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BACKGROUND: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest. OBJECTIVE: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. METHODS: In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. RESULTS: The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. CONCLUSIONS: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps.
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Perda Auditiva , Aplicativos Móveis , Telemedicina , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Perda Auditiva/reabilitação , Perda Auditiva/psicologia , Estudos Longitudinais , Idoso , Estudos Transversais , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Auxiliares de AudiçãoRESUMO
OBJECTIVE: Smartphone-based self-testing could facilitate large-scale data collection and remote diagnostics. For this purpose, the matrix sentence test (MST) is an ideal candidate due to its repeatability and accuracy. In clinical practice, the MST requires professional audiological equipment and supervision, which is infeasible for smartphone-based self-testing. Therefore, it is crucial to investigate the feasibility of self-administering the MST on smartphones, including the development of an appropriate user interface for the small screen size. DESIGN: We compared the traditional closed matrix user interface (10 × 5 matrix) to three alternative, newly-developed interfaces (slide, type, wheel) regarding SRT consistency, user preference, and completion time. STUDY SAMPLE: We included 15 younger normal hearing and 14 older hearing-impaired participants in our study. RESULTS: The slide interface is most suitable for mobile implementation, providing consistent and fast SRTs and enabling all participants to perform the tasks effectively. While the traditional matrix interface works well for most participants, some participants experienced difficulties due to its small size on the screen. CONCLUSIONS: We propose the newly-introduced slide interface as a plausible alternative for smartphone screens. This might be more attractive for elderly patients that may exhibit more challenges with dexterity and vision than our test subjects employed here.
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Objectives: Investigate factors contributing to the effective management of age-related hearing loss (ARHL) rehabilitation. Methods: A systematic review was conducted following PRISMA guidelines. The protocol was registered in PROSPERO (CRD42022374811). Articles were identified through systematic searches in the Scopus, PubMed, Web of Science, and Cochrane databases in May 2024. Only articles published between January 2005 and May 2024 were included. Studies were assessed for eligibility by two independent researchers and evaluated using the Crowe Critical Appraisal Tool v1.4 (CCAT). Results: Of the 278 articles identified, 54 were included. Three factors explain effective HA use. First, hearing aid signal processing, with directional microphones and noise reduction, improves user comfort and understanding regarding noise. Second, there is hearing aid fitting, with the NAL prescription rules as the gold standard, and bilateral, high-level HA performance for spatial localization and noise comprehension. Third, there is a patient-centered approach, using patient-related outcome measures (PROMs), questionnaires, counseling, and regular follow-up to involve patients in their therapeutic rehabilitation. Conclusions: Reaching a consensus on acoustic parameters is challenging due to variability in audiological results. Involving patients in their rehabilitation, addressing their needs and expectations, and offering individualized care are crucial.
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For characterizing the complexity of hearing deficits, it is important to consider different aspects of auditory functioning in addition to the audiogram. For this purpose, extensive test batteries have been developed aiming to cover all relevant aspects as defined by experts or model assumptions. However, as the assessment time of physicians is limited, such test batteries are often not used in clinical practice. Instead, fewer measures are used, which vary across clinics. This study aimed at proposing a flexible data-driven approach for characterizing distinct patient groups (patient stratification into auditory profiles) based on one prototypical database (N = 595) containing audiogram data, loudness scaling, speech tests, and anamnesis questions. To further maintain the applicability of the auditory profiles in clinical routine, we built random forest classification models based on a reduced set of audiological measures which are often available in clinics. Different parameterizations regarding binarization strategy, cross-validation procedure, and evaluation metric were compared to determine the optimum classification model. Our data-driven approach, involving model-based clustering, resulted in a set of 13 patient groups, which serve as auditory profiles. The 13 auditory profiles separate patients within certain ranges across audiological measures and are audiologically plausible. Both a normal hearing profile and profiles with varying extents of hearing impairments are defined. Further, a random forest classification model with a combination of a one-vs.-all and one-vs.-one binarization strategy, 10-fold cross-validation, and the kappa evaluation metric was determined as the optimal model. With the selected model, patients can be classified into 12 of the 13 auditory profiles with adequate precision (mean across profiles = 0.9) and sensitivity (mean across profiles = 0.84). The proposed approach, consequently, allows generating of audiologically plausible and interpretable, data-driven clinical auditory profiles, providing an efficient way of characterizing hearing deficits, while maintaining clinical applicability. The method should by design be applicable to all audiological data sets from clinics or research, and in addition be flexible to summarize information across databases by means of profiles, as well as to expand the approach toward aided measurements, fitting parameters, and further information from databases.
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For supporting clinical decision-making in audiology, Common Audiological Functional Parameters (CAFPAs) were suggested as an interpretable intermediate representation of audiological information taken from various diagnostic sources within a clinical decision-support system (CDSS). Ten different CAFPAs were proposed to represent specific functional aspects of the human auditory system, namely hearing threshold, supra-threshold deficits, binaural hearing, neural processing, cognitive abilities, and a socio-economic component. CAFPAs were established as a viable basis for deriving audiological findings and treatment recommendations, and it has been demonstrated that model-predicted CAFPAs, with machine learning models trained on expert-labeled patient cases, are sufficiently accurate to be included in a CDSS, but it requires further validation by experts. The present study aimed to validate model-predicted CAFPAs based on previously unlabeled cases from the same data set. Here, we ask to which extent domain experts agree with the model-predicted CAFPAs and whether potential disagreement can be understood in terms of patient characteristics. To these aims, an expert survey was designed and applied to two highly-experienced audiology specialists. They were asked to evaluate model-predicted CAFPAs and estimate audiological findings of the given audiological information about the patients that they were presented with simultaneously. The results revealed strong relative agreement between the two experts and importantly between experts and the prediction for all CAFPAs, except for the neural processing and binaural hearing-related ones. It turned out, however, that experts tend to score CAFPAs in a larger value range, but, on average, across patients with smaller scores as compared with the machine learning models. For the hearing threshold-associated CAFPA in frequencies smaller than 0.75 kHz and the cognitive CAFPA, not only the relative agreement but also the absolute agreement between machine and experts was very high. For those CAFPAs with an average difference between the model- and expert-estimated values, patient characteristics were predictive of the disagreement. The findings are discussed in terms of how they can help toward further improvement of model-predicted CAFPAs to be incorporated in a CDSS for audiology.
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Common Audiological Functional Parameters (CAFPAs) were previously introduced as abstract, measurement-independent representation of audiological knowledge, and expert-estimated CAFPAs were shown to be applicable as an interpretable intermediate layer in a clinical decision support system (CDSS). Prediction models for CAFPAs were built based on expert knowledge and one audiological database to allow for data-driven estimation of CAFPAs for new, individual patients for whom no expert-estimated CAFPAs are available. Based on the combination of these components, the current study explores the feasibility of constructing a CDSS which is as interpretable as expert knowledge-based classification and as data-driven as machine learning-based classification. To test this hypothesis, the current study investigated the equivalence in performance of predicted CAFPAs compared to expert-estimated CAFPAs in an audiological classification task, analyzed the importance of different CAFPAs for high and comparable performance, and derived explanations for differences in classified categories. Results show that the combination of predicted CAFPAs and statistical classification enables to build an interpretable but data-driven CDSS. The classification provides good accuracy, with most categories being correctly classified, while some confusions can be explained by the properties of the employed database. This could be improved by including additional databases in the CDSS, which is possible within the presented framework.
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OBJECTIVE: A model-based determination of the average supra-threshold ("distortion") component of hearing impairment which limits the benefit of hearing aid amplification. DESIGN: Published speech recognition thresholds (SRTs) were predicted with the framework for auditory discrimination experiments (FADE), which simulates recognition processes, the speech intelligibility index (SII), which exploits frequency-dependent signal-to-noise ratios (SNR), and a modified SII with a hearing-loss-dependent band importance function (PAV). Their attenuation-component-based prediction errors were interpreted as estimates of the distortion component. STUDY SAMPLE: Unaided SRTs of 315 hearing-impaired ears measured with the German matrix sentence test in stationary noise. RESULTS: Overall, the models showed root-mean-square errors (RMSEs) of 7 dB, but for steeply sloping hearing loss FADE and PAV were more accurate (RMSE = 9 dB) than the SII (RMSE = 23 dB). Prediction errors of FADE and PAV increased linearly with the average hearing loss. The consideration of the distortion component estimate significantly improved the accuracy of FADE's and PAV's predictions. CONCLUSIONS: The supra-threshold distortion component-estimated by prediction errors of FADE and PAV-seems to increase with the average hearing loss. Accounting for a distortion component improves the model predictions and implies a need for effective compensation strategies for supra-threshold processing deficits with increasing audibility loss.
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Auxiliares de Audição , Perda Auditiva Neurossensorial , Perda Auditiva , Percepção da Fala , Limiar Auditivo , Perda Auditiva/diagnóstico , Humanos , Inteligibilidade da FalaRESUMO
Latent Variable Models (LVMs) are well established tools to accomplish a range of different data processing tasks. Applications exploit the ability of LVMs to identify latent data structure in order to improve data (e.g., through denoising) or to estimate the relation between latent causes and measurements in medical data. In the latter case, LVMs in the form of noisy-OR Bayes nets represent the standard approach to relate binary latents (which represent diseases) to binary observables (which represent symptoms). Bayes nets with binary representation for symptoms may be perceived as a coarse approximation, however. In practice, real disease symptoms can range from absent over mild and intermediate to very severe. Therefore, using diseases/symptoms relations as motivation, we here ask how standard noisy-OR Bayes nets can be generalized to incorporate continuous observables, e.g., variables that model symptom severity in an interval from healthy to pathological. This transition from binary to interval data poses a number of challenges including a transition from a Bernoulli to a Beta distribution to model symptom statistics. While noisy-OR-like approaches are constrained to model how causes determine the observables' mean values, the use of Beta distributions additionally provides (and also requires) that the causes determine the observables' variances. To meet the challenges emerging when generalizing from Bernoulli to Beta distributed observables, we investigate a novel LVM that uses a maximum non-linearity to model how the latents determine means and variances of the observables. Given the model and the goal of likelihood maximization, we then leverage recent theoretical results to derive an Expectation Maximization (EM) algorithm for the suggested LVM. We further show how variational EM can be used to efficiently scale the approach to large networks. Experimental results finally illustrate the efficacy of the proposed model using both synthetic and real data sets. Importantly, we show that the model produces reliable results in estimating causes using proofs of concepts and first tests based on real medical data and on images.
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OBJECTIVE: As a step towards the development of an audiological diagnostic supporting tool employing machine learning methods, this article aims at evaluating the classification performance of different audiological measures as well as Common Audiological Functional Parameters (CAFPAs). CAFPAs are designed to integrate different clinical databases and provide abstract representations of measures. DESIGN: Classification and evaluation of classification performance in terms of sensitivity and specificity are performed on a data set from a previous study, where statistical models of diagnostic cases were estimated from expert-labelled data. STUDY SAMPLE: The data set contains 287 cases. RESULTS: The classification performance in clinically relevant comparison sets of two competing categories was analysed for audiological measures and CAFPAs. It was found that for different audiological diagnostic questions a combination of measures using different weights of the parameters is useful. A set of four to six measures was already sufficient to achieve maximum classification performance which indicates that the measures contain redundant information. CONCLUSIONS: The current set of CAFPAs was confirmed to yield in most cases approximately the same classification performance as the respective optimum set of audiological measures. Overall, the concept of CAFPAs as compact, abstract representation of auditory deficiencies is confirmed.
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Audiologia , Bases de Dados Factuais , Humanos , Aprendizado de Máquina , Modelos Estatísticos , Sensibilidade e EspecificidadeRESUMO
Objective: Statistical knowledge about many patients could be exploited using machine learning to provide supporting information to otolaryngologists and other hearing health care professionals, but needs to be made accessible. The Common Audiological Functional Parameters (CAFPAs) were recently introduced for the purpose of integrating data from different databases by providing an abstract representation of audiological measurements. This paper aims at collecting expert labels for a sample database and to determine statistical models from the labelled data set.Design: By an expert survey, CAFPAs as well as labels for audiological findings and treatment recommendations were collected for patients from the database of Hörzentrum Oldenburg.Study sample: A total of 287 single patient cases were assessed by twelve highly experienced audiological experts.Results: The labelled data set was used to derive probability density functions for categories given by the expert labels. The collected data set is suitable for estimating training distributions due to realistic variability contained in data for different, distinct categories. Suitable distribution functions were determined. The derived training distributions were compared regarding different audiological questions.Conclusions: The method-expert survey, sorting data into categories, and determining training distributions - could be extended to other data sets, which could then be integrated via the CAFPAs and used in a classification task.
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Audiologia/estatística & dados numéricos , Correção de Deficiência Auditiva/estatística & dados numéricos , Conjuntos de Dados como Assunto , Sistemas Inteligentes , Modelos Estatísticos , Interpretação Estatística de Dados , Bases de Dados Factuais , Testes Auditivos/estatística & dados numéricos , Humanos , Probabilidade , Reprodutibilidade dos TestesRESUMO
The application of machine learning for the development of clinical decision-support systems in audiology provides the potential to improve the objectivity and precision of clinical experts' diagnostic decisions. However, for successful clinical application, such a tool needs to be accurate, as well as accepted and trusted by physicians. In the field of audiology, large amounts of patients' data are being measured, but these are distributed over local clinical databases and are heterogeneous with respect to the applied assessment tools. For the purpose of integrating across different databases, the Common Audiological Functional Parameters (CAFPAs) were recently established as abstract representations of the contained audiological information describing relevant functional aspects of the human auditory system. As an intermediate layer in a clinical decision-support system for audiology, the CAFPAs aim at maintaining interpretability to the potential users. Thus far, the CAFPAs were derived by experts from audiological measures. For designing a clinical decision-support system, in a next step the CAFPAs need to be automatically derived from available data of individual patients. Therefore, the present study aims at predicting the expert generated CAFPA labels using three different machine learning models, namely the lasso regression, elastic nets, and random forests. Furthermore, the importance of different audiological measures for the prediction of specific CAFPAs is examined and interpreted. The trained models are then used to predict CAFPAs for unlabeled data not seen by experts. Prediction of unlabeled cases is evaluated by means of model-based clustering methods. Results indicate an adequate prediction of the ten distinct CAFPAs. All models perform comparably and turn out to be suitable choices for the prediction of CAFPAs. They also generalize well to unlabeled data. Additionally, the extracted relevant features are plausible for the respective CAFPAs, facilitating interpretability of the predictions. Based on the trained models, a prototype of a clinical decision-support system in audiology can be implemented and extended towards clinical databases in the future.
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OBJECTIVE: As a step towards objectifying audiological rehabilitation and providing comparability between different test batteries and clinics, the Common Audiological Functional Parameters (CAFPAs) were introduced as a common and abstract representation of audiological knowledge obtained from diagnostic tests. DESIGN: Relationships between CAFPAs as an intermediate representation between diagnostic tests and audiological findings, diagnoses and treatment recommendations (summarised as "diagnostic cases") were established by means of an expert survey. Expert knowledge was collected for 14 given categories covering different diagnostic cases. For each case, the experts were asked to indicate expected ranges of diagnostic test outcomes, as well as traffic light-encoded CAFPAs. STUDY SAMPLE: Eleven German experts in the field of audiological rehabilitation from Hanover and Oldenburg participated in the survey. RESULTS: Audiological findings or treatment recommendations could be distinguished by a statistical model derived from the experts' answers for CAFPAs as well as audiological tests. CONCLUSIONS: The CAFPAs serve as an abstract, comprehensive representation of audiological knowledge. If more detailed information on certain functional aspects of the auditory system is required, the CAFPAs indicate which information is missing. The statistical graphical representations for CAFPAs and audiological tests are suitable for audiological teaching material; they are universally applicable for real clinical databases.