Whispered Voice Test Research Articles

Monitoring hearing and vision functions in older adults: rationale and process.

Hearing and vision impairment are highly prevalent in ageing individuals and are significant public health concerns given their meaningful impacts on individuals and society. Yet, many cases of both visual and hearing impairment remain unidentified and thus, unaddressed. This article describes the rationale and process of monitoring for visual and hearing impairment in older adults, by summarising guidance and resources available from the World Health Organisation (WHO) that were developed based upon the best current available evidence. It is recommended that vision screening be offered at least annually to adults aged over 50years and hearing screening be offered every 5years to adults aged 50-64years, and every 1-3years to adults aged 65years or older. Both hearing and vision screening can be conducted in community, home or clinical settings by trained health workers with simple equipment. More specifically, vision screening can be conducted with a simple eye chart. Hearing screening can be conducted without specialised equipment by using pure tones set to a fixed level, an automated mobile- or web-based digits-in-noise test, or the whispered voice test. Hearing screening can also be conducted in audiology clinics using pure-tone air conduction threshold testing. There exists WHO guidance to support the monitoring of hearing and vision impairment, which, when warranted, can facilitate referral for comprehensive assessment and prompt appropriate, person-centred interventions to mitigate the negative consequences of hearing and vision impairment.

Are conversation and whispered voice hearing tests comparable to pure tone audiometry for assessment of hearing loss? A retrospective analysis

BackgroundPure tone audiometry (PTA) is considered the standard method of hearing assessment. However, technical and logistical challenges preclude its usage for hearing screening at primary healthcare facilities. Free field hearing (FFH) tests such as conversation voice (CV) and whispered voice (WV) tests have been used for hearing assessment. However, their correlation to PTA and accuracy in detection of hearing loss are doubtful. This study aims to determine if FFH tests can be used for estimation of hearing thresholds. MethodsA retrospective analytical study was conducted at the otorhinolaryngology department. Spearman's correlation coefficient (ρ) was determined between FFH recognition distance and average air conduction PTA thresholds. A statistical regression model was developed to estimate hearing thresholds from the FFH recognition distance. The FFH tests were studied for their accuracy in detection of hearing loss. ResultsThe audiometric records of 437 persons (874 ears) were analysed. The CV and WV tests were found to have a high correlation (ρ = −0.757 and −0.758, respectively) with average PTA thresholds in persons with hearing loss. The WV test was found to have a 94.7% sensitivity, 90.8% specificity, 97.6% positive predictive value, 80.9% negative predictive value, and 93.9% accuracy in detection of hearing loss. ConclusionFFH tests such as WV test can be used to estimate the hearing thresholds and screen for hearing loss when audiometric tests are not logistically feasible, such as at primary-level healthcare facilities, remote locations, and in schools. However, such tests should not be regarded as a substitute to PTA.

Prevalence of Cognitive Impairment Amongst Older Adults and the Associated Risk Factors

Cognitive impairment in older adults refers to a decline in mental abilities such as memory, attention, and problem-solving, often associated with aging. This study aimed to show the prevalence of cognitive impairment among older people and examine the risk factors in acquiring the disease. This cross-sectional, community-based study was implemented between August 2022 and August 2023. The study population involved older adults (n= 400) living in urban regions aged ≥60 years. A questionnaire used to collect sociodemographic data. Further, mini mental state examination tool to assess cognitive function, activities of daily living tool to assess physical functional capacity, patient health questionnaire-9 tool to identify depressive symptoms, Snellen chart to examine visual acuity and whispered voice test to examine hearing acuity were used. Chi-square test used to investigate the association between risk factors and cognitive impairment. The prevalence of cognitive impairment was 31.25% in examined community. The risk of the disease was higher in the following participants: age group 90-100 (71.4%), female (45.9%), unemployed (47.1%), having insufficient socioeconomic level (51.2%), being illiterate (49.3%), having low hearing acuity (77.4%), having sever functional impairment (78.6%), being widowed (56.8%), living with others rather than a spouse (54.4%), having low visual acuity (33.3%), and having depressive symptoms (65.1%). The severity of cognitive impairment is statistically significantly related to age group of 90-100 years old (80%), smokers (n = 21) is mostly mild [n=9/21 (42.85%)], the decrease in hearing acuity is more frequent among those with sever cognitive impairment [n= 9/24 (37.5%)], and most of the features were of mild severity [n= 45/69 (65.2%)]. Cognitive impairment is a prevalent disease, and the risk factors are being females, unemployed, have a low socioeconomic level, illiterate, and widowed. Moreover, the disease is substantially related with increasing age, low hearing and visual acuity, depressive symptoms, and physical functional impairment.

Introducing practical tools for fit to drive assessment of the elderly: A step toward improving the health of the elderly.

Today, as age increases, the demand for independent living has increased. Since driving is one of the safest and preferred ways for the elderly to travel, paying close attention to the accurate assessment of the elderly's driving ability can prevent traffic accidents in this age group. The purpose of this study was to identify and introduce practical tools for drive assessment fitness of the elderly. This systematic review was conducted according to Cochrane methodology and reported findings according to PRISMA. The following databases were searched from PubMed, ISI web of knowledge, Scopus, ProQuest, Medlib, SID, Magiran, Iran doc, and Iran Medex based on the population intervention comparison outcome method. The total records involving 12 main tools were assessed from 26 selected records in the final evaluation. The research findings indicated the selection of seven tools in the psycho-cognitive function domain such as TMT-B, Clock Drawing Test, MAZE, Montreal Cognitive Assessment, GDS-15, MMSE, and ACE-R, three tools in the sensory function domain such as Snellen, Confrontation Visual field, and Whispered Voice Test, and also two tools in motor function domain such as Rapid pace walk, and Manual test of the range of motion. The findings led to selecting practical, accurate, and fast tools for widespread use for the assessment of driving competencies of the elderly. Therefore, it is recommended that the selected tools be used in practical batteries to assess the driving skills of the elderly.

Использование задержанной вызванной отоакустической эмиссии в качестве скринингового метода оценки слуха после воздействия шума высокой интенсивности

Hearing organ damage caused by high-intensity noise continues to be one of the actual problems of modern otorhinolaryngology. This study aims to evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAEs) as a screening method for hearing research. 15 patients (men aged 18 to 28 years) were examined before and after exposure to high-intensity noise of artillery weapons. All patients passed a set of diagnostic tests: otoscopy, whispered voice test, tonal threshold audiometry, and TEOAE. Hearing thresholds according to audiometry did not exceed normal values. However, the number of people who passed the test TEOAE after noise exposure was 46.6% in the right ear and 40.0% in the left ear, which was statistically significantly different from the data obtained before the shooting. The authors conclude that TEOAE allows evaluation of the functional state of the hearing organ better than tonal threshold audiometry. This technique can be used for mass screening of individuals who are most sensitive to the effects of high-intensity noise, as well as for their further in-depth audiological monitoring.

Technology Usage among Elderly with Self-Reported Hearing Disability: Results from InveCe.Ab

Background: Awareness of hearing disability in the elderly has adverse cognitive and functional consequences over time, in a longitudinal population-based study. Aim: To analyze the hypothesis that over time old people aware of hearing disability make less use of technology and lose more instrumental activities of daily living than peers with other self-reported hearing conditions. Methods: We analyzed 1171 healthy participants in the longitudinal population-based InveCe.Ab study. The consistency between self-reported hearing loss with clinician-evaluated hearing status (Whispered Voice Test; WVT), was categorized by consistency as: unaware of hearing loss (UHL), aware of hearing loss (AHL), only subjective hearing loss (OSHL), without hearing loss (noHL). Results: At baseline (2010), hearing loss was found in 159 [13.6% (95% CI: 11.7 - 15.7)] of the participants [28 = 17.6% (95% CI: 12.0 - 24.4) AHL; 131 = 82.4% (95% CI: 75.6 - 88) UHL], while 23 [2.3% (95% CI: 1.4 - 3.4)] of the subjects with normal WVT had OSHL. Mobile phone usage was significantly associated with different consistency categories (p i.e. executive, memory and visuo-spatial) were independently associated with maintaining mobile phone usage and instrumental activities of daily living. Conclusion: Self-reported hearing disability is linked to subsequent loss of mobile phone usage and functional dependency. As cognitive performances independently influence technology usage and functional impairment, targeted preventive interventions should address functional impact of perceived hearing loss, but also encourage social participation and improve mobile phone usage. Trial registration: ClinicalTrials.gov, NCT01345110; registered on April 29, 2011.

Hearing screenings for preschool children: A comparison between whispered voice and pure tone audiogram tests

IntroductionThis prospective study compares the efficiency of two hearing screening tests performed on preschool children. These tests are known as whispered voice test and pure tone audiometry. MethodsStandard hearing screenings were performed on five-year old children using a whispered voice test followed by ENT examination with pure tone audiometry. ResultsA total of 827 children were included in the study. Hearing loss (>25 dB) was observed in 5.8% of the evaluated children (n = 48), being bilateral in only 1.6% (n = 13) of these cases. Slight hearing impairment (hearing loss of 16–25 dB) was observed in 25.4% (n = 210) of the children, with 14.5% bilateral cases (n = 120). Interestingly, 62 children (7.5%) were under suspicion of hearing loss by their parents; however, an audiogram revealed the poor consistency of this diagnosis (sensitivity 20.8%, Cohen's kappa coefficient of 0.048). The whispered voice test (6 m distance) throwed a hearing impairment diagnosis in 807 (48.8%) of examined ears; however, its sensitivity was of only 56.5%, with a specificity of 51.6% and Cohen's kappa coefficient of 0.0254 (poor). ConclusionThe hearing loss incidence in preschool children coupled with the low efficacy of whispered voice tests and the parents’ unreliability during the hearing impairment survey advocate for a more efficient audiometric hearing screening before beginning school attendance.

Facial nerve palsy in acute otitis media – case study

The hearing and balance organ maintains human spatial orientation as well as the ability to localize and discriminate individual sounds. Without properly functioning hearing organ, it would be impossible to develop speech, which is a mean of communication and social interaction. Therefore, it is important to observe the condition of particular senses, including hearing, and in case of disturbing symptoms or accidents causing damage, contact a specialist. This will enable early diagnosis and intervention. Sound is received by human organism through the conductive and receiving parts of the hearing organ. It is important to determine which part of hearing organ is impaired, since the procedure for receiving and conductive hearing loss is different. Precise diagnosis may determine the location of hearing damage. The basic element of diagnostics is case history. Further, a complex laryngological examination is conducted. The next step is the examination of the patient with appropriate subjective tests (Weber tests, distraction test, whispered voice test) and objective tests (OAE, tympanometry, brainstem auditory evoked potentials). These tests indicate the location and extent of hearing damage and also suggest the appropriate treatment for the individual patient. Acute otitis media is a condition that mainly affects children, but it also occurs in adults – more often men. It is usually caused by viral and bacterial infections of the upper respiratory tract. Characteristic is the sudden onset of discomfort, exudation in the tympanic cavity, along with ear pain and inflammation. Acute otitis media may lead to complications such as facial nerve palsy, tympanosclerosis, labyrinthitis, mastoiditis, and brain abscess.

The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature

IntroductionCommunity health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world....

Adverse effect of self-reported hearing disability in elderly Italians: Results from the InveCe.Ab study

ObjectiveHearing loss is a common chronic condition in elderly people. The prevalence of disabling hearing loss among the elderly worldwide is 33% and in Italy ranges from 0.6% (profound hearing loss) to 39% (mild hearing loss). We investigated the relationship between self-reported hearing disability and clinician-evaluated hearing status, and its longitudinal consequences in relation to cognitive impairment and functional decline. We hypothesised that subjects who report that they have a hearing disability have a worse functional and cognitive profile than people who do not report having a hearing disability. MethodsWe analysed 1171 participants in the InveCe.Ab study, a longitudinal population-based study. We evaluated whether self-reported hearing disability was consistent with clinician-evaluated hearing status (using the Whispered Voice Test; WVT), categorizing this variable as: unaware of hearing loss (UHL), aware of hearing loss (AHL), only subjective hearing loss (OSHL), without hearing loss (noHL). We also examined its relationship with various population characteristics, and its long-term effects on functional and cognitive performance and depressive symptoms. ResultsAt baseline, hearing loss was found in 13.6% (95% CI: 11.7–15.7) of the participants [17.6% (95% CI: 12.0–24.4) AHL; 82.4% (95% CI: 75.6–88) UHL], while 2.3% (95% CI: 1.4–3.4) of the subjects with normal WVT hearing status had OSHL. Male gender, age, functional and cognitive performance, and depressive symptoms were associated with consistency between self-reported hearing disability and WVT hearing status. Longitudinal analysis revealed worsening functional performance and selective attention, global cognitive deterioration, and depressive symptoms in the AHL group. ConclusionsOur results showed that awareness of hearing disability in the elderly has adverse cognitive and functional consequences over time. When clinicians inform those who are unaware of their hearing problems, they should arrange for prompt referral not only for audiometric evaluation but also for counselling in order to prevent a negative impact of awareness of hearing loss.

Exposure to tobacco smoke prenatally and during infancy and risk of hearing impairment among children in Japan: A retrospective cohort study.

Previous studies of the association between tobacco smoke and hearing loss in children are limited, involve small samples and are cross-sectional. We investigated the association of maternal smoking during pregnancy and exposure to tobacco smoke at age 4months with hearing impairment at age 3years in children. This population-based retrospective cohort study included 50734 children born between 2004 and 2010 in Kobe City, Japan. Smoking during pregnancy and exposure to tobacco smoke at 4months was measured using parent-reported questionnaires. Hearing impairment was determined by the whispered voice test. Of the included children, 3.8% were exposed to smoking only during pregnancy; 3.9% were exposed only to second-hand smoke at 4months; and 0.9% were exposed to tobacco smoke during pregnancy and at 4months. The prevalence of hearing impairment at age 3years was 4.6%. Compared with children not exposed to tobacco smoke prenatally and at 4months, the risk of hearing impairment was elevated in children exposed to only maternal past smoking during pregnancy (RR 1.26, 95% CI 1.13, 1.40), only second-hand smoke at 4months (RR 1.30, 95% CI 1.07, 1.56), only smoking during pregnancy (RR 1.68, 95% CI 1.42, 2.00) and smoking during pregnancy and second-hand smoke at 4months (RR 2.35, 95% CI 1.79, 3.10). Exposure to tobacco smoke prenatally and postnatally was associated with hearing impairment in children. A prevention of smoking before and during pregnancy and exposure to second-hand smoke postnatally may reduce hearing impairment risk in children.

Screening of hearing in elderly people: assessment of accuracy and reproducibility of the whispered voice test.

Given the high prevalence of presbycusis and its detrimental effect on quality of life, screening tests can be useful tools for detecting hearing loss in primary care settings. This study therefore aimed to determine the accuracy and reproducibility of the whispered voice test as a screening method for detecting hearing impairment in older people. This cross-sectional study was carried out with 210 older adults aged between 60 and 97 years who underwent the whispered voice test employing ten different phrases and using audiometry as a reference test. Sensitivity, specificity and positive and negative predictive values were calculated and accuracy was measured by calculating the area under the ROC curve. The test was repeated on 20% of the ears by a second examiner to assess inter-examiner reproducibility (IER). The words and phrases that showed the highest area under the curve (AUC) and IER values were: "shoe" (AUC = 0.918; IER = 0.877), "window" (AUC = 0.917; IER = 0.869), "it looks like it's going to rain" (AUC = 0.911; IER = 0.810), and "the bus is late" (AUC = 0.900; IER = 0.810), demonstrating that the whispered voice test is a useful screening tool for detecting hearing loss among older people. It is proposed that these words and phrases should be incorporated into the whispered voice test protocol.

Detection of Hearing Impairment in Patients with Subjective Complaints of Hearing Loss using the Whispered Voice Test and Standard Pure Tone Audiometry: A Prospective Non-Randomized Trial

Background: Standard tools for the detection of hearing impairment have limitations because access to specialists and audiometric evaluation is not always possible. These require time, training, and technology that are not available in the primary care setting. The WVT is a simple screening tool that has been tested in adults and children however, it lacks standardization, compromising its application. Objectives: To determine the accuracy of the WVT compared to standard PTA in detecting hearing impairment in patients with subjective complaints of hearing loss and to determine the association of PTA and WVT to age as well as to each other. Keywords: whispered voice test, pure tone audiometry, hearing screening, sensitivity, specificity, accuracy, diagnosis, hearing loss

Hearing Loss and Risk of Mild Cognitive Impairment and Dementia: Findings from the Singapore Longitudinal Ageing Study

Aim: To investigate the associations between hearing loss and prevalent and incident mild cognitive impairment (MCI), dementia and MCI or dementia (all cases). Methods: Cross-sectional and longitudinal analyses of baseline and follow-up data were performed in a population-based cohort. The baseline sample of 2,599 adults aged ≥55 included 1,515 cognitively normal subjects who were followed up to 8 years. Hearing loss at baseline was determined by the whispered voice test, and MCI and dementia by Mini-Mental State Examination screening, Clinical Dementia Rating scale, neurocognitive tests, MRI, and panel consensus diagnosis. Results: Hearing impairment was associated with increased prevalence of dementia (odds ratio = 3.63, 95% confidence interval [CI] 1.16-11.4, p = 0.027) but not MCI alone or all cases of MCI or dementia, adjusted for sex, age, ethnicity, education, central obesity, hypertension, diabetes, dyslipidemia, smoking, alcohol, leisure time activity, cardiac diseases, and depressive symptoms. Among participants who were cognitively normal at baseline, those with hearing impairment were more likely to develop MCI or dementia (hazard ratio [HR] = 2.30, 95% CI 1.08-4.92, p = 0.032). Hearing loss was associated with elevated but statistically nonsignificant estimates of adjusted HR (1.85, 95% CI 0.78-4.40) for incident MCI alone. Conclusions: Hearing loss is independently associated with prevalent dementia and incident MCI or dementia.

Does COPD have a clinically relevant impact on hearing loss? A retrospective matched cohort study with selection of patients diagnosed with COPD

ObjectivesChronic obstructive pulmonary disease (COPD) as a multisystemic disease has a measurable and biologically explainable impact on the auditory function detectable in the laboratory. This study tries to clarify if...

Assessing potential risks of treatment with long-term azithromycin in COPD patients: long-term oxygen users beware?

Long-term daily azithromycin therapy reduces the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) in a randomized controlled clinical trial setting. Concerns exist regarding arrhythmic and auditory toxicities from chronic use in the real-world setting. We hypothesized that risk factors for adverse drug reactions to azithromycin would be more frequent than previously reported, that certain specific subgroups would have different frequencies of these risk factors and that the whispered voice test would be a useful test with which to test for hearing deficits. Following ethical approval, 47 consecutive hospital-based patients with a mean age 69 years±8.2, and with physician-diagnosed COPD (mean FEV1 45.1±18% predicted), were screened for subjective hearing impairment (screening questions and whispered voice test) and by electrocardiogram for prolonged QTc. Other potential risk factors and contraindications to long-term daily azithromycin were sought. In total, 38 patients (80.9%) had at least one risk factor or contraindication to azithromycin treatment. 19 patients (40.4% of total) had subjective hearing impairment. 17 (36.1%) had prolonged QTc intervals. 4 patients (8.51%) had contraindicating co-morbidities. Those on long-term oxygen therapy were significantly more likely to have at least one risk factors or contraindications to azithromycin (p=0.0025). In a COPD population who would otherwise potentially be candidates for long-term daily azithromycin therapy, over 80% had risk factors for complications from long-term daily azithromycin. Preventative treatment with long-term daily azithromycin may be appropriate for fewer COPD patients than previously thought, especially in those on long-term oxygen therapy.

Validation of the self-reported hearing questions in the Irish Longitudinal Study on Ageing against the Whispered Voice Test.

BackgroundSelf report questions are often used in population studies to assess sensory efficacy and decline. These questions differ in their validity in assessing sensory impairment depending on the wording of the question and the characteristics of the population. We tested the validity of the self-report questions on hearing efficacy (self reported hearing, ability in following a conversation, use of a telephone and use of hearing aids) used in The Irish Longitudinal Study on Ageing (TILDA).MethodsWe tested sensitivity and specificity, positive and negative predictive values of each question against the Whispered Voice Test, a relatively easy to administer and cost effective alternative to the standard audiometric test.ResultsIn this population the question ‘Is your hearing (with or without a hearing appliance)/ Excellent/Very Good/Good/Fair/Poor?’ showed the best diagnostic value in relation to the other questions (sensitivity 55.56% and specificity 94.67%). The question ‘Can you use a normal telephone?’ was deemed ineffective because of a very poor sensitivity (5.56%) and was proposed for exclusion from subsequent waves of TILDA.ConclusionsWe showed that this validity check was useful to select the questions that most effectively assess hearing deficits and provided crucial information for the subsequent waves. We argue that longitudinal studies using self-reports of sensory efficacy would benefit from a similar check.

Stability of physical assessment of older drivers over 1 year

Older adults represent the fastest-growing population of drivers with a valid driver's licence. Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability. Determining the reliability of physical measures used to assess older drivers’ functional ability is important to identifying those who are safe to continue driving. Most previous reliability studies of clinical physical measures of health used test–retest intervals shorter than those between patient visits with a clinician. In the present study we examined a more clinically representative interval of 1 year to determine the stability of commonly used physical measures collected during the Candrive II prospective cohort study of older drivers. Reliability statistics indicate that the sequential finger–thumb opposition, rapid pace walk and the Pelli–Robson contrast sensitivity tests have adequate stability over 1 year. Poor stability was observed for the one-legged stance and Snellen visual acuity test. Several assessments with nominal data (Marottoli method [functional neck range of motion], whispered voice test, range of motion and strength testing) lacked sufficient variability to conduct reliability analyses; however, a lack of variability between test days suggests consistency over a 1-year time frame. Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year.

The effect of experience on the sensitivity and specificity of the whispered voice test: a diagnostic accuracy study

ObjectivesTo determine the sensitivity and specificity of the whispered voice test (WVT) in detecting hearing loss when administered by practitioners with different levels of experience.DesignDiagnostic accuracy study of WVT, through...

Review: self report of hearing loss and the whispered voice test are useful for screening for hearing impairment

Review: self report of hearing loss and the whispered voice test are useful for screening for hearing impairment