Cas Smits

Development and validation of an automatic speech-in-noise screening test by telephone

To meet the need for an objective self-test for hearing screening, a new Dutch speech-in-noise test was developed. Digit triplets were used as speech material. The test was made fully automatic, was controlled by a computer, and can be done by telephone. It measures the speech reception threshold (triplet SRTn) using an adaptive procedure, in about 3 min. Our experiments showed no significant influence of telephone type or listening environment. Measurement errors were within 1 dB, which makes the test accurate. In additional experiments with hearing-impaired subjects (76 ears of 38 listeners), the new test was compared to the existing sentence SRTn test of Plomp and Mimpen, which is considered to be the standard. The correlation between both SRTns was 0.866. As expected, correlations between the triplet SRTn test by telephone and average pure-tone thresholds are somewhat lower: 0.732 for PTA0.5, 1, 2, and 0.770 for PTA0.5, 1, 2,4. When proper SRTn values were chosen for distinguishing between normal-hearing and hearingimpaired subjects, the triplet SRTn test was found to have a sensitivity of 0.91 and a specificity of 0.93. Sumario Para satisfacer la necesidad de un test objetivo de autoevaluacio´n para identificacio´n de problemas auditivos, se desarrollo´ una nueva prueba holandesa de lenguaje en ruido. Se utilizaron cifras de tres di´gitos como material logoaudiome´trico. El test se hizo totalmente automa´tico, controlado por una computadora y realizable por tele´fono. Mide el umbral de recepcio´n del lenguaje (SRTn triplet) en 3 minutos, utilizando un procedimiento adaptativo. Nuestras pruebas no muestran una influencia significativa del tipo de tele´fono o del ambiente de la prueba. Los errores de medicio´n no variaron en ma´s de 1 dB, lo que hace que la prueba sea exacta. En experimentos adicionales con sujetos hipoacu´sicos (76 oi´dos de 36 sujetos), la nueva prueba se comparo´ con el test de SRTn con frases de Plomp y Mimpen, considerado como el esta´ndar de referencia. La correlacio´n entre los SRTnfue de 0.866. Como se esperaba, la correlacio´n entre la prueba telefo´nica de SRTncon di´gitos triples y el promedio de umbrales tonales puros es un poco ma´s baja: 0.732 para el PTA0.5, 1, 2 y 0.770 para el PTA0.5, 1, 2, 4. Cuando se escogieron los valores apropiados de SRTnpara distinguir entre sujetos normo-oyentes e hipoacu´sicos, la prueba de SRTncon di´gitos triples demostro´ una sensibilidad de 0.91 y una especificidad de 0.93.

The association between hearing status and psychosocial health before the age of 70 years: results from an internet-based national survey on hearing

Objective: There is a substantial lack of knowledge of the impact of reduced hearing on psychosocial functioning in adults younger than 70 yr. The aim of this study was to examine the association between hearing status and psychosocial health in adults aged between 18 and 70 yr. Design: This was a cross-sectional cohort study. Baseline data of the National Longitudinal Study on Hearing are analyzed using regression models. The cohort consisted of 1511 participants. Hearing status was determined using the National Hearing test, a recently launched speech-in-noise screening test over the Internet. We assessed self-reported psychosocial health using a set of online questionnaires. Results: Adjusting for confounding variables, significant adverse associations between hearing status and distress, somatization, depression, and loneliness are found. For every decibel signal to noise ratio (dB SNR) reduction of hearing status, both the distress and somatization scores increased by 2% [distress: b = 0.02, 95% confidence interval (CI) = 0.00 to 0.03, p = 0.03; somatization: b = 0.02, 95% CI = 0.01 to 0.04, p < 0.001]. The odds for developing moderate or severe depression increase by 5% for every dB SNR reduction in hearing (odds ratio = 1.05, 95% CI = 1.00 to 1.09, p = 0.03). The odds for developing severe or very severe loneliness significantly increase by 7% for every dB SNR reduction in hearing (odds ratio = 1.07, 95% CI = 1.02 to 1.12, p = 0.004). Different age groups exhibit different associations between hearing status and psychosocial health, with loneliness being an issue particularly in the youngest age group (18 to 30 yr). In the group of middle-aged adults (40 to 50 yr), the number of significant associations is highest. Conclusions: Hearing status is negatively associated with higher distress, depression, somatization, and loneliness in young and middle-aged adults. The associations are different in different age groups. The findings underline the need to seriously address the adverse effects of limited hearing among young and middle-aged adults both in future research and in clinical practice.

Results from the Dutch speech-in-noise screening test by telephone

Objective: The objective of the study was to implement a previously developed automatic speech-in-noise screening test by telephone (Smits, Kapteyn, & Houtgast, 2004), introduce it nationwide as a self-test, and analyze the results. Design: The test was implemented on an interactive voice response system, which can handle multiple lines. The test measures the speech reception threshold in speech-shaped noise by telephone (SRTTn) in an adaptive procedure using digit triplets as speech material. The test result is given as either good, insufficient, or poor. Questions about age, sex, and subjective rating of hearing were included in the test. The test was introduced as the National Hearing test and publicity was generated. In the first 4 mo, 65,924 people took the initiative and dialed the test. The possibility to use mobile phones was disabled because of significant worse results (0.7 dB) with that telephone type. Results: After applying exclusion criteria, results from 39,968 callers were analyzed. Seventy-five percent of the callers were older than 44 yr of age. Starting at about 45 yr of age, there is an increase in SRTTn with increasing age. SRTTns for men are significantly worse than SRTTns for women for age groups 50 to 54 and higher. Older people tend to rate their hearing better than might be expected from their SRTTn. However, after converting the mean SRTTn values per age group and per subjective score to percentile values, the values remain constant across age groups. Mean measurement error was within 1 dB. These errors increase with increasing SRTTn. Conclusions: This study shows the implementation and results from a functional hearing screening test by telephone. The test can be done in about 3 minutes, 30 sec, including introductory text, explanation of the test procedure, test result, and recommendation for audiological evaluation. The high number of callers implies that the test is probably fulfilling the need for a functional hearing screening test and has enhanced public awareness about hearing loss.

Speech reception thresholds in noise and self-reported hearing disability in a general adult population

Objective: The principal objective of this study was to describe speech reception thresholds in noise (SRTTn, i.e., the signal-to-noise ratio corresponding to 50% intelligibility) and self-reported hearing disability in a general adult population. A secondary objective was to investigate to what extent the functional measurements could be predicted on the basis of the self-reported data. Design: The sample consisted of 1086 subjects over 60 yr of age who participated in the Longitudinal Aging Study Amsterdam and 128 younger adults, mainly between 20 and 30 yr of age. Subjects were given a diotic speech-in-noise test by telephone to estimate the SRTTn and filled in a questionnaire to allow determination of the self-reported hearing disability. The SNR loss (signal-to-noise ratio loss), defined as the amount by which the measured SRTTn exceeds that for subjects with normal hearing, was determined and classified in three hearing-status categories: good, insufficient, and poor. Results: The median SNR loss for the 60- to 64-year age group was 2.2 dB for men and 1.2 dB for women. The corresponding figures for the 80- to 84-year age group were 5.0 dB and 3.6 dB, respectively. Only 42% of the subjects with poor hearing possessed hearing aids. A single question from the self-reported hearing disability questionnaire could be used to predict the hearing-status category corresponding to the results of the speech-in-noise test correctly in 62% of the cases. Use of all five of the questions from the questionnaire allowed 69% of the subjects to be classified correctly. There is a strong effect of age on the relation between reported hearing disability and SNR loss. Conclusions: SNR loss is a common disability in people aged 60 yr or more. Relatively few people with significant SNR loss have hearing aids. Screening for SNR loss with a speech-in-noise test performed by telephone is preferable to use of a short questionnaire, even when an age-specific scoring method is applied.

Permanent unilateral hearing loss after radiotherapy for parotid gland tumors

The purpose of this retrospective study was to determine the long‐term effects of radiotherapy on hearing function in patients who underwent parotidectomy and postoperative radiotherapy for unilateral tumors of the parotid gland.

The digits-in-noise test: Assessing auditory speech recognition abilities in noise

A speech-in-noise test which uses digit triplets in steady-state speech noise was developed. The test measures primarily the auditory, or bottom-up, speech recognition abilities in noise. Digit triplets were formed by concatenating single digits spoken by a male speaker. Level corrections were made to individual digits to create a set of homogeneous digit triplets with steep speech recognition functions. The test measures the speech reception threshold (SRT) in long-term average speech-spectrum noise via a 1-up, 1-down adaptive procedure with a measurement error of 0.7 dB. One training list is needed for naive listeners. No further learning effects were observed in 24 subsequent SRT measurements. The test was validated by comparing results on the test with results on the standard sentences-in-noise test. To avoid the confounding of hearing loss, age, and linguistic skills, these measurements were performed in normal-hearing subjects with simulated hearing loss. The signals were spectrally smeared and/or low-pass filtered at varying cutoff frequencies. After correction for measurement error the correlation coefficient between SRTs measured with both tests equaled 0.96. Finally, the feasibility of the test was approved in a study where reference SRT values were gathered in a representative set of 1386 listeners over 60 years of age.

Measurements and calculations on the simple up-down adaptive procedure for speech-in-noise tests

The simple up-down adaptive procedure is a common method for measuring speech reception thresholds. It is used by the Dutch speech-in-noise telephone screening test [National Hearing test; Smits and Houtgast Ear Hear. 26, 89-95 (2005)]. The test uses digit triplets to measure the speech reception threshold in noise by telephone (SRTT(n)). About 66 000 people took this test within four months of its introduction and details were stored of all individual measurements. Analyses of this large volume of data have revealed that the standard deviation of SRTT(n) estimates increases with hearing loss. This paper presents a calculation model which--using an intelligibility function as input--can determine the standard deviation of SRTT(n) estimates and the bias for the simple up-down procedure. The effects of variations in the slope of the intelligibility function, the guess rate, the starting level, the heterogeneity of the speech material, and the possibilities of optimizing SRTT(n) measurements were all explored with this model. The predicted decrease in the standard deviation of SRTT(n) estimates as a result of optimizing the speech material was confirmed by measurements in 244 listeners. The paper concludes by discussing possibilities for optimizing the development of comparable tests.

Hearing loss in older persons: Does the rate of decline affect psychosocial health?

Objective: This study investigates whether the rate of decline in older persons’ hearing status is associated with the rate of decrease in their psychosocial health and explores moderation by baseline hearing status, health-related factors, and sociodemographic factors. Method: Multilevel analyses were applied to data of 1,178 older participants from the Longitudinal Aging Study Amsterdam (LASA), covering 3 to 7 years of follow-up. Results: Faster decrease in speech-in-noise recognition was significantly associated with more increase in loneliness for persons with a moderate baseline speech-in-noise recognition (emotional and social loneliness) and for persons who recently lost their partner (emotional loneliness). No relationship was found with depression. Discussion: The results indicate that faster hearing decline results in more increase in loneliness in specific subgroups of older persons: in persons with an already impaired hearing and in widow(er)s. Monitoring older persons’ hearing seems important and may be a relevant starting point for targeted loneliness prevention efforts.

Decision making in advanced otosclerosis: An Evidence‐Based Strategy

To propose an evidence‐based strategy for the management of patients with advanced otosclerosis accompanied by severe to profound hearing loss.

The interpretation of speech reception threshold data in normal-hearing and hearing-impaired listeners: Steady-state noise

Speech-in-noise-measurements are important in clinical practice and have been the subject of research for a long time. The results of these measurements are often described in terms of the speech reception threshold (SRT) and SNR loss. Using the basic concepts that underlie several models of speech recognition in steady-state noise, the present study shows that these measures are ill-defined, most importantly because the slope of the speech recognition functions for hearing-impaired listeners always decreases with hearing loss. This slope can be determined from the slope of the normal-hearing speech recognition function when the SRT for the hearing-impaired listener is known. The SII-function (i.e., the speech intelligibility index (SII) against SNR) is important and provides insights into many potential pitfalls when interpreting SRT data. Standardized SNR loss, sSNR loss, is introduced as a universal measure of hearing loss for speech in steady-state noise. Experimental data demonstrates that, unlike the SRT or SNR loss, sSNR loss is invariant to the target point chosen, the scoring method or the type of speech material.