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A Smartphone National Hearing Test: Performance and Characteristics of Users

American Speech-Language-Hearing Association
American Journal of Audiology
Authors:
Karina C. De Sousa at University of Pretoria
Karina C. De Sousa
DeWet Swanepoel at University of Pretoria
DeWet Swanepoel
David R Moore at Cincinnati Children's Hospital Medical Center
David R Moore
Cas Smits at Amsterdam University Medical Center
Cas Smits
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Abstract and Figures

Purpose The smartphone digits-in-noise hearing test, called hearZA, was made available as a self-test in South Africa in March 2016. This study determined characteristics and test performance of the listeners who took the test. Method A retrospective analysis of 24,072 persons who completed a test between March 2016 and August 2017 was conducted. User characteristics, including age, English-speaking competence, and self-reported hearing difficulty, were analyzed. Regression analyses were conducted to determine predictors of the speech reception threshold. Results Overall referral rate of the hearZA test was 22.4%, and 37% of these reported a known hearing difficulty. Age distributions showed that 33.2% of listeners were ages 30 years and younger, 40.5% were between ages 31 and 50 years, and 26.4% were older than 50 years. Age, self-reported English-speaking competence, and self-reported hearing difficulty were significant predictors of the speech reception threshold. Conclusions High test uptake, particularly among younger users, and high overall referral rate indicates that the hearZA app addresses a public health need. The test also reaches target audiences, including those with self-reported hearing difficulty and those with normal hearing who should monitor their hearing ability.
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AJA
Research Article
A Smartphone National Hearing Test:
Performance and Characteristics of Users
Karina C. De Sousa,
a
De Wet Swanepoel,
a,b,c
David R. Moore,
d,e
and Cas Smits
f
Purpose: The smartphone digits-in-noise hearing test, called
hearZA, was made available as a self-test in South Africa in
March 2016. This study determined characteristics and test
performance of the listeners who took the test.
Method: A retrospective analysis of 24,072 persons who
completed a test between March 2016 and August 2017 was
conducted. User characteristics, including age, English-
speaking competence, and self-reported hearing difficulty,
were analyzed. Regression analyses were conducted to
determine predictors of the speech reception threshold.
Results: Overall referral rate of the hearZA test was 22.4%,
and 37% of these reported a known hearing difficulty. Age
distributions showed that 33.2% of listeners were ages
30 years and younger, 40.5% were between ages 31 and
50 years, and 26.4% were older than 50 years. Age, self-
reported English-speaking competence, and self-reported
hearing difficulty were significant predictors of the speech
reception threshold.
Conclusions: High test uptake, particularly among younger
users, and high overall referral rate indicates that the hearZA
app addresses a public health need. The test also reaches
target audiences, including those with self-reported hearing
difficulty and those with normal hearing who should monitor
their hearing ability.
The global burden of hearing loss has been increasing
steadily with close to half a billion people esti-
mated to suffer from permanent disabling hearing
loss (Vos et al., 2016; Vos et al., 2015; Wilson, Tucci,
Merson, & O’Donoghue, 2017). The rise in recreational
noise exposure further places an estimated 1.1 billion young
people between the ages of 12 to 35 years at risk for acquir-
ing hearing loss (World Health Organization [WHO], 2017).
Regardless of high prevalence rates and significant conse-
quences, hearing loss continues to be an undetected and
untreated disability that is not adequately positioned or
prioritized within many health care systems (Mackenzie &
Smith, 2009). This is especially true in low- and middle-
income countries (LMICs) where hearing health care is
scarce or often unavailable due to the lack of resources
and poor awareness among the lay public and health pro-
fessionals (Mackenzie & Smith, 2009). Consequences of
unaddressed hearing loss are far reaching, affecting social
participation (Hallam, Ashton, Sherbourne, & Gailey, 2008),
psychological well-being (Fellinger, Holzinger, & Pollard,
2012), cognitive function (Livingston et al., 2017), and
employment opportunity (Tucci, Merson, & Wilson, 2010;
WHO, 2017). With high proportions of occupations depen-
dant on spoken communication (Ruben, 2015), the cumu-
lative effects of hearing loss can have significant economic
implications for the individual and society. Recent WHO
estimates of the global estimated costs associated with hear-
ing loss equaled 750 billion (WHO, 2017). Emphasis on
prevention and treatment of hearing loss is, therefore, im-
portant on a global scale with particular focus on LMICs
(Wilson et al., 2017).
Although it is well established that timely identifi-
cation and management could substantially reduce the
functional impairment of hearing loss (Cacciatore et al.,
1999), most cases remain undiagnosed and untreated, espe-
cially in older adults (Pronk et al., 2011). Hearing screen-
ing programs have a critical role in monitoring hearing
and early detection of hearing difficulty (WHO, 2017).
a
Department of Speech-Language Pathology and Audiology,
University of Pretoria, Gauteng, South Africa
b
Ear Sciences Centre, School of Surgery, The University of Western
Australia, Nedlands
c
Ear Science Institute Australia, Subiaco
d
Communication Sciences Research Center, Cincinnati Childrens’
Hospital Medical Center, Cincinnati, OH
e
Manchester Centre for Audiology and Deafness, School of Health
Sciences, University of Manchester, United Kingdom
f
Department of Otolaryngology/Head & Neck Surgery, Section Ear &
Hearing, and Amsterdam Public Health Research Institute, VU
University Medical Center, the Netherlands
Correspondence to De Wet Swanepoel: dewet.swanepoel@up.ac.za
Editor-in-Chief: Sumitrajit (Sumit) Dhar
Editor: Ariane Laplante-Lévesque
Received January 15, 2018
Revision received April 26, 2018
Accepted April 30, 2018
https://doi.org/10.1044/2018_AJA-IMIA3-18-0016
Publisher Note: This article is part of the Special Issue: Internet and
Audiology.
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
American Journal of Audiology •Vol. 27 •448–454 •November 2018 •Copyright © 2018 American Speech-Language-Hearing Association448
... Advances in mobile technology and global connectivity through the internet have allowed development of sensitised 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 & Houtgast 2005;Potgieter et al. 2018;Motlagh Zadeh et al. 2021;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. ...
... SRT is the usual outcome measure; the speech (digit) signal-to-noise 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 and antiphasic presentation of the digits (De Sousa et al. 2018;. For example, De showed that presenting digits that are phase inverted (antiphasic) between the ears, while leaving the masking noise interaurally in-phase, significantly improves sensitivity of the DIN test (area under the receiver operating characteristic curve, AUROC ¼ 0.94). ...
Remote self-report and speech-in-noise measures predict clinical audiometric thresholds
Article
Objective: Developments in smartphone technology and the COVID-19 pandemic have highlighted the feasibility and need for remote, but reliable hearing tests. Previous studies used remote testing but did not directly compare results in the same listeners with standard lab or clinic testing. This study investigated validity and reliability of remote, self-administered digits-in-noise (remote-DIN) compared with lab-based, supervised (lab-DIN) testing. Predictive validity was further examined in relation to a commonly used self-report, Speech, Spatial, and Qualities of Hearing (SSQ-12), and lab-based, pure tone audiometry. Design: DIN speech reception thresholds (SRTs) of adults (18-64 y/o) with normal hearing (NH, N = 16) and hearing loss (HL, N = 18), were measured using English-language digits (0-9), binaurally presented as triplets in one of four speech-shaped noise maskers (broadband, low-pass filtered at 2, 4, 8 kHz) and two phases (diotic, antiphasic). Results: High, significant intraclass correlation coefficients indicated strong internal consistency of remote-DIN SRTs, which also correlated significantly with lab-DIN SRTs. There was no significant mean difference between remote- and lab-DIN on any tests. NH listeners had significantly higher SSQ scores and remote- and lab-DIN SRTs than listeners with HL. All versions of remote-DIN SRTs correlated significantly with pure-tone-average (PTA), with the 2-kHz filtered test being the best predictor, explaining 50% of the variance in PTA. SSQ total score also significantly and independently predicted PTA (17% of variance) and all test versions of the remote-DIN, except the antiphasic BB test. Conclusions: This study underscores the effectiveness of remote DIN test and SSQ-12 in assessing auditory function. These findings suggest the potential for wider access to reliable hearing assessment, particularly in remote or underserved communities.
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... The results show that non-native speakers perform worse compared to speakers that are fluent in English. 22,23 When considering English proficiency in terms of the ability to independently determine hearing thresholds, it is relevant to examine the work of Rourke and colleagues, 24 who showed that children were able to intuitively understand and perform tests despite a lack of language proficiency. However, Rourke and colleagues did not assess the extent to which this ability translated into test accuracy. ...
Impact of Language Barriers and Age on English Hearing Test App Accuracy for Polish Users
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Objective The development of health applications (apps) includes those for testing hearing, although most of them are available only in English. This study investigates whether poor English language proficiency creates a barrier for Polish users in the accuracy of such an app in measuring self‐determined hearing thresholds. Study Design The study compared hearing thresholds measured by an English‐language app and a professionally conducted reference test, with attention to participants' English proficiency and age. Setting The English‐language app “Hearing test, Audiogram,” was used to determine hearing thresholds. A reference test was performed by an audiologist using specialized equipment. Methods Participants were 87 nonnative English language speakers aged 16 to 88. They were divided into 3 groups based on their proficiency in English: no knowledge (Group 1), basic (Group 2), and advanced (Group 3). The mean differences between hearing thresholds determined using the app and the reference tests were measured for each group. Results The accuracy of the results varied according to the level of English proficiency. A statistically significant difference was found between Group 1 (no knowledge) and Group 3 (advanced), with mean differences of 13.6, 9.3, and 6.7 dB for Groups 1, 2, and 3, respectively, meaning that discrepancies were larger in the less proficient groups. However, when participant age was considered, language proficiency was less important and was no longer a significant factor. Conclusion This study revealed that English language proficiency does affect the accuracy of mobile app‐based hearing tests, but age of the user is also important.
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... To favor the prevention and identification of hearing loss, a large series of simple and cheap methods and instruments for hearing loss screening have been developed. The availability of portable audiometric screening platforms, the access to hearing health services in remote locations, and the applied automated hearing screening test with a smartphone or tablet at home, even in absence of specialized professionals, have significantly improved the identification of hearing impairment [49][50][51][52][53]. Regarding smartphones, at least 44 applications specifically prepared for adults have been developed, and some of them have been found effective in hearing loss screening, particularly in low-and middle-income countries and settings of limited in-person medical care. ...
Smartphone-Based Artificial Intelligence for the Detection and Diagnosis of Pediatric Diseases: A Comprehensive Review
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Full-text available
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In recent years, the use of smartphones and other wireless technology in medical care has developed rapidly. However, in some cases, especially for pediatric medical problems, the reliability of information accessed by mobile health technology remains debatable. The main aim of this paper is to evaluate the relevance of smartphone applications in the detection and diagnosis of pediatric medical conditions for which the greatest number of applications have been developed. This is the case of smartphone applications developed for the diagnosis of acute otitis media, otitis media with effusion, hearing impairment, obesity, amblyopia, and vision screening. In some cases, the information given by these applications has significantly improved the diagnostic ability of physicians. However, distinguishing between applications that can be effective and those that may lead to mistakes can be very difficult. This highlights the importance of a careful application selection before including smartphone-based artificial intelligence in everyday clinical practice.
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... Pure Tone Audiometry uses minimal cognitive resources but cannot reliably predict the difficulty a person will have in understanding speech in a challenging environment [6]. In contrast, adaptive Speech-in-Noise tests allow us to reliably and sensitively measure speech recognition difficulties [7]. ...
Development of Digit in Noise Test in Hindi
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  • Mar 2024
Background: The digit in the noise test is a simple hearing screening tool that can identify hearing loss at the early stage. This screening tool takes less time than traditional pure-tone audiometry. There is a scarcity of hearing health professionals with few resources for carrying out hearing screening on a large scale in India. Hence, a hearing screening tool for the Hindi-speaking population is needed. Aim and Objective: The study aimed to develop and validate the Digit in Noise test in Hindi (DIN-H). Methods: A native Hindi female speaker recorded single digits from 1 to 9 made into triplet combinations, which were binaurally presented to 20 normal hearing subjects having hearing thresholds less than 25 dBHL from 250 to 8000 Hz in the presence of broadband speech-shaped noise. The digit triplets were homogenized using speech intelligibility function for similar difficulty levels across stimuli. The homogenized stimuli were evaluated by obtaining the Speech Recognition Threshold (SRT) of 20 normal hearing subjects. Results: The Mean SRT was − 10.4 and − 11.3 dB before and after homogenization. A strong positive correlation existed between test and retest SRTs (0.78). Mean SRT and slope obtained before and after optimization were comparable to other languages like Korean and English. This test can act as a reliable screening tool for assessing individuals. The test was administered to 106 normal hearing participants. The 95th percentile of the SRT value obtained was − 5.6 dB, which was kept as a cut-off score for the screening test. Conclusion: DIN-H can be used as a screening tool for assessing the integrity of the auditory system on a large scale in less time for the Hindi-speaking population.
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... A fixed noise level with varying speech levels was used for negative SNRs and a fixed speech level with varying noise levels was used for positive SNRs. This helped to avoid waveform clipping and provide a comfortable listening experience (Potgieter et al. 2016(Potgieter et al. , 2018De Sousa et al. 2018. To ensure noise refreshment, a noise fragment was randomly selected for each mixing. ...
The Chinese Zodiac-in-Noise Test: An Internet-Based Speech-in-Noise Test for Large-Scale Hearing Screening
Article
  • Dec 2023
  • Ear Hear
Objectives Motivated by the growing need for hearing screening in China, the present study has two objectives. First, to develop and validate a new test, called the Chinese Zodiac-in-noise (ZIN) test, for large-scale hearing screening in China. Second, to conduct a large-scale remote hearing screening in China, using the ZIN test developed. Design The ZIN test was developed following a similar procedure as the digits-in-noise test but emphasizes the importance of consonant recognition by employing the 12 zodiac animals in traditional Chinese culture as speech materials. It measures the speech reception threshold (SRT) using triplets of Chinese zodiac animals in speech-shaped noise with an adaptive procedure. Results Normative data of the test were obtained in a group of 140 normal-hearing listeners, and the performance of the test was validated by comparisons with pure-tone audiometry in 116 listeners with various hearing abilities. The ZIN test has a reference SRT of −11.0 ± 1.6 dB in normal-hearing listeners with a test-retest variability of 1.7 dB and can be completed in 3 minutes. The ZIN SRT is highly correlated with the better-ear pure-tone threshold ( r = 0.82). With a cutoff value of −7.7 dB, the ZIN test has a sensitivity of 0.85 and a specificity of 0.94 for detecting a hearing loss of 25 dB HL or more at the better ear. A large-scale remote hearing screening involving 30,552 participants was performed using the ZIN test. The large-scale study found a hearing loss proportion of 21.0% across the study sample, with a high proportion of 57.1% in the elderly study sample aged over 60 years. Age and gender were also observed to have associations with hearing loss, with older individuals and males being more likely to have hearing loss. Conclusions The Chinese ZIN test is a valid and efficient solution for large-scale hearing screening in China. Its remote applications may improve access to hearing screening and enhance public awareness of hearing health.
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... In the market of medical equipment, there are many software applications for conducting an audiometric examination on a smartphone. Table 1 presents the generalized results of a comparative analysis of the modern market of audio metric systems based on available publications [18][19][20][21][22][23][24][25]. ...
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Development and validation of the Italian digit-innoise test Details Statistics How to Cite
Article
Full-text available
  • Dec 2024
  • Acta Otorhinolaryngol Ital
Objective. This research aims to validate the digits-in-noise (DIN) test for the Italian language and develop a version capable of independently assessing both ears while maintaining acceptable administration times. Methods. Individual digits from 0 to 9 in Italian were recorded and adjusted to equalise recognition probabilities. An iOS application (APP) was developed for the independent ear test using triplets in noise. The application incorporates a new proprietary adaptive procedure developed by Amplifon to minimise the number of steps required to determine the Speech Reception Threshold (SRT). Thirty-nine subjects were recruited for equalisation of digits, 45 normal-hearing and 62 with various degrees of hearing loss for normative-data assessment. Results. The results demonstrate the ability to determine a threshold value for normal hearing consistent with the existing literature and identify threshold values corresponding to the main World Health Organization hearing loss categories. Conclusions. A DIN test for the Italian language has been developed and validated to evaluate the SRT of each ear individually. The adaptive algorithm optimises the necessary steps while maintaining acceptable test duration for both ears. Users can autonomously conduct the test using a standard personal iOS device (tablet or smartphone).
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Explaining Discrepancies Between the Digit Triplet Speech-in-Noise Test Score and Self-Reported Hearing Problems in Older Adults
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Full-text available
Purpose The purpose of this study is to determine which demographic, health-related, mood, personality, or social factors predict discrepancies between older adults' functional speech-in-noise test result and their self-reported hearing problems. Method Data of 1,061 respondents from the Longitudinal Aging Study Amsterdam were used (ages ranged from 57 to 95 years). Functional hearing problems were measured using a digit triplet speech-in-noise test. Five questions were used to assess self-reported hearing problems. Scores of both hearing measures were dichotomized. Two discrepancy outcomes were created: (a) being unaware: those with functional but without self-reported problems (reference is aware: those with functional and self-reported problems); (b) reporting false complaints: those without functional but with self-reported problems (reference is well: those without functional and self-reported hearing problems). Two multivariable prediction models (logistic regression) were built with 19 candidate predictors. The speech reception threshold in noise was kept (forced) as a predictor in both models. Results Persons with higher self-efficacy (to initiate behavior) and higher self-esteem had a higher odds to being unaware than persons with lower self-efficacy scores (odds ratio [OR] = 1.13 and 1.11, respectively). Women had a higher odds than men (OR = 1.47). Persons with more chronic diseases and persons with worse (i.e., higher) speech-in-noise reception thresholds in noise had a lower odds to being unaware (OR = 0.85 and 0.91, respectively) than persons with less diseases and better thresholds, respectively. A higher odds to reporting false complaints was predicted by more depressive symptoms (OR = 1.06), more chronic diseases (OR = 1.21), and a larger social network (OR = 1.02). Persons with higher self-efficacy (to complete behavior) had a lower odds (OR = 0.86), whereas persons with higher self-esteem had a higher odds to report false complaints (OR = 1.21). The explained variance of both prediction models was small (Nagelkerke R ² = .11 for the unaware model, and .10 for the false complaints model). Conclusions The findings suggest that a small proportion of the discrepancies between older individuals' results on a speech-in-noise screening test and their self-reports of hearing problems can be explained by the unique context of these individuals. The likelihood of discrepancies partly depends on a person's health (chronic diseases), demographics (gender), personality (self-efficacy to initiate behavior and to persist in adversity, self-esteem), mood (depressive symptoms), and social situation (social network size). Implications are discussed.
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Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise
Article
Full-text available
  • Mar 2018
Objectives: The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise. Design: In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps. Results: Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise. Conclusions: Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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The South African English Smartphone Digits-in-Noise Hearing Test: Effect of Age, Hearing Loss, and Speaking Competence
Article
Full-text available
  • Nov 2017
Objectives: This study determined the effect of hearing loss and English-speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers. Design: A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone air conduction thresholds to the speech reception threshold (SRT) recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners' self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 to 90 years), of whom 337 listeners had a best ear four-frequency pure-tone average (4FPTA; 0.5, 1, 2, and 4 kHz) of ≤25 dB HL. Results: A linear regression model identified three predictors of the digits-in-noise SRT, namely, 4FPTA, age, and self-reported English-speaking competence. The NN group with poor self-reported English-speaking competence (≤5/10) performed significantly (p < 0.01) poorer than the N and NN (≥6/10) groups on the digits-in-noise test. Screening characteristics of the test improved with separate cutoff values depending on English-speaking competence for the N and NN groups (≥6/10) and NN group alone (≤5/10). Logistic regression models, which include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operating characteristic curve, 0.962 and 0.903, respectively). Conclusions: Self-reported English-speaking competence had a significant influence on the SRT obtained with the smartphone digits-in-noise test. A logistic regression approach considering SRT, self-reported English-speaking competence, and age as predictors of best ear 4FPTA >25 dB HL showed that the test can be used as an accurate hearing screening tool for N and NN English speakers. The smartphone digits-in-noise test, therefore, allows testing in a multilingual population familiar with English digits using dynamic cutoff values that can be chosen according to self-reported English-speaking competence and age.
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Laboratory evaluation of an optimised internet-based speech-in-noise test for occupational high-frequency hearing loss screening: Occupational Earcheck
Article
Full-text available
  • Jun 2017
Objective: The "Occupational Earcheck" (OEC) is a Dutch online self-screening speech-in-noise test developed for the detection of occupational high-frequency hearing loss (HFHL). This study evaluates an optimised version of the test and determines the most appropriate masking noise. Design: The original OEC was improved by homogenisation of the speech material, and shortening the test. A laboratory-based cross-sectional study was performed in which the optimised OEC in five alternative masking noise conditions was evaluated. Study sample: The study was conducted on 18 normal-hearing (NH) adults, and 15 middle-aged listeners with HFHL. Results: The OEC in a low-pass (LP) filtered stationary background noise (test version LP 3: with a cut-off frequency of 1.6 kHz, and a noise floor of -12 dB) was the most accurate version tested. The test showed a reasonable sensitivity (93%), and specificity (94%) and test reliability (intra-class correlation coefficient: 0.84, mean within-subject standard deviation: 1.5 dB SNR, slope of psychometric function: 13.1%/dB SNR). Conclusions: The improved OEC, with homogenous word material in a LP filtered noise, appears to be suitable for the discrimination between younger NH listeners and older listeners with HFHL. The appropriateness of the OEC for screening purposes in an occupational setting will be studied further.
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Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
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Background: Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods: We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings: We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation: Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.
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Validation of a Computer-Administered Version of the Digits-in-Noise Test for Hearing Screening in the United States
Article
Full-text available
  • Aug 2016
Background: The sooner people receive treatment for hearing loss (HL), the quicker they are able to recognize speech and to master hearing aid technology. Unfortunately, a majority of people with HL wait until their impairments have progressed from moderate to severe levels before seeking auditory rehabilitation. To increase the number of individuals with HL who pursue and receive auditory rehabilitation, it is necessary to improve methods for identifying and informing these people via widely accessible hearing screening procedures. Screening for HL is the first in a chain of events that must take place to increase the number of patients who enter the hearing health-care system. New methods for hearing screening should be readily accessible through a common medium (e.g., telephone or computer) and should be relatively easy and quick for people to self-administer. Purpose: The purpose of this study was to assess a digits-in-noise (DIN) hearing screening test that was delivered via personal computer. Research design: Participants completed the Hearing Handicap Inventory for Adults (HHIA) questionnaire, audiometric testing in a sound booth, and computerized DIN testing. During the DIN test, sequences of three spoken digits were presented in noise via headphones at varying signal-to-noise ratios (SNRs). Participants entered each three-digit sequence they heard using an on-screen keypad. Study sample: Forty adults (16 females, 24 males) participated in the study, of whom 20 had normal hearing and 20 had HL (pure-tone average [PTA] thresholds for 0.5, 1, 2, and 4 kHz >25 dB HL). Data collection and analysis: DIN SNR and PTA data were analyzed and compared for each ear tested. Receiver operating characteristic curves based on these data were plotted. A measure of overall accuracy of a screening test is the area under the receiver operating characteristic curve (AUC). This measures the average true positive rate across false positives at varying DIN SNR cutoffs. Larger values of the AUC indicate, on average, more accurate screening tests. HHIA responses were analyzed and compared to PTA and DIN SNR results using Pearson correlation statistics. Results: HHIA scores were positively correlated with audiometric PTA and DIN SNR results (p < 0.001 for all correlations). For an HL criterion of one or more frequencies from 0.25 to 8 kHz >25 dB HL, the AUC for the DIN test was 0.95. When a criterion of hearling level was set at one or more frequencies from 0.25 to 8 kHz >20 dB HL, the AUC for the DIN test was 0.96. Conclusions: The computer version of the DIN test demonstrated excellent sensitivity and specificity for our sample of 40 participants. AUC results (≥0.95) suggest that this DIN test administered via computer should be very useful for adult hearing screening.
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Dementia prevention, intervention, and care
Article
  • Jul 2017
  • LANCET
Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society. Dementia is the greatest global challenge for health and social care in the 21st century. It occurs mainly in people older than 65 years, so increases in numbers and costs are driven, worldwide, by increased longevity resulting from the welcome reduction in people dying prematurely. The Lancet Commission on Dementia Prevention, Intervention, and Care met to consolidate the huge strides that have been made and the emerging knowledge as to what we should do to prevent and manage dementia. Globally, about 47 million people were living with dementia in 2015, and this number is projected to triple by 2050. Dementia affects the individuals with the condition, who gradually lose their abilities, as well as their relatives and other supporters, who have to cope with seeing a family member or friend become ill and decline, while responding to their needs, such as increasing dependency and changes in behaviour. Additionally, it affects the wider society because people with dementia also require health and social care. The 2015 global cost of dementia was estimated to be US$818 billion, and this figure will continue to increase as the number of people with dementia rises. Nearly 85% of costs are related to family and social, rather than medical, care. It might be that new medical care in the future, including public health measures, could replace and possibly reduce some of this cost.
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Global hearing health care: New findings and perspectives
Article
  • Jul 2017
  • LANCET
In 2015, approximately half a billion people had disabling hearing loss, about 6·8% of the world's population. These numbers are substantially higher than estimates published before 2013, and point to the growing importance of hearing loss and global hearing health care. In this Review, we describe the burden of hearing loss and offer our and others' recommendations for halting and then reversing the continuing increases in this burden. Low-cost possibilities exist for prevention of hearing loss, as do unprecedented opportunities to reduce the generally high treatment costs. These possibilities and opportunities could and should be exploited. Additionally, a comprehensive worldwide initiative like VISION 2020 but for hearing could provide a focus for support and also enable and facilitate the increased efforts that are needed to reduce the burden. Success would produce major personal and societal gains, including gains that would help to fulfil the “healthy lives” and “disability inclusive” goals in the UN's new 2030 Agenda for Sustainable Development.
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Survey of ENT services in sub-Saharan Africa: Little progress between 2009 and 2015
Article
  • May 2017
Background: A 2009 survey of ENT, audiology, and speech therapy services and training opportunities in 18 Sub-Saharan African countries reported that the availability of services was extremely poor, the distribution of services was very inequitable, and training opportunities were limited. Objective: We conducted a new survey to determine the current status of ear, nose, and throat (ENT), audiology, and speech therapy services in sub-Saharan Africa. Method: This study is a cross-sectional study. A questionnaire was distributed by email to an ad hoc group of ENT surgeons and audiologists in 30 sub-Saharan African countries. Data from the current survey were compared to those of a 2009 survey. The numbers of ENT surgeons, audiologists, and speech therapists/100,000 people were compared to the ratios in the United Kingdom. Results: A total of 22 countries responded to the questionnaire. When data of the 15 countries that responded in both 2009 and 2015 are compared, the number of ENT surgeons had increased by 43%, audiologists had increased by 2.5%, and speech therapists by 30%. When the 23% population growth is taken into account, the numbers of ENT surgeons, audiologists, and speech therapists per 100,000 people had declined in four countries, and there remains a severe shortfall of ENT surgeons, audiologists, and speech therapists when compared to the UK Respondents cited lack of availability of basic equipment as the most frequent limitation in providing ENT services. Other important factors causing limitations in daily practice were: lack of ENT training facilities and audiological rehabilitation, low awareness of the burden of ENT pathology, as well as poor human resources management. Conclusions: There has been a lack of progress in ENT, audiology, and speech therapy services and training opportunities in sub-Saharan Africa between 2009 and 2015. There is a need to look at increased collaboration with developed countries and non-governmental organisations, establishing new and improving existing training centres in Africa, and task-shifting of some ENT services to primary health workers.
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