nontraditional models like OTC hearing aids.
数字在噪声测试（DIN）是一种流行的自我测试措施，传统上用于通过提供通过或参考结果来筛选听力损失。标准方法要么对每只耳朵进行单耳测试，要么使用双耳迪奥迪特版本，其中相同的数字和噪声同时呈现给两只耳朵。最近，开发了一种双相，反相版本，提高了 DIN 对单侧或不对称感音神经性听力损失（SNHL）和传导性听力损失（CHL）的敏感性。本研究的目的是确定反相和迪奥迪特 DIN 的预测因素和正常范围，并确定迪奥迪特和反相 DIN 的组合是否可以准确地将听力分为（1）正常，（2）双侧 SNHL，或（3）单侧 SNHL 或 CHL。
分析样本包括年龄在 18 至 92 岁之间的 489 名参与者，他们具有不同类型、对称性和听力损失程度。听力损失的程度和类型基于标准的临床四频（0.5-4 kHz）纯音空气和骨传导阈值平均值确定。样本包括双侧正常听力（n=293）、双侧 SNHL（n=172）、单侧 SNHL（n=42）和 CHL（n=32）。所有参与者（n=489）首先完成反相 DIN（数字刺激在耳朵之间相差 180°），而样本中的 393 名参与者还完成了迪奥迪特 DIN。评估了两种程序将听力分为三种听力组之一的能力。第一种方法使用固定的反相截止值，结合由反相和迪奥迪特言语识别阈值（SRT）或双耳可懂度级差的线性组合形成的截止值。
较差耳朵的纯音平均听力是反相 DIN 评分的最强预测因素，而较好耳朵的纯音平均听力解释了迪奥迪特 SRT 中更多的方差。反相 DIN 的敏感性和特异性分别为 90%和 84%，用于检测听力损失，接收器工作特性曲线下面积超过 0.93，可用于识别较差耳朵的听力损失。第一个固定的 SRT 截止值程序可以正确分类 75%的所有参与者，而第二个程序将正确分类提高到 79%。两种程序的假阴性率均低于 10%。
连续的反相和迪奥迪特 DIN 可以将听力合理地分为三组（1）正常听力；（2）双侧 SNHL；和（3）单侧不对称 SNHL 或 CHL。这种方法可以通过识别单侧 SNHL 和 CHL 作为需要医疗转诊的病例，优化使用远程和非接触式测试的护理途径。相比之下，双侧 SNHL 病例可以直接转诊给听力学家，或采用非传统模式，如 OTC 助听器。
