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The objective of the study was to examine the ability to understand digits in different types of noise. Adaptive speech-in-noise tests were developed that measure the speech-reception-threshold (SRTn) i.e. signal-to-noise ratio that corresponds to 50% intelligibility. Digits were presented in continuous noise, 16-Hz interrupted noise, and 32-Hz int...
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Citations
... The test-retest reliability is defined as the error of measurement, denoted by the root mean square of the within-participant standard deviation of the difference between test and retest, divided by √2 (Smits & Houtgast 2007) (Eq. [2]). ...
Objectives
The study aimed to develop and validate the Mandarin digit-in-noise (DIN) test using four digit (i.e., two-, three-, four-, and five-digit) sequences. Test-retest reliability and criterion validity were evaluated. How the number of digits affected the results was examined. The research might lead to more informed choice of DIN tests for populations with specific cognitive needs such as memory impairment.
Design
The International Collegium of Rehabilitative Audiology guideline for developing the DIN was adapted to create test materials. The test-retest reliability and psychometric function of each digit sequence were determined among young normal-hearing adults. The criterion validity of each digit sequence was determined by comparing the measured performance of older adult hearing aid users with that obtained from two other well-established sentence-in-noise tests: the Mandarin hearing-in-noise test and the Mandarin Chinese matrix test. The relation between the speech reception thresholds (SRTs) of each digit sequence of the DIN test and working memory capacity measured using the digit span test and the reading span test were explored among older adult hearing aid users. Together, the study sample consisted of 54 young normal-hearing adults and 56 older adult hearing aid users.
Results
The slopes associated with the two-, three-, four-, and five-digit DIN test were 16.58, 18.79, 20.42, and 21.09 %/dB, respectively, and the mean SRTs were −11.11, −10.99, −10.56, and −10.02 dB SNR, respectively. Test-retest SRTs did not differ by more than 0.74 dB across all digit sequences, suggesting good test-retest reliability. Spearman rank-order correlation coefficients between SRTs obtained using the DIN across the four digit (i.e., two-, three-, four-, and five-digit) sequences and the two sentence-in-noise tests were uniformly high ( r s = 0.9) across all participants, when data from all participants were considered. Results from the digit span test and reading span test correlated significantly with the results of the five-digit sequences ( r s = −0.37 and −0.42, respectively) but not with the results of the two-, three-, and four-digit sequences among older hearing aid users.
Conclusions
While the three-digit sequence was found to be appropriate for clinical use for assessment of auditory perception, the two-digit sequence could be used for hearing screening. The five-digit sequence could be difficult for older hearing aid users, and with its SRT related to working memory capacity, its use in the evaluation of speech perception should be investigated further. The Mandarin DIN test was found to be reliable, and the findings are in line with SRTs obtained using standardized sentence tests, suggesting good criterion validity.
... Dutch and English DIN tests showed no difference in steady-state noise, but the English DIN yielded significantly better scores for interrupted noise. Previously, Smits and Houtgast [29] suggested 16-Hz interrupted noise which resulted in the highest spread in SRT values is considered beneficial compared to 32-Hz interrupted noise or continuous speech-shaped noise. In contrast, speech-spectrum noise compared to multi-talker babble noise resulted in better SRT in the Persian DIN test [30]. ...
... HI listeners, especially those who have high-frequency sensorineural hearing loss, are more influenced by masking features of noise type compared to NH listeners [29,31]. Patients with high-frequency hearing loss resulted in a higher correlation with DIN than NH listeners in the interrupted noise compared to broadband noise [24]. ...
Background and objectives:
: The digits-in-noise (DIN) test was developed as a simple and time-efficient hearing-in-noise test worldwide. The Korean version of the DIN (K-DIN) test was previously validated for both normal-hearing and hearing-impaired listeners. This study aimed to explore the factors influencing the outcomes of the K-DIN test further by analyzing the threshold (representing detection ability) and slope (representing test difficulty) parameters for the psychometric curve fit.
Subjects and methods:
: In total, 35 young adults with normal hearing participated in the K-DIN test under the following four experimental conditions: 1) background noise (digit-shaped vs. pink noise); 2) gender of the speaker (male vs. female); 3) ear side (right vs. left); and 4) digit presentation levels (55, 65, 75, and 85 dB). The digits were presented using the method of constant stimuli procedure. Participant responses to the stimulus trials were used to fit a psychometric function, and the threshold and slope parameters were estimated according to pre-determined criteria. The accuracy of fit performance was determined using the root-mean-square error calculation.
Results:
: The listener's digit detection ability (threshold) was slightly better with pink noise than with digit-shaped noise, with similar test difficulties (slopes) across the digits. Gender and the tested ear side influenced neither the detection ability nor the task difficulty. Additionally, lower presentation levels (55 and 65 dB) elicited better thresholds than the higher presentation levels (75 and 85 dB); however, the test difficulty varied slightly across the presentation levels.
Conclusions:
: The K-DIN test can be influenced by stimulus factors. Continued research is warranted to understand the accuracy and reliability of the test better, especially for its use as a promising clinical measure.
... Speech audiometry in noise measures speech reception threshold (SRT) that determines a signal-to-noise ratio (SNR) at which a given ratio (commonly 50%) of the presented items (sentences, words or digits) are recognized correctly. The smaller the standard deviation of the SRT in a given item sample, the more efficient the test [51,52]. The optimization of the test consists in minimizing the SRT deviation by determining correction coefficients of item-specific SRTs so that the intelligibility of each item is similar [23]. ...
... The continuous noise was chosen from a cyclic buffer of 5 s in length containing speech-shaped noise at a pseudo-random position. The modulated noise was created from continuous noise using rectangular envelope of 20 dB depth and modulation frequency of 16 Hz [52]. A constant shift of the noise modulation relative to the digit was provided. ...
Background:
The development of the global digit-in-noise test requires optimization of each language version on a group of normal-hearing native-speakers. An alternative solution may be an adaptive optimization during ongoing tests in a group of subjects with unknown hearing impairments. The objective of the research was to compare the optimization results between these groups.
Methods:
Digit triplets consisting of three pseudo-randomly selected digits were presented in speech-shaped noise at various signal-to-noise ratios (SNRs), according to the protocol of the final speech test. Digit-specific and position-specific speech reception thresholds (SRTs) were determined and compared between groups.
Results:
The study sample consisted of 82 subjects, 26 normal-hearing subjects and 56 patients with diverse hearing disorders. Statistically significant differences in digit-specific SRTs between the control and the investigated group were obtained for three digits in continuous noise (digits 0, 4, 6; p-value of 0.04, 0.03, 0.05) and two in modulated noise (digits 1 and 6; p-value of 0.05 and 0.01). An analysis including only ears with SRTs within the range of the normal hearing control group showed no statistically significant differences between digits.
Conclusion:
Optimization of speech material can be carried out in a group of subjects with unknown hearing impairments, provided the ears with scores outside normal range are rejected.
... Both groups of CI users demonstrated a large and significant fluctuating masker benefit, 5.4 and 3.8 dB for bilateral and bimodal CI users, respectively. It is well known that normal-hearing individuals experience an improvement in speech recognition in fluctuating noise (Rhebergen et al., 2008;Smits et al., 2016;Smits and Houtgast, 2007). Hearing-impaired listeners often experience less fluctuating masker benefit than normal-hearing listeners (Bernstein and Grant, 2009;Desloge et al., 2010;. ...
Objectives
The number of bilateral adult cochlear implant (CI) users and bimodal CI users is expanding worldwide. The addition of a hearing aid (HA) in the contralateral non-implanted ear (bimodal) or a second CI (bilateral) can provide CI users with some of the benefits associated with listening with two ears. Our was to examine whether bilateral and bimodal CI users demonstrate binaural summation, binaural unmasking and a fluctuating masker benefit.
Methods
Direct audio input was used to present stimuli to 10 bilateral and 10 bimodal CochlearTM CI users. Speech recognition in noise (speech reception threshold, SRT) was assessed monaurally, diotically (identical signals in both devices) and dichotically (antiphasic speech) with different masking noises (steady-state and interrupted), using the digits-in-noise test.
Results
Bilateral CI users demonstrated a trend towards better SRTs with both CIs than with one CI. Bimodal CI users showed no difference between the bimodal SRT and the SRT for CI alone. No significant differences in SRT were found between the diotic and dichotic conditions for either group. Analyses of electrodograms created from bilateral stimuli demonstrated that substantial parts of the interaural speech cues were preserved in the Advanced Combination Encoder, an n-of-m channel selection speech coding strategy, used by the CI users. Speech recognition in noise was significantly better with interrupted noise than with steady-state masking noise for both bilateral and bimodal CI users.
Conclusion
Bilateral CI users demonstrated a trend towards binaural summation, but bimodal CI users did not. No binaural unmasking was demonstrated for either group of CI users. A large fluctuating masker benefit was found in both bilateral and bimodal CI users.
... Digits (0 to 9) have been used as stimuli in several speech perception tests (Ramkissoon et al. 2002;Wilson et al. 2005) and in clinical screening (Smits and Houtgast 2007;Ozimek et al. 2009;Smits et al. 2013;Vlaming et al. 2014). Digits are highly overlearned stimuli that are easily recognized by a wide range of people including young children (Koopmans et al. 2018) and, especially in the case of English digits, by non-native language speakers . ...
Objectives: Hearing loss is most commonly observed at high frequencies. High-frequency hearing loss (HFHL) precedes and predicts hearing loss at lower frequencies. It was previously shown that an automated, self-administered digits-in-noise (DIN) test can be sensitized for detection of HFHL by low-pass filtering the speech-shaped masking noise at 1.5 kHz. This study was designed to investigate whether sensitivity of the DIN to HFHL can be enhanced further using low-pass noise filters with higher cutoff frequencies. Design: The US-English digits 0 to 9, homogenized for audibility, were binaurally presented in different noise maskers including one broadband and three low-pass (cutoff at 2, 4, and 8 kHz) filtered speech-shaped noises. DIN-speech reception thresholds (SRTs) were obtained from 60 normal hearing (NH), and 40 mildly hearing impaired listeners with bilateral symmetric sensorineural hearing loss. Standard and extended high-frequency audiometric pure-tone averages (PTAs) were compared with the DIN-SRTs. Results: Narrower masking noise bandwidth generally produced better (more sensitive) mean DIN-SRTs. There were strong and significant correlations between SRT and PTA in the hearing impaired group. Lower frequency PTA-LF (0.5,1, 2, 4 kHz) had the highest correlation and the steepest slope with SRTs obtained from the 2-kHz filter. Higher frequency PTA-HF (4,8,10,12.5 kHz) correlated best with SRTs obtained from 4-and 8-kHz filtered noise. The 4-kHz low-pass filter also had the highest sensitivity (92%) and equally highest (with the 8-kHz filter) specificity (90%) for detecting an average PTA-HF of 20 dB or more. Conclusions: Of the filters used, DIN sensitivity to higher frequency hearing loss was greatest using the 4-kHz low-pass filter. These results suggest that low-pass filtered noise may be usefully substituted for broadband noise to improve earlier detection of HFHL using DIN.
... Digits (0 to 9) have been used as stimuli in several speech perception tests (Ramkissoon et al. 2002;Wilson et al. 2005) and in clinical screening (Smits and Houtgast 2007;Ozimek et al. 2009;Smits et al. 2013;Vlaming et al. 2014). Digits are highly overlearned stimuli that are easily recognized by a wide range of people including young children (Koopmans et al. 2018) and, especially in the case of English digits, by non-native language speakers . ...
Objectives:
Hearing loss is most commonly observed at high frequencies. High-frequency hearing loss (HFHL) precedes and predicts hearing loss at lower frequencies. It was previously shown that an automated, self-administered digits-in-noise (DIN) test can be sensitized for detection of HFHL by low-pass filtering the speech-shaped masking noise at 1.5 kHz. This study was designed to investigate whether sensitivity of the DIN to HFHL can be enhanced further using low-pass noise filters with higher cutoff frequencies.
Design:
The US-English digits 0 to 9, homogenized for audibility, were binaurally presented in different noise maskers including one broadband and three low-pass (cutoff at 2, 4, and 8 kHz) filtered speech-shaped noises. DIN-speech reception thresholds (SRTs) were obtained from 60 normal hearing (NH), and 40 mildly hearing impaired listeners with bilateral symmetric sensorineural hearing loss. Standard and extended high-frequency audiometric pure-tone averages (PTAs) were compared with the DIN-SRTs.
Results:
Narrower masking noise bandwidth generally produced better (more sensitive) mean DIN-SRTs. There were strong and significant correlations between SRT and PTA in the hearing impaired group. Lower frequency PTALF 0.5,1, 2, 4 kHz had the highest correlation and the steepest slope with SRTs obtained from the 2-kHz filter. Higher frequency PTAHF 4,8,10,12.5 kHz correlated best with SRTs obtained from 4- and 8-kHz filtered noise. The 4-kHz low-pass filter also had the highest sensitivity (92%) and equally highest (with the 8-kHz filter) specificity (90%) for detecting an average PTAHF of 20 dB or more.
Conclusions:
Of the filters used, DIN sensitivity to higher frequency hearing loss was greatest using the 4-kHz low-pass filter. These results suggest that low-pass filtered noise may be usefully substituted for broadband noise to improve earlier detection of HFHL using DIN.
... 7-2-5) embedded in speech-shaped noise. The signal-to-noise ratio (SNR) is varied adaptively to determine the listener's speech reception threshold (SRT), the SNR at which the intelligibility of triplets is 50% (Smits and Houtgast 2007;Smits, Theo Goverts, and Festen 2013;Vlaming et al. 2014). DIN tests are useful self-screening tools for many reasons. ...
... All three digits of a triplet had to be identified correctly to count as a correct response. The initial SNR level was À4 dB, about 9 dB above the mean SRT of unhomogenized digits (À13 dB, Table 1) consistent with the initial SNR level used by Smits and Houtgast (2007). The SRT was estimated as the average SNR of the final 19 of 25 total trials. ...
Objective:
The prevalence of unrecognised and late-diagnosed hearing loss is higher in low- and middle-income than in high-income countries, due in part to lack of access to hearing services. Because hearing screening is important for early identification of hearing loss, development of an accessible, self-screening test that can detect hearing loss reliably and quickly would provide significant benefits, especially for underserved populations. This study aimed to develop and validate a new version of the digits-in-noise (DIN) test for Persian speaking countries.
Design:
Recordings of Persian digits 0-9 were binaurally presented in broadband speech-shaped noise. Using fitted speech intelligibility functions, digits were homogenised to achieve equal perceptual difficulty across stimuli. The evaluation was established by reference to existing English DIN tests.
Study sample:
Thirty Persian speaking young adults with normal hearing thresholds (≤20 dB HL, 0.25-8 kHz).
Results:
Speech intelligibility functions produced a mean speech reception threshold (SRT) of -7.7 dB, corresponding closely to previously developed DIN tests. There was no significant difference between test and retest SRTs, indicating high reliability of the test. Our findings suggest that language-specific factors need to be considered for cross-language comparison of DIN-SRTs.
Conclusion:
This study introduces a convenient tool for future hearing screening in Persian speaking countries with limited access to audiology services.
... Only a few of the previous studies compared participants with and without hearing impairment but none assessed the role of the hearing threshold (11)(12)(13)(14)(15)(16). It is important to take the effect of hearing loss itself into account, as the amount of hearing loss is strongly associated with speech in noise understanding (17)(18)(19)(20). The aim of our study is to investigate whether there is an association between tinnitus and speech understanding in noise, independent of hearing loss, in a large population-based study. ...
... All frequency thresholds were < 20 dB in 11.6% of the population. The PTA 0.5-4 over the frequencies was between 20 and 50 dB for 47.9% of the population. The mean SRT n was À4.41 (SD 3.25) with a mean intratest standard deviation of 2.17 (SD 0.53). ...
... The most important factor is one's hearing acuity. The SRT is highly correlated with the pure-tone hearing threshold (17,20). Smits compared the SRT n of the DIN with sentence SRT n and found a correlation coefficient of Mean speech reception threshold-in noise (SRT n ) per stratum based on pure-tone averages (PTA) over 0.5 to 4 kHz and 2 to 8 kHz. ...
Background:
Tinnitus is a prevalent auditory disorder that frequently co-occurs with hearing loss. It is suggested that tinnitus might have negative impact on speech perception. However, studies thus far have not been able to disentangle tinnitus, hearing loss, and speech in noise intelligibility. We therefore investigated whether there is an association between tinnitus and speech understanding in noise, independent of hearing loss.
Methods:
Of 4,211 participants from the population-based Rotterdam Study (mean age 67.8 [SD 8.9], 57.3% female) data was available on tinnitus, pure-tone audiometry, and digits in noise test. We compared the speech reception threshold in noise (SRTn) in participants with and without tinnitus for the whole population as well as for subgroups stratified for average hearing threshold in 10-dB strata. Additionally, we regressed tinnitus on SRTn with a multivariable regression model, adjusting for sex, age, highest achieved education, and cognitive function.
Results:
Participants with tinnitus (20.8%) had a higher SRTn (-3.6 dB [SD 3.7] versus -4.6 dB [SD 3.1]). This difference remained only in the subgroups of participants with hearing loss, between 0.6 and 0.8 dB difference in the SRTn for the different subgroups. In the fully adjusted model tinnitus was associated with 0.2 dB (95% CI 0.00, 0.39) SRTn increase.
Conclusion:
We have shown that tinnitus is associated with speech intelligibility in noise, but it is a small effect, only found in people with co-occurring hearing loss.
... Digits (0 through 9) have been used as stimuli in several speech perception tests (29)(30)(31) and in clinical screening (5,24,(32)(33)(34). Digits are highly overlearned stimuli that are easily recognized by a wide range of people, including young children (35) and nonnative language speakers (36). ...
Significance
Understanding speech in noisy environments is an essential communication skill that varies widely between individuals and is poorly understood. We show here that extended high-frequency (EHF) hearing, beyond the currently tested range of clinical audiometry, contributes to speech perception in noise. EHF hearing loss is common in otherwise normally hearing young adults and predicts self-reported difficulty hearing speech in noise. The data suggest that EHF hearing is a long sought missing link between audiometry and speech perception and may be a sensitive predictor of age-related hearing loss much earlier in life when preventive measures can be effectively deployed.
... deviation. Across participants, e.g. for the NH and HI groups, the TRTE was calculated 217 as the standard deviation of the individual TRTEs (Smits & Houtgast, 2007). This 218 definition results in a TRTE estimate that has the same variability as the difference 219 between estimated and underlying actual threshold. ...
Objective: To investigate modifications of the Flemish Digit Triplet Test (DTT) to improve its efficiency, i.e. the use of a low-pass filtered noise and variable adaptive step sizes according to a digit scoring procedure, targeting different recognition probabilities.
Design and study sample: Speech reception thresholds (SRT) were evaluated in terms of their test-retest reliability and correlation with pure tone averages (PTA) in a group of 68 adult participants with different degrees of hearing impairment.
Results: The use of a low-pass filtered noise did not result in better test-retest reliability or an improved SRT-PTA correlation. Using digit scoring with adaptive step sizes parametrised to target a recognition probability of 79% (D79), corresponding to the recognition probability of the currently used DTT with triplet scoring and fixed adaptive step sizes of 2 dB, increased test-retest reliability. Lower recognition probabilities of 57 and 35% demonstrated worse reliability and worse SRT-PTA correlations.
Conclusions: Given the increased test-retest reliability of D79, a similar reliability as for the currently used DTT could be obtained after considerably fewer trials, leading to a profit in test duration.
