Development of Telscreen: a telephone-based speech-in-noise hearing screening test with a novel masking noise and scoring procedure

Exploring Hearing Care Technology from Clinic to Capability

Healthcare systems are traditionally a clinician-led and reactive structure that does not promote clients managing their health issues or concerns from an early stage. However, when clients are proactive in starting their healthcare earlier than later, they can achieve better outcomes and quality of life. Hearing healthcare and the rehabilitation journey currently fit into this reactive and traditional model of care. With the development of service delivery models evolving to offer services to the consumer online and where they are predominately getting their healthcare information from the internet and the advancement of digital applications and hearing devices beyond traditional hearing aid structures, we are seeing a change in how consumers engage in hearing care. Similarly, as the range of hearing devices evolves with increasingly blended and standard levels of technology across consumer earbuds/headphones and medical grade hearing aids, we are seeing a convergence of consumers engaging earlier and becoming increasingly aware of hearing health needs. This article will discuss how the channels, service, and technology are coming together to reform traditionally clinician-led healthcare models to an earlier consumer-led model and the benefits and limitations associated with it. Additionally, we look to explore advances in hearing technologies and services, and if these will or can contribute to a behavioral change in the hearing healthcare journey of consumers.

A Study of Event-Related Potentials During Monaural and Bilateral Hearing in Single-Sided Deaf Cochlear Implant Users

OBJECTIVES

Single-sided deafness (SSD) is characterized by a profoundly deaf ear and normal hearing in the contralateral ear. A cochlear implant (CI) is the only method to restore functional hearing in a profoundly deaf ear. In a previous study, we identified that the cortical processing of a CI signal differs from the normal-hearing ear (NHE) when directly compared using an auditory oddball paradigm consisting of pure tones. However, exactly how the brain integrates the electrical and acoustic signal is not well investigated. This study aims to understand how the provision of the CI in combination with the NHE may improve SSD CI users' ability to discriminate and evaluate auditory stimuli.

DESIGN

Electroencephalography from 10 SSD-CI participants (4 participated in the previous pure-tone study) were recorded during a semantic acoustic oddball task, where they were required to discriminate between odd and even numbers. Stimuli were presented in four hearing conditions: directly through the CI, directly to the NHE, or in free field with the CI switched on and off. We examined task-performance (response time and accuracy) and measured N1, P2, N2N4, and P3b event-related brain potentials (ERPs) linked to the detection, discrimination, and evaluation of task relevant stimuli. Sound localization and speech in noise comprehension was also examined.

RESULTS

In direct presentation, task performance was superior during NHE compared with CI (shorter and less varied reaction times [~720 versus ~842 msec], higher target accuracy [~93 versus ~70%]) and early neural responses (N1 and P2) were enhanced for NHE suggesting greater signal saliency. However, the size of N2N4 and P3b target-standard effects did not differ significantly between NHE and CI. In free field, target accuracy was similarly high with the CI (FF-On) and without the CI (FF-Off) (~95%), with some evidence of CI interference during FF-On (more variable and slightly but significantly delayed reaction times [~737 versus ~709 msec]). Early neural responses and late effects were also greater during FF-On. Performance on sound localization and speech in noise comprehension (S CI N NHE configuration only) was significantly greater during FF-On.

CONCLUSIONS

Both behavioral and neural responses in the semantic oddball task were sensitive to CI in both direct and free-field presentations. Direct conditions revealed that participants could perform the task with the CI alone, although performance was suboptimal and early neural responses were reduced when compared with the NHE. For free-field, the addition of the CI was associated with enhanced early and late neural responses, but this did not result in improved task performance. Enhanced neural responses show that the additional input from the CI is modulating relevant perceptual and cognitive processes, but the benefit of binaural hearing on behavior may not be realized in simple oddball tasks which can be adequately performed with the NHE. Future studies interested in binaural hearing should examine performance under noisy conditions and/or use spatial cues to allow headroom for the measurement of binaural benefit.

Odd-even oddball task: Evaluating event-related potentials during word discrimination compared to speech-token and tone discrimination

Tonal and speech token auditory oddball tasks have been commonly used to assess auditory processing in various populations; however, tasks using non-word sounds may fail to capture the higher-level ability to interpret and discriminate stimuli based on meaning, which are critical to language comprehension. As such, this study examines how neural signals associated with discrimination and evaluation-processes (P3b) from semantic stimuli compare with those elicited by tones and speech tokens. This study comprises of two experiments, both containing thirteen adults with normal hearing in both ears (PTA ≤ 20 dB HL). Scalp electroencephalography and auditory event related potentials were recorded in free field while they completed three different oddball tasks: (1) tones, (2) speech tokens and (3) odd/even numbers. Based on the findings of experiment one, experiment two was conducted to understand if the difference in responses from the three tasks was attributable to stimulus duration or other factors. Therefore, in experiment one, stimulus duration was not controlled and in experiment two, the duration of each stimulus was modified to be the same across all three tasks (∼400 ms). In both experiments, P3b peak latency was significantly different between all three tasks. P3b amplitude was sensitive to reaction time, with tasks that had a large reaction time variability resulting in the P3b amplitude to be smeared, thereby reducing the amplitude size. The findings from this study highlight the need to consider all factors of the task before attributing any effects to any additional process, such as semantic processing and mental effort. Furthermore, it highlights the need for more cautious interpretation of P3b results in auditory oddball tasks.

The one-up one-down adaptive (staircase) procedure in speech-in-noise testing: Standard error of measurement and fluctuations in the track

The one-up one-down adaptive (staircase or up-down) procedure is often used to estimate the speech recognition threshold (SRT) in speech-in-noise testing. This article provides a brief historical overview of the one-up one-down procedure in psychophysics, discussing the groundbreaking early work that is still relevant to clinical audiology and scientific research. Next, this article focuses on two aspects of the one-up one-down adaptive procedure: first, the standard error of measurement (SEM) and, second, the fluctuations in the track [i.e., the standard deviation of the signal-to-noise ratios of the stimuli within the track (SD_track)]. Simulations of ideal and non-ideal listeners and experimental data are used to determine and evaluate different relationships between the parameters slope of the speech recognition function, SRT, SEM, and SD_track. Hearing loss and non-ideal behavior (inattentiveness, fatigue, and giving up when the task becomes too difficult) slightly increase the average value of SD_track. SD_track, however, poorly discriminates between reliable and unreliable SRT estimates.

Is Teleaudiology Achieving Person-Centered Care: A Review

Digital health and person-centered care are unquestionably linked in today’s Australian healthcare landscape. Teleaudiology is the application of digital health in the field of audiology, and it has become a popular component of standard audiological care. Behavior modification is essential in audiology intervention. Guidance on achieving behavior change, which is dependent on digitally enabled intervention, is a valuable resource when used in tandem to achieve person-centered care. The aim of this review is to determine whether teleaudiology achieves person-centered care. A qualitative review was conducted, followed by mapping and analysis. Analysis identified evidence of teleaudiology use, and ascertained guiding principles are appropriate to behavior change dependent digital intervention supported or enabled person-centered care. In conclusion, teleaudiology will continue to be a promising technology for promoting relatedness, a positive user experience, confidence and capability, and appropriate levels of autonomy for the user to choose from among the person-centered care options available.

Robust and Efficient Online Auditory Psychophysics

Most human auditory psychophysics research has historically been conducted in carefully controlled environments with calibrated audio equipment, and over potentially hours of repetitive testing with expert listeners. Here, we operationally define such conditions as having high ‘auditory hygiene’. From this perspective, conducting auditory psychophysical paradigms online presents a serious challenge, in that results may hinge on absolute sound presentation level, reliably estimated perceptual thresholds, low and controlled background noise levels, and sustained motivation and attention. We introduce a set of procedures that address these challenges and facilitate auditory hygiene for online auditory psychophysics. First, we establish a simple means of setting sound presentation levels. Across a set of four level-setting conditions conducted in person, we demonstrate the stability and robustness of this level setting procedure in open air and controlled settings. Second, we test participants’ tone-in-noise thresholds using widely adopted online experiment platforms and demonstrate that reliable threshold estimates can be derived online in approximately one minute of testing. Third, using these level and threshold setting procedures to establish participant-specific stimulus conditions, we show that an online implementation of the classic probe-signal paradigm can be used to demonstrate frequency-selective attention on an individual-participant basis, using a third of the trials used in recent in-lab experiments. Finally, we show how threshold and attentional measures relate to well-validated assays of online participants’ in-task motivation, fatigue, and confidence. This demonstrates the promise of online auditory psychophysics for addressing new auditory perception and neuroscience questions quickly, efficiently, and with more diverse samples. Code for the tests is publicly available through Pavlovia and Gorilla.

Efficacy of the Digit-in-Noise Test: A Systematic Review and Meta-Analysis

Background and Objectives

Although the digit-in-noise (DIN) test is simple and quick, little is known about its key factors. This study explored the considerable components of the DIN test through a systematic review and meta-analysis.

Materials and Methods

After six electronic journal databases were screened, 14 studies were selected. For the meta-analysis, standardized mean difference was used to calculate effect sizes and 95% confidence intervals.

Results

The overall result of the meta-analysis showed an effect size of 2.224. In a subgroup analysis, the patient’s hearing status was found to have the highest effect size, meaning that the DIN test was significantly sensitive to screen for hearing loss. In terms of the length of the presenting digits, triple digits had lower speech recognition thresholds (SRTs) than single or pairs of digits. Among the types of background noise, speech-spectrum noise provided lower SRTs than multi-talker babbling. Regarding language variance, the DIN test showed better performance in the patient’s native language(s) than in other languages.

Conclusions

When uniformly developed and well validated, the DIN test can be a universal tool for hearing screening.

The digit triplet test: a scoping review

OBJECTIVE

This review article presents an overview of all Digit Triplet Tests (DTT) and digits-in-noise tests (DIN) and their variations in language, speech material, masking noise, test procedures, and targeted population. The effects on aspects of validity, reliability, and feasibility are investigated.

DESIGN

Scoping review.

STUDY SAMPLE

All studies referring to the DTT and DIN were collected from Pubmed and Embase. Search terms "digit triplet test" and "digits in noise" were used. Citations of selected articles were scanned backwards in time (the bibliography of the already selected research article) and forward in time (articles that cited the already selected research article). The search terms yielded 95 results in total. Eventually, 39 papers were selected.

RESULTS

Analyses showed psychometric reference-curves with steep slopes and speech reception thresholds with high measurement precision which are strongly associated with pure tone audiometry. High sensitivity and specificity to detect elevated pure tone thresholds were noted for test variants. Certain procedural modifications of the DTT and DIN can further improve the test. Additionally, large-scale application of the DTT and DIN is feasible.

CONCLUSION

The DTT and DIN are a very valuable tool for screening and diagnostics for a wide variety of populations.

Poorer Speech Reception Threshold in Noise Is Associated With Lower Brain Volume in Auditory and Cognitive Processing Regions

Purpose Hearing loss is associated with changes in brain volume in regions supporting auditory and cognitive processing. The purpose of this study was to determine whether there is a systematic association between hearing ability and brain volume in cross-sectional data from a large nonclinical cohort of middle-aged adults available from the UK Biobank Resource ( http://www.ukbiobank.ac.uk ). Method We performed a set of regression analyses to determine the association between speech reception threshold in noise (SRTn) and global brain volume as well as predefined regions of interest (ROIs) based on T1-weighted structural images, controlling for hearing-related comorbidities and cognition as well as demographic factors. In a 2nd set of analyses, we additionally controlled for hearing aid (HA) use. We predicted statistically significant associations globally and in ROIs including auditory and cognitive processing regions, possibly modulated by HA use. Results Whole-brain gray matter volume was significantly lower for individuals with poorer SRTn. Furthermore, the volume of 9 predicted ROIs including both auditory and cognitive processing regions was lower for individuals with poorer SRTn. The greatest percentage difference (-0.57%) in ROI volume relating to a 1 SD worsening of SRTn was found in the left superior temporal gyrus. HA use did not substantially modulate the pattern of association between brain volume and SRTn. Conclusions In a large middle-aged nonclinical population, poorer hearing ability is associated with lower brain volume globally as well as in cortical and subcortical regions involved in auditory and cognitive processing, but there was no conclusive evidence that this effect is moderated by HA use. This pattern of results supports the notion that poor hearing leads to reduced volume in brain regions recruited during speech understanding under challenging conditions. These findings should be tested in future longitudinal, experimental studies. Supplemental Material https://doi.org/10.23641/asha.7949357.

Age Dependence of Thresholds for Speech in Noise in Normal-Hearing Adolescents

Previously found effects of age on thresholds for speech reception thresholds in noise in adolescents as measured by an online screening survey require further study in a well-controlled teenage sample. Speech reception thresholds (SRT) of 72 normal-hearing adolescent students were analyzed by means of the online speech-in-noise screening tool Earcheck (In Dutch: Oorcheck). Screening was performed at school and included pure-tone audiometry to ensure normal-hearing thresholds. The students’ ages ranged from 12 to 17 years. A group of young adults was included as a control group. Data were controlled for effects of gender and level of education. SRT scores within the controlled teenage sample revealed an effect of age on the order of an improvement of −0.2 dB per year. Effects of level of education and gender were not significant. Hearing screening tools that are based on SRT for speech in noise should control for an effect of age when assessing adolescents. Based on the present data, a correction factor of −0.2 dB per year between the ages of 12 and 17 is proposed. The proposed age-corrected SRT cut-off scores need to be evaluated in a larger sample including hearing-impaired adolescents.