Abstract
In France 58% of persons with hearing loss still do not wear hearing aids. Pure-tone audiometry is the traditional gold standard in assessment and screening of hearing impairment, but it requires the use of calibrated devices and soundproof booth. The antiphasic digits-in-noise (DIN) test does not require calibrated material and can run on a standard headset or earbuds connected to a smartphone or a computer. The DIN test is highly correlated with pure tone audiometry and has already shown to be effective in hearing loss screening in its English version promoted by the WHO. The aim of the present study was to develop and validate a French version of the antiphasic DIN test for implementation on a national screening test offered as a smartphone app. The audio files recorded from a French native female speaker were selected and normalized in intensity according to their recognition probability. The French DIN test application was then tested on normal hearing- and hearing-impaired subjects. Based on the strong correlation between pure tone audiometry (PTA) and DIN SRT, we calculated ROC curves and Z-score. For PTA > 20 dB HL, a SNR cutoff of 12.9 dB corresponds to a sensitivity and specificity of 0.96 and 0.93, respectively. To detect moderate and more severe hearing loss (PTA > 40 dB HL), the SNR cutoff was −10.9 dB, corresponding to a sensitivity and specificity of 0.99 and 0.83, respectively. The Z-score was calculated to define statistical criteria of normality for speech-in-noise evaluation. While a score of 0 roughly corresponds to the normality (DIN SRT = −15.4 dB SNR), a subject with DIN SRT > −12.2 (Z-score > 2) is ranked in the hearing loss population. Next, the French antiphasic DIN test was implemented in the Höra iOS and Android apps. In total, 19,545 Höra tests were completed and analyzed. Three quarters of them were classified as normal (74 %) and one quarter presented mild (9%) or more severe loss (17%). Together, results argue for the use of the French version of antiphasic DIN test in the general population to improve the screening of hearing-impaired individuals.
Highlights
Hearing loss burden on health and quality of life is often underestimated by public authorities, health care professionals and the public
The time course of DIN speech reception thresholds (SRT) was similar to pure tone audiometry (PTA) (Figure 2B) with a mean score of −15.4 dB signal-to-noise ratio (SNR) (±1.3 dB) up to a cutoff age of 44-years of age (±6 years) where the mean DIN SRT increase at a pace of 0.43 dB SNR/year (±0.07 dB/year)
Our results support the use of the French version of the antiphasic DIN test to detect all hearing losses with high sensitivity (0.92) and specificity (0.86)
Summary
Hearing loss burden on health and quality of life is often underestimated by public authorities, health care professionals and the public. In the world, hearing loss affects around 20% (1.5 billion people) of the population with an estimated 5.5% (430 million) experiencing significant hearing loss. In France as in other high-income countries, the prevalence is expected to increase rapidly over the three decades due to an aging population and noise exposure of younger people [1]. The impact of untreated hearing loss is far reaching with economic cost estimates of ∼22.5 billion Euros in France, and 225 billion in Europe [1]. On an individual level, untreated hearing loss is associated with social isolation, increased risk of depression, cognitive decline, dementia, and hospitalization [2]. Hearing loss has recently been identified as the most significant modifiable risk factor in mid-life for dementia [6], which emphasizes the importance of early detection and timely intervention
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
