Monique C. J. Leensen

Speech-in-noise screening tests by internet, Part 1: Test evaluation for noise-induced hearing loss identification

Abstract Objective: In the Netherlands three internet-based self-screening tests have been developed; the National Hearing Test (NHT), Earcheck (EC), and Occupational Earcheck (OEC). These tests are adaptive speech-in-noise tests using either digit triplets or monosyllables, presented in stationary speech-shaped noise. These tests can be highly valuable in increasing the awareness and prevention of noise-induced hearing loss (NIHL). This study evaluates these online speech-in-noise tests and investigates their potential to detect NIHL. Design: In a multi-centre study the results of the three online screening tests are compared to pure-tone audiometry and to the Dutch sentence SRT test (21), which is considered the clinical standard. Study sample: In total, 49 normal-hearing listeners and 49 patients with different degrees of NIHL participated. Results: The online tests show good reliability, but there is much overlap in outcomes between normal-hearing listeners and participants with early NIHL. In addition, rather low correlations of the test results with both the Dutch sentence SRT test and pure-tone thresholds are found. These findings result in rather low test sensitivity: 54% (NHT) and 51% (EC), or low specificity: 49% (OEC). Conclusions: The online screening tests in their current form are unsuitable to be used for early NIHL screening purposes. Sumario Objetivo: Tres pruebas auto-aplicadas de tamiz por internet han sido desarrolladas en Holanda; la Prueba Nacional de Audición (NHT), la prueba Earcheck (EC) y la prueba Earcheck Ocupacional (OEC). Estas son pruebas adaptativas de lenguaje en ruido que utilizan cifras de tres dígitos o monosílabos, presentados en ruido estacionario de configuración lingüística. Estas pruebas pueden tener un alto valor en la concienciación y la prevención de hipoacusia por ruido (NIHL). Este estudio evalúa estas pruebas de lenguaje en ruido hechas por internet e investiga su potencial para detectar NIHL. Diseño: En un estudio multicéntrico los resultados de las tres pruebas de tamiz por internet, son comparados con una audiometría tonal y con la prueba SRT de frases en holandés (21) que es considerada el estándar clínico. Muestra: Participaron 49 sujetos normoyentes y 49 pacientes con diferentes grados de NIHL. Resultados: Las pruebas por internet mostraron una buena fiabilidad, pero hay mucho traslape entre los resultados entre los normoyentes y los participantes con NIHL incipiente. Adicionalmente se encontró una baja correlación entre los resultados de las pruebas y la prueba SRT de frases en holandés y la audiometría tonal. Estos resultados implican una muy baja sensibilidad de la prueba 54% (NHT) y 51% (EC), o una baja especificidad, 49% (OEC). Conclusiones: las pruebas de tamiz por internet, en su forma actual, no son apropiadas para la detección de NIHL incipiente

Speech-in-noise screening tests by internet, part 2: improving test sensitivity for noise-induced hearing loss

Abstract Objective: An easily accessible screening test can be valuable in the prevention of noise-induced hearing loss (NIHL). The Dutch National Hearing Foundation developed ‘Earcheck’, an internet-based speech-in-noise test, presenting CVC-words in stationary broadband noise. However, its sensitivity to detect NIHL appeared to be low, 51% (12, part 1). The aim of the current study is to examine ways to improve Earchecks sensitivity for (early) NIHL using different forms of noise filtering. Design: The tests stationary broadband masking noise is replaced by six alternatives, including noises that have been temporally modulated, spectrally filtered by high-pass or low-pass filters, and combinations of temporal modulation and spectral filtering. Study sample: In this multi-centre study, 49 normal-hearing and 49 subjects with different degrees of NIHL participated. Results: Hearing-impaired subjects deviated more clearly from normal performance when executing the test with alternative masking noises, except for the high-pass filtered conditions. Earcheck with low-pass filtered noise made the best distinction between normal hearing and NIHL, without reducing test reliability. The use of this noise condition improved the sensitivity of Earcheck to 95%. Conclusion: The use of low-pass filtered masking noise makes speech-in-noise tests more sensitive to detect NIHL in an early stage. Sumario Objetivo: Una prueba de tamiz accessible podría tener valor en la prevención de hipoacusia inducida por ruido (NIHL). La Fundación Nacional Holandesa para la Audición desarrolló la prueba “Earcheck”; una prueba de lenguaje en ruido por internet que presenta palabras CVC en ruido de banda ancha estacionario. Sin embargo, al parecer su sensibilidad para detectar la hipoacusia inducida por ruido es baja, 51% (Leensen et al, parte 1, 2011). El objetivo de este estudio es examinar las formas para mejorar la sensibilidad de Earcheck en la detección de NIHL (incipiente), utilizando diferentes formas de filtración del ruido. Diseño: el ruido estacionario enmascarante de banda ancha de la prueba, es sustituído por seis diferentes alternativas, incluyendo ruidos que han sido temporalmente modulados, espectralmente filtrados por filtros pasa bajo o pasa alto y combinaciones de modulación temporal y filtración espectral. Muestra: en este estudio multicéntrico participaron 49 normoyentes y 49 sujetos con diferentes grados de NIHL. Resultados: Los sujetos con hipoacusia se desviaron más claramente del desempe o normal cuando ejecutaron la prueba con ruido enmascarante alternativo, excepto en las condiciones de filtro pasa alto. La mayor distinción entre normoyentes y sujetos con NIHL en la prueba Earcheck fue con el ruido con filtro pasa-bajo. El uso de este tipo de ruido mejor la sensibilidad de la prueba Earcheck hasta llegar a un 95%. Conclusiones: El uso de ruido enmascarante con filtro pasa-bajo hace que la prueba de lenguaje en ruido sea más sensible para detectar NIHL en una fase inicial.

Speech-in-noise screening tests by internet, part 3: test sensitivity for uncontrolled parameters in domestic usage.

Abstract Objective: The online speech-in-noise test ‘Earcheck’ is sensitive for noise-induced hearing loss (NIHL). This study investigates effects of uncontrollable parameters in domestic self-screening, such as presentation level and transducer type, on speech reception thresholds (SRTs) obtained with Earcheck. Design: Subjects performed 26 Earchecks that differed regarding presentation level (65, 71, and 77 dBA), presentation mode (monotic or diotic), and masking noise (two different low-pass filtered noises) in the lab. To investigate effects of test environment, participants conducted eight additional Earchecks at home using different transducer types (headphones or loudspeakers). Study sample: Thirty noise-exposed workers, either normal-hearing (n = 10), or with different degrees of NIHL (n = 20), participated. Results: There was a minor effect of presentation levels exceeding 65 dBA in severely impaired listeners. Diotic presentation mode yielded lower SRTs compared to monotic presentation mode. Normal-hearing test results at home were poorer than in the laboratory, whereas hearing-impaired subjects performed better in domestic testing. Using loudspeakers deteriorated SRTs significantly in comparison to headphones, but only in hearing-impaired subjects. Conclusions: A monotic presentation mode using headphones is recommended for domestic screening. Since domestic testing affects SRT results, a follow up study using a large study population should assess Earchecks validity when performed at home.

The applicability of a speech-in-noise screening test in occupational hearing conservation

Abstract Objective: Noise-induced hearing loss (NIHL) is the most reported occupational health disease in the Netherlands. The internet-based speech-in-noise test Earcheck (Albrecht et al, 2005; Leensen et al, 2011b) is designed to detect beginning NIHL and can be a valuable tool in occupational hearing health surveillance. The aim of this study is to investigate the validity of Earcheck compared to regular screening audiometry. Design: Subjects performed online Earcheck tests at home. The results are compared to a pure-tone screening audiogram obtained during regular occupational health examination. A subgroup performed the measurements twice to assess test-retest reliability. Study sample: Two hundred and forty-nine male construction employees who recently had a periodic occupational health examination participated. Results: An average learning effect of −1.6 dB was found, that reduced with increasing test number. The test-retest variability was 1.6 dB. Sensitivity to detect beginning NIHL was 68%, with a specificity of 71%. Conclusions: Although sensitivity and specificity values are only moderate, the broad internet application still promises a valuable addition to current practice. The relatively high learning effect indicates that more reliable results can be obtained after a longer test session. When this is put into practice some improvement in sensitivity and specificity may be expected as well.

Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands

Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes. Design Longitudinal prospective intervention study using a one-group design. Setting Two hospitals in the Netherlands. Participants Of the eligible patients, 56% participated; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included. Patients completed questionnaires on RTW, the importance of work, work ability (WAI), RTW self-efficacy, fatigue (MFI), and quality of life (EORTC QLQ C-30) at baseline and 6, 12 and 18 months follow-up. Before and after the exercise programme 1-repetition maximum (1RM) muscle strength and cardiorespiratory fitness (VO2 peak) were assessed. Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme, 59% of the cancer patients returned to work, 86% at 12 months and 83% at 18 months. In addition, significant improvements (p<0.05) in the importance of work, work ability, RTW self-efficacy, and quality of life were observed, whereas fatigue levels were significantly reduced. After completing the exercise programme, 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level. Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life.

Laboratory evaluation of an optimised internet-based speech-in-noise test for occupational high-frequency hearing loss screening: Occupational Earcheck

Abstract 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.

Application of the online hearing screening test "Earcheck": Speech intelligibility in noise in teenagers and young adults

Objective: The objective was to describe the speech intelligibility in noise test results among Dutch teenagers and young adults aged 12–24 years, using a national online speech reception threshold (SRT) test, the Earcheck. A secondary objective was to assess the effect of age and gender on speech intelligibility in noise. Design: Cross-sectional SRT data were collected over a 5-year period (2010–2014), from participants of Earcheck. Regression analyses were performed, with SRT as the dependent variable, and age and gender as explaining variables. To cross-validate the model, data from 12- to 24-year olds from the same test distributed by a hearing aid dispenser (Hoorscan) were used. Results: In total, 96,803 valid test results were analyzed. The mean SRT score was −18.3 dB signal-to-noise ratio (SNR) (standard deviation (SD) = 3.7). Twenty-five percent of the scores was rated as insufficient or poor. SRT performance significantly improved with increasing age for teenagers aged 12–18 years by 0.49 dB SNR per age-year. A smaller age-effect (0.09 dB SNR per age-year) was found for young adults aged 19–24 years. Small differences between male and female users were found. Conclusion: Earcheck generated large quantities of national SRT data. The data implied that a substantial number of users of Earcheck may have some difficulty in understanding speech in noise. Furthermore, the results of this study showed an effect of gender and age on SRT performance, suggesting an ongoing maturation of speech-in-noise performance into late adolescence. This suggests the use of age-dependent reference values, but for this purpose, more research is required.

Cross-sectional evaluation of an internet-based hearing screening test in an occupational setting

Objectives The Occupational Earcheck (OEC) is an online internet test to detect high-frequency hearing loss for the purposes of occupational hearing screening. In this study, we evaluated the OEC in an occupational setting in order to assess test sensitivity, specificity, and validity. Methods A cross-sectional study was conducted in 2015, in which the optimized OEC was evaluated on 94 employees from the army and three different companies in construction and manufacturing. Subjects underwent OEC in an office-like room. Pure-tone air conduction audiometry was performed as a reference test. The OEC was repeated for a subset of subjects (N=19). Important test characteristics (ie, sensitivity and specificity, test validity, and test-retest reliability) were assessed. Results When analyzed on the individual level, the sensitivity and specificity of OEC were 90% and 77%, respectively. The speech reception threshold results correlated strongly with the pure-tone average of the frequencies 3, 4 and 6 kHz, reflecting good test validity (r=0.79). The difference between test and retest was not significant. The intra-class correlation coefficient was moderate (r=0.57), indicating a reasonable agreement between test and retest. Conclusions The OEC appears to be a suitable test for the detection of high-frequency hearing loss among noise-exposed employees, with good sensitivity and specificity values, even when performed in a semi-controlled occupational setting, though a possible learning effect should be taken into account.

Rehabilitation and return to work after cancer — instruments and practices

The ‘Rehabilitation and return to work after cancer — instruments and practices’ project provides an insight into the issues surrounding rehabilitation and return to work (RTW) after a cancer diagnosis and the problems encountered by workers affected by cancer and their employers. Furthermore, the report presents recommendations for instruments, practices, policies and interventions to successfully support the RTW of workers affected by cancer. Each year, an estimated 3.4 million new cases of cancer are diagnosed in Europe. About half of the people diagnosed with cancer are of working age. Although cancer occurrence differs from one region to another in Europe, the most frequent forms of cancer are breast, colorectal, prostate and lung cancer. These types of cancer were estimated to account for over half of the overall burden of cancer in Europe in 2012. The impact of cancer on a person’s daily life is immediate and striking. The diagnosis usually results in long periods of sickness absence because of medical treatments and functional restrictions. Although, in general, cancer management has improved over the past three decades and the overall number of people who survive cancer is increasing, many cancer survivors still face long-term symptoms and impairments after their treatment ends, such as fatigue. These symptoms and impairments can affect the workability of cancer survivors, making it more difficult to remain in or re-enter the job market. Research shows that most cancer survivors are able to remain in or return to work, but that overall the risk of unemployment among cancer survivors is 1.4 times higher than among people who have never been diagnosed with cancer. Optimising the rehabilitation and RTW of workers affected by cancer is therefore important to both improve the well-being of this vulnerable group and reduce the societal and financial impacts of cancer on European enterprises and society at large. Instruments, practices, policies and interventions aimed at the promotion of rehabilitation and RTW are clearly important. This ‘Rehabilitation and return to work after cancer — instruments and practices’ project reports on the emerging issue of rehabilitation and RTW after cancer and provides national examples of successful instruments, practices, policies and interventions to prevent long-term sickness absences and unemployment. The project is divided into the following main tasks:  a literature review on rehabilitation and RTW after a cancer diagnosis;  detailed descriptions of instruments, practices, policies and interventions to support rehabilitation and RTW after a cancer diagnosis;  company case studies;  qualitative research with experts and intermediaries;  support for the EU-OSHA stakeholder seminar.