National Hearing Test Research Articles

Uptake of Hearing Aids and Hearing Assistive Technology in a Working Population: Longitudinal Analyses of The Netherlands Longitudinal Study on Hearing.

Objective:To identify predictors of the 5-year uptake of hearing aids (HAs) and hearing assistive technology (HAT) in a sample of Dutch employees eligible for HAs and/or HAT. The potential predictors included demographic factors (age, sex, marital status, and living situation), education, hearing factors (ability to recognize speech in noise and self-reported hearing disability), distress, self-efficacy, and work-related factors (job demand, job control, and need for recovery).Design:Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) collected until January 2019 were included. An online digit-triplet in noise test, the National Hearing Test (NHT), was used to assess speech-recognition-in-noise ability. In addition, online questionnaires on demographic, socioeconomic, self-reported hearing disability, health, and work-related characteristics were administered. Adults who worked over 12 hours per week, who had not yet taken up HAs or HAT, but who would be eligible for HAs/HAT based on their NHT score (insufficient or poor hearing ability), were included in the study. The 5-year uptake of HAs/HAT was defined as a dichotomous variable of self-reported HA/HAT use reported 5 years later. Generalized Estimating Equations analyses were performed to analyze the associations between potential predicting factors and the 5-year uptake of HAs/HAT, taking into account the repeated measurements of the predicting factors and the 5-year uptake of HAs/HAT.Results:Data of 218 participants were included. The cumulative incidence of the 5-year uptake of HAs/HAT was 15 to 33%, of which 52 employees took up HAs and 11 employees took up HAT. Married participants had increased odds for 5-year uptake of HAs/HAT compared with unmarried participants (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.05 to 4.35). Higher self-reported hearing disability (per one unit, scale range 0 to 74) was associated with increased odds for 5-year uptake of HAs/HAT (OR = 1.05, 95% CI = 1.03 to 1.07). Job demand showed a significant interaction with sex (p = 0.002), and therefore, stratified analyses were performed. In male participants, participants with higher job demand scores (per one unit, scale range 12 to 48) had increased odds for 5-year uptake of HAs/HAT (OR = 1.18, 95% CI = 1.05 to 1.35). No difference was seen in females.Conclusion:This study confirms that factors predicting the uptake of HAs/HAT in the general or older populations, including marital status and self-reported hearing disability, also extend to the working population. The identification of job demand as a predictor of the uptake of HAs/HAT (in males only) was a novel finding. It demonstrates the importance of considering work-related factors in aural rehabilitation.

10-Year Follow-Up Results of The Netherlands Longitudinal Study on Hearing: Trends of Longitudinal Change in Speech Recognition in Noise.

Previous findings of longitudinal cohort studies indicate that acceleration in age-related hearing decline may occur. Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) showed that around the age of 50 years, the decline in speech recognition in noise accelerates compared with the change in hearing in younger participants. Other longitudinal studies confirm an accelerated loss in speech recognition in noise but mostly use older age groups as a reference. In the present study, we determined the change in speech recognition in noise over a period of 10 years in participants aged 18 to 70 years at baseline. We additionally investigated the effects of age, sex, educational level, history of tobacco smoking, and alcohol use on the decline of speech recognition in noise. Baseline (T0), 5-year (T1), and 10-year (T2) follow-up data of the NL-SH collected until May 2017 were included. The NL-SH is a web-based prospective cohort study which started in 2006. Central to the NL-SH is the National Hearing test (NHT) which was administered to the participants at all three measurement rounds. The NHT uses three-digit sequences which are presented in a background of stationary noise. The listener is asked to enter the digits using the computer keyboard. The outcome of the NHT is the speech reception threshold in noise (SRT) (i.e., the signal to noise ratio where a listener recognizes 50% of the digit triplets correctly). In addition to the NHT, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics at T0, T1, and T2. A linear mixed model was used for the analysis of longitudinal changes in SRT. Data of 1349 participants were included. At the start of the study, the mean age of the participants was 45 years (SD 13 years) and 61% of the participants were categorized as having good hearing ability in noise. SRTs significantly increased (worsened) over 10 years (p < 0.001). After adjustment for age, sex, and a history of tobacco smoking, the mean decline over 10 years was 0.89 dB signal to noise ratio. The decline in speech recognition in noise was significantly larger in groups aged 51 to 60 and 61 to 70 years compared with younger age groups (18 to 30, 31 to 40, and 41 to 50 years) (p < 0.001). Speech recognition in noise in participants with a history of smoking declined significantly faster during the 10-year follow-up interval (p = 0.003). Sex, educational level, and alcohol use did not appear to influence the decline of speech recognition in noise. This study indicated that speech recognition in noise declines significantly over a 10-year follow-up period in adults aged 18 to 70 years at baseline. It is the first longitudinal study with a 10-year follow-up to reveal that the increased rate of decline in speech recognition ability in noise already starts at the age of 50 years. Having a history of tobacco smoking increases the decline of speech recognition in noise. Hearing health care professionals should be aware of an accelerated decline of speech recognition in noise in adults aged 50 years and over.

A Smartphone National Hearing Test: Performance and Characteristics of Users.

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. 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. 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. 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.

Feasibility of a low-cost hearing screening in rural Indiana

BackgroundHearing loss remains a neglected public health issue in the rural and agricultural communities in the United States and therefore, promotion of a low-cost hearing screening may be important for these underserved populations. The major objectives of our study were to assess feasibility of a low-cost telephone-administered hearing test in rural Indiana and to identify the challenges, barriers and viable implementation strategies associated with this test. Also, we evaluated whether a focus group session could change the hearing health attitude of rural residents.MethodsWe recruited 126 adults from six rural Indiana counties who participated in study activities in the following order: 1) a pre-focus group demographic, knowledge and attitude survey, 2) a focus group for discussing the feasibility of a telephone-administered hearing screening, 3) a post focus group attitude survey and 4) hearing was screened using an audiometer and self-assessment scale. These activities generated both qualitative and quantitative data, which were subsequently analyzed.ResultsHearing impairment was perceived as an important public health issue. Many participants expressed interests to try the low-cost National Hearing Test (NHT). However, participants recommended NHT to be facilitated by community organizations to provide access to landline phones. The focus group turned out to be an excellent awareness building activity producing significant improvement in hearing health attitudes. Comparison of self and audiometric evaluations indicated underestimation of hearing handicap in our rural study population.ConclusionsThe study results underscore the urgent need for an effective strategy to promote low-cost hearing screening in rural US communities.

Smartphone-based National Hearing Test Launched in South Africa

Smartphone-based National Hearing Test Launched in South Africa

Characteristics of 40,000 calls to the National Hearing Test

The National Hearing Test (NHT) is a telephone-administered screen for hearing loss (Watson et al., J. Am. Acad. Audiol., 2012) that obtains thresholds for three-digit sequences in a noise background. The NHT has been validated by comparing threshold SNR values to mean pure-tone loss. During five weeks in 2014 the NHT was offered without charge to the general public. Over 40,000 calls were made after articles describing the test appeared in eight large-circulation and 19 smaller circulation newspapers, estimated to reach less than 10% of the US public. Among those who completed the test, 81% were estimated to have clinically significant loss in one or both ears. Call numbers suggested that 88% were made from landlines and the remainder from cell phones. Threshold SNRs for cell phones were about 1.0 dB higher than those for landline phones. Samples of the callers were later contacted through telephone and email surveys. Responses indicated a positive influence in terms of the likelihood of seeking further evaluation and obtaining hearing aids if advised to do so. [Research supported by the National Institute for Deafness and other Communication Disorders of the National Institutes of Health under award number 5R44DC009719.]

Deterioration of Speech Recognition Ability Over a Period of 5 Years in Adults Ages 18 to 70 Years: Results of the Dutch Online Speech-in-Noise Test.

The first aim of the present study was to determine the change in speech recognition in noise over a period of 5 years in participants ages 18 to 70 years at baseline. The second aim was to investigate whether age, gender, educational level, the level of initial speech recognition in noise, and reported chronic conditions were associated with a change in speech recognition in noise. The baseline and 5-year follow-up data of 427 participants with and without hearing impairment participating in the National Longitudinal Study on Hearing (NL-SH) were analyzed. The ability to recognize speech in noise was measured twice with the online National Hearing Test, a digit-triplet speech-in-noise test. Speech-reception-threshold in noise (SRTn) scores were calculated, corresponding to 50% speech intelligibility. Unaided SRTn scores obtained with the same transducer (headphones or loudspeakers) at both test moments were included. Changes in SRTn were calculated as a raw shift (T1 - T0) and an adjusted shift for regression towards the mean. Paired t tests and multivariable linear regression analyses were applied. The mean increase (i.e., deterioration) in SRTn was 0.38-dB signal-to-noise ratio (SNR) over 5 years (p < 0.001). Results of the multivariable regression analyses showed that the age group of 50 to 59 years had a significantly larger deterioration in SRTn compared with the age group of 18 to 39 years (raw shift: beta: 0.64-dB SNR; 95% confidence interval: 0.07-1.22; p = 0.028, adjusted for initial speech recognition level - adjusted shift: beta: 0.82-dB SNR; 95% confidence interval: 0.27-1.34; p = 0.004). Gender, educational level, and the number of chronic conditions were not associated with a change in SRTn over time. No significant differences in increase of SRTn were found between the initial levels of speech recognition (i.e., good, insufficient, or poor) when taking into account the phenomenon regression towards the mean. The study results indicate that hearing deterioration of speech recognition in noise over 5 years can also be detected in adults ages 18 to 70 years. This rather small numeric change might represent a relevant impact on an individual's ability to understand speech in everyday life.

Validation of a screening test of auditory function using the telephone.

Several European countries have demonstrated successful use of telephone screening tests for auditory function. The screening test consists of spoken three-digit sequences presented in a noise background. The speech-to-noise ratios of the stimuli are determined by an adaptive tracking method that converges on the level required to achieve 50% correct recognition. A version of the three-digit telephone screening protocol for the United States was developed: the US National Hearing Test (NHT). The objective of the current study was to determine the sensitivity and specificity as well as the feasibility of the NHT for use within the Department of Veterans Affairs (VA). Research Design and Study Sample: Using a multisite study design with convenience sampling, we used the NHT to collect data from 693 participants (1379 ears) from three geographical areas of the United States (Florida, Tennessee, and California). The NHT procedures were as follows: the participants (1) called a toll-free telephone number, (2) entered their assigned ear-specific identification code, (3) listened to 40-sets of digit triplets presented in speech-spectrum background noise, and (4) entered in the numbers that they heard on the telephone key pad. The NHT was performed on each ear, either at home or in a VA clinic. In addition to collecting data from the experimental task, we gathered demographic data and the data from other standard-of-care tests (i.e., audiometric thresholds and speech recognition tests in quiet and in noise). A total of 505 participants completed the NHT at a VA clinic, whereas 188 completed the test at home. Although the ear-specific NHT and mean pure-tone threshold all correlated significantly (p < 0.001), there were more modest correlations in the low- and high-frequency ranges with the highest correlation seen with the 2000 Hz mean pure-tone threshold. When the NHT 50% point or threshold was compared with the three-frequency PTA at 500, 1000, and 2000 Hz, the sensitivity was 0.87 and specificity was 0.54. When comparing the NHT with the four-frequency PTA at 500, 1000, 2000, and 4000 Hz, the sensitivity was 0.81 and specificity increased to 0.65. The NHT also correlated strongly with other speech-in-noise measures. The NHT was found to correlate with other audiometric measures, including pure-tone thresholds and speech recognition tests in noise, at sufficiently high correlation values to support its use as a screening test of auditory function.

The U.S. National Hearing Test, a 2013–2014 progress report

A telephone-administered screening test for sensorineural hearing loss was made publically available in the United States in September 2013. This test is similar to the digits-in-noise test developed by Smits and colleagues in the Netherlands, versions of which are now in use in most European countries and in Australia. The test was initially offered in the United States for a small fee ($8, then $4) but after a year of promotion it became clear that either the fee or the complexity of paying it was inhibiting. During the first month in which the test was subsequently offered free of charge, 31,806 calls were made to the test line, of which 26,507 were completed tests. Analyses of test performance suggest that about 81% of the test takers had at least a mild hearing loss, and 40% had a substantial loss (estimated to be in excess of 45 dB PTA). Follow-up studies are being conducted to determine whether those who failed the test sought a full-scale hearing assessment, and whether those advised to obtain hearing aids did so. [Work funded by Grant No. 5R44DC009719 from the National Institute for Deafness and other Communication Disorders.]

The relationship between hearing status and the participation in different categories of work: Demographics

To investigate the association between hearing status, socioeconomic status and work status. Cross-sectional data of 18-64 year old participants (N=1888) from the National Longitudinal Study on Hearing (NL-SH) were used. Both normal hearing and hearing impaired subjects participated. Hearing ability in noise was measured with the National Hearing test, an online speech-in-noise test. Educational level, monthly income, being primary income earner and working status (i.e. paid employment, unemployed and looking for work, unfit for work, voluntary work, household work, being a student, or taking early retirement, and the type of work contract) were assessed with a questionnaire. Logistic regression analyses were applied. Participants with poorer hearing ability were less likely to be found in the upper categories of educational level and income, having paid work > 12 hours per week, being a student, or taking early retirement. On the other hand they were more likely to look for work or to be unfit for work. No associations were found with voluntary work and household work. Hearing ability seems to be related to both socioeconomic status and being employed. Our findings underline the importance of rehabilitation programs in audiology, aimed at supporting people with hearing impairment to help them to successfully enter or re-enter the workforce.

Hearing Ability in Working Life and Its Relationship With Sick Leave and Self-Reported Work Productivity

Reduced hearing ability has been shown to influence various aspects of daily life, such as communication, psychosocial functioning, and working life. The aim of this study is to examine the association between hearing ability in noise and both sick leave and self-reported work productivity. In addition, the relationship between hearing ability and perceived health-caused limitations at work is examined. Data were collected at the baseline measurement of the Dutch "National Longitudinal Study on Hearing" and at each month during a subsequent period of 3 mo. Hearing ability was determined by means of the National Hearing Test, a speech-in-noise test over the Internet using digit triplets. The sample comprised 748 workers (385 with normal hearing ability and 363 with insufficient or poor hearing ability). Linear regression analyses revealed a significant adverse association between reduced hearing ability and self-reported absolute and differential productivity; for every dB signal-to-noise ratio (dB SNR) poorer hearing ability, self-rated absolute productivity for people experiencing little social support decreased by 0.054 points on a scale from 0 to 10 (b = -0.054; 95% confidence interval [CI] = -0.088 to -0.02). For people with less than three other chronic conditions, self-rated differential productivity also decreased significantly with decreasing hearing ability (no chronic conditions: b = -0.048 points/dB SNR on a scale from -10 to + 10, 95% CI = -0.094 to -0.001; one or two other chronic conditions: b = -0.035 points/dB SNR, 95% CI = -0.067 to -0.002). With adjustment for confounders, poorer hearing ability in noise furthermore significantly increased the odds for experiencing limitations (in the type or amount of work one could do) sometimes (odds ratio = 1.14; 95% CI = 1.07-1.21) and often to very often (odds ratio = 1.24; 95% CI = 1.05-1.45) in comparison with experiencing limitation seldom to never. A higher level of need for recovery among people with poorer hearing ability appeared to be one of the factors mediating the higher odds for sick leave of more than 5 days. Reduced hearing ability in noise was significantly associated with a lower self-reported absolute and differential productivity in specific cases. Also, poorer hearing increased the odds for experiencing health-caused limitations in the type or amount of work one can do. The significant relationship between hearing ability and sick leave, which was found when not adjusting for confounders, could partly be explained by a higher need for recovery among people with reduced hearing ability in noise.

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

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 (), 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.SumarioObjetivo: 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 () 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

The Association Between Hearing Status and Psychosocial Health Before the Age of 70 Years: Results From an Internet-Based National Survey on Hearing

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. 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. 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. 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.

How we do it: The Dutch functional hearing–screening tests by telephone and internet

Keypoints * The Dutch National Hearing Test is a reliable and very successful functional hearing-screening test by telephone. An internet version of the National Hearing Test was also implemented. * The National Hearing Test is a fully automatic adaptive speech-in-noise test that uses digit-triplets as speech material. The result of the test is given as 'good,''insufficient,' or 'poor.' * The test by telephone performs better in reaching older subjects, who are more likely to suffer from hearing loss, than the test by internet. * More than 50% of the participants who scored 'insufficient' or 'poor' followed the recommendation to visit a GP, hearing-aid dispenser, ENT specialist or Audiological Center. * The tests contribute to increase the identification and treatment of older hearing-impaired subjects.

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.

Results From the Dutch Speech-in-Noise Screening Test by Telephone

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. 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. 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. 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.