Neonatal hearing screening - does failure in TEOAE screening matter when the AABR test is passed?

PURPOSE: Newborns who fail the transient evoked otoacoustic emissions (TEOAE) but pass the automatic auditory brainstem response (AABR) in universal newborn hearing screening (UNHS), frequently have no further diagnostic test or follow-up. The present study aimed to investigate whether hearing loss might be missed by ignoring neonatal TEOAE failure in the presence of normal AABR. METHODS: A retrospective analysis was conducted in newborns presenting between 2017 and 2021 to a tertiary referral centre due to failure in the initial UNHS. The main focus was on infants who failed TEOAE tests, but passed AABR screening. The clinical characteristics and audiometric outcomes were analysed and compared with those of other neonates. RESULTS: Among 1,095 referred newborns, 253 (23%) failed TEOAE despite passing AABR screening. Of the 253 affected infants, 154 returned for follow-up. At 1-year follow-up, 46 (28%) achieved normal audiometric results. 32 (21%) infants had permanent hearing loss (HL) confirmed by diagnostic ABR, 58 (38%) infants had HL solely due to middle ear effusion (MEE), and for 18 (12%) infants HL was suspected without further differentiation. The majority of permanent HL was mild (78% mild vs. 13% moderate vs. 9% profound). The rate of spontaneous MEE clearance was rather low (29%) leading to early surgical intervention in 36 children. The profile of the risk factors for hearing impairment was similar to that of newborns with failure in both, TEOAE and AABR; however, there was a stronger association between the presence of risk factors and the incidence of HL (relative risk 1.55 vs. 1.06; odds ratio 3.61 vs. 1.80). CONCLUSION: In newborns, the discordance between a "refer" in TEOAE and a "pass" in AABR screening is associated with a substantial prevalence of hearing impairment at follow-up, especially in the presence of risk factors.

Establishment of self-reported hearing cut-off value on the Chinese version of short form of speech, spatial and qualities of hearing scale (SSQ12).

OBJECTIVE: The aim of this study was to evaluate the efficacy of the Chinese version of Speech, Spatial and Qualities of Hearing Scale (C-SSQ12) in the Chinese Mandarin-speaking population and to determine its screening cut-off value by comparing measured pure-tone average (PTA), the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) scores and C-SSQ12 scores. DESIGN: All participants completed the C-SSQ12 questionnaire and underwent the pure-tone audiometry. Older subjects aged ≧ 60 years completed the HHIE-S questionnaire. The optimal cut-off value for the C-SSQ12 as a hearing screening tool was calculated by comparing different cut-offs and hearing thresholds. STUDY SAMPLE: A total of 300 subjects were recruited. RESULTS: There was a negative correlation between C-SSQ12 scores and HHIE-S scores (r = -0.749). C-SSQ12 scores were negatively correlated with PTA (r = -0.507; r = -0.542). The best cut-off value for the C-SSQ12 was 6.0, with a sensitivity of 78.2%, specificity of 80.3%, positive predictive value of 63.7% and negative predictive value of 97.0% (PTA > 40dBHL for bilateral ears). CONCLUSIONS: Compared to mild hearing loss, the C-SSQ12 is a reliable and validated hearing screening tool with increased sensitivity for detecting moderate-to-severe hearing loss.

Digits in noise testing in a multilingual sample of Asian adults.

OBJECTIVE: Appropriate speech-in noise assessment is challenging in multilingual populations. This study aimed to assess whether first preferred language affected performance on an English Digits-in-noise (DIN) test in the local Asian multilingual population, controlling for hearing threshold, age, sex, English fluency and educational status. A secondary aim was to determine the association between DIN test scores and hearing thresholds. DESIGN: English digit-triplets in noise testing and pure-tone audiometry were conducted. Multiple regression analysis was performed with DIN scores and hearing thresholds as dependent variables. Correlation analysis was performed between DIN-SRT and hearing thresholds. STUDY SAMPLE: 165 subjects from the Singapore Longitudinal Ageing Study, a population-based longitudinal study of community-dwellers over 55 years of age. RESULTS: Mean DIN speech reception threshold (DIN-SRT) was -5.7 dB SNR (SD 3.6; range 6.7 to -11.2). Better ear pure tone average and English fluency were significantly associated with DIN-SRT. CONCLUSIONS: DIN performance was independent of first preferred language in a multilingual ageing Singaporean population after adjusting for age, gender and education. Those with poorer English fluency had a significantly lower DIN-SRT score. The DIN test has the potential to provide a quick, uniform method of testing speech in noise in this multilingual population.

Acoustic reflexes: should we be paying more attention?

OBJECTIVE: The clinical audiology test battery often involves playing physically simple sounds with questionable ecological value to the listener. In this technical report, we revisit how valid this approach is using an automated, involuntary auditory response; the acoustic reflex threshold (ART). DESIGN: The ART was estimated four times in each individual in a quasi-random ordering of task conditions. The baseline condition (referred to as Neutral) measured the ART following a standard clinical practice. Three experimental conditions were then used in which a secondary task was performed whilst the reflex was measured: auditory attention, auditory distraction and visual distraction tasks. STUDY SAMPLE: Thirty-eight participants (27 males) with a mean age of 23 years were tested. All participants were audiometrically healthy. RESULTS: The ART was elevated when a visual task was performed at the same time as the measurements were taken. Performing an auditory task did not affect the ART. CONCLUSIONS: These data indicate that simple audiometric measures widely used in the clinic, can be affected by central, non-auditory processes even in healthy, normal-hearing volunteers. The role of cognition and attention on auditory responses will become ever more important in the coming years.

Modelling the cost-effectiveness of a newborn hearing screening programme; usability and pitfalls.

OBJECTIVE: The EUSCREEN project concerns the study of European vision and hearing screening programmes. Part of the project was the development of a cost-effectiveness model to analyse such programmes. We describe the development and usability of an online tool to enable stakeholders to design, analyse or modify a newborn hearing screening (NHS) programme. DESIGN: Data from literature, from existing NHS programmes, and observations by users were used to develop and refine the tool. Required inputs include prevalence of the hearing impairment, test sequence and its timing, attendance, sensitivity, and specificity of each screening step. Outputs include the number of cases detected and the costs of screening and diagnostics. STUDY SAMPLE: Eleven NHS programmes with reliable data. RESULTS: Three analyses are presented, exploring the effect of low attendance, number of screening steps, testing in the maternity ward, or screening at a later age, on the benefits and costs of the programme. Knowledge of the epidemiology of a staged screening programme is crucial when using the tool. CONCLUSIONS: This study presents a tool intended to aid stakeholders to design a new or analyse an existing hearing screening programme in terms of benefits and costs.

Pre-school hearing screening is necessary to detect childhood hearing loss after the newborn period: a study exploring risk factors, additional disabilities, and referral pathways.

OBJECTIVE: To explore strategies for detecting childhood hearing loss, aside from newborn hearing screening. DESIGN: A retrospective review of medical records on the modes of detection of hearing loss, risk factors for late-onset hearing loss, hearing loss degree, aetiology, additional disabilities, and timelines from referral to intervention. STUDY SAMPLE: Children, born 2006 to 2015, enrolled for intervention whose hearing loss was detected up to age 7 years but not from newborn hearing screening (n = 326). RESULTS: Universal pre-school hearing screening detected 38% of the cohort at 4-5 years of age. Risk factors for late-onset hearing loss were present in 36% of children, 80% of whom had a reported family history. Sixty-nine percent had mild bilateral or unilateral hearing loss. Children with additional disabilities faced significantly longer delays from referral to intervention. Children self-referred due to parent concern had more severe degree of hearing loss than those referred from screening. CONCLUSION: Most children with hearing loss detected after the newborn period do not have any known risk factors for late-onset hearing loss. Pre-school hearing screening is needed for comprehensive detection of hearing loss in early childhood. More work is needed towards improving timely diagnosis and intervention for children with additional disabilities.

Revisiting the transient-evoked otoacoustic emissions passing criteria used for newborn hearing screening.

OBJECTIVE: To assess transient-evoked otoacoustic emissions (TEOAE) data from 15 years of a newborn hearing screening program and evaluate how well various criteria separate ears with and without hearing loss. DESIGN: Retrospective review of TEOAE data using logistic regression, receiver operating characteristic curves, and cumulative percentage graphs.Study sample: Children with hearing loss who passed TEOAE screening as a newborn were compared to children who failed TEOAE screening and normal hearing children who either passed or failed. Exclusions were applied for acquired hearing loss or auditory neuropathy. RESULTS: Ears with hearing loss that passed screening had significantly lower TEOAE response levels compared to ears with normal hearing. Noise levels, test times, and number of sweeps were also lower. Most of these ears had mild hearing loss. Logistic regression results showed that high-frequency TEOAE response level is the best predictor of hearing loss. A multivariate "logit" score calculated from the regression was the best indicator for separating ears with hearing loss from ears with normal hearing. CONCLUSIONS: TEOAE response levels or an algorithm which incorporates logit scores should be considered as a minimum passing criterion to increase the sensitivity of the TEOAE screening.

Web-based psychoacoustics: Hearing screening, infrastructure, and validation.

Anonymous web-based experiments are increasingly used in many domains of behavioral research. However, online studies of auditory perception, especially of psychoacoustic phenomena pertaining to low-level sensory processing, are challenging because of limited available control of the acoustics, and the inability to perform audiometry to confirm normal-hearing status of participants. Here, we outline our approach to mitigate these challenges and validate our procedures by comparing web-based measurements to lab-based data on a range of classic psychoacoustic tasks. Individual tasks were created using jsPsych, an open-source JavaScript front-end library. Dynamic sequences of psychoacoustic tasks were implemented using Django, an open-source library for web applications, and combined with consent pages, questionnaires, and debriefing pages. Subjects were recruited via Prolific, a subject recruitment platform for web-based studies. Guided by a meta-analysis of lab-based data, we developed and validated a screening procedure to select participants for (putative) normal-hearing status based on their responses in a suprathreshold task and a survey. Headphone use was standardized by supplementing procedures from prior literature with a binaural hearing task. Individuals meeting all criteria were re-invited to complete a range of classic psychoacoustic tasks. For the re-invited participants, absolute thresholds were in excellent agreement with lab-based data for fundamental frequency discrimination, gap detection, and sensitivity to interaural time delay and level difference. Furthermore, word identification scores, consonant confusion patterns, and co-modulation masking release effect also matched lab-based studies. Our results suggest that web-based psychoacoustics is a viable complement to lab-based research. Source code for our infrastructure is provided.

Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.

BACKGROUND: While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested. OBJECTIVE: We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA. DESIGN: Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5-8%/year) and discontinuation (13-4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30-120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening. PARTICIPANTS: Forty-year-old persons in US primary care across their lifetime. INTERVENTION: Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05-2.25-fold). MAIN MEASURES: Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs). KEY RESULTS: CD resulted in 1.20 average person-years of hearing aid use compared to 1.27-1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness. LIMITATION: Input uncertainty around screening effectiveness. CONCLUSIONS: We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.

Association between in vitro fertilization-embryo transfer and hearing loss: risk factors for hearing loss among twin infants in a cohort study.

Assisted reproductive technologies (ART), including in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI), are known to contribute a higher risk of birth defects; however, studies have rarely evaluated the association between IVF-ET and diagnostic hearing loss (HL). This study aimed to evaluate the prevalence of and risk factors for HL and to clarify the association between IVF-ET and HL among twinborn infants. We enrolled 1860 live-born twin neonates born at a hospital in China from January 2017 to December 2020. After multi-step hearing screening, participants were diagnosed with HL by pediatric audiologists at 6 months of age. The prevalence of hearing loss and the adjusted odds ratios (AORs) for specific risk factors were estimated using generalized estimation equation (GEE) models in twin-born infants. Characteristics and prevalence of failure for hearing screening and HL were measured in IVF-ET twin infants. IVF-ET conception and preterm birth conferred a higher risk of hearing loss, with increased adjusted odds ratios (AOR [95% confidence intervals (CI)] IVF-ET: 2.82 [1.17-6.80], P = 0.021; preterm birth: 6.14 [2.30-16.40], P < 0.001) than the control group, respectively. Among the 1860 twin infants, more IVF-ET twins failed in dual-step hearing screening (3.26%) and were diagnosed with hearing loss (2.21%) than those conceived by spontaneous pregnancy. CONCLUSION: IVF-ET conception and premature birth were associated with a higher risk of hearing impairment. Twin infants conceived by IVF-ET tended to fail in hearing screening and be diagnosed with hearing loss. These observations provide a more comprehensive approach for the prevention and management of deafness in twin-born children. WHAT IS KNOWN: • IVF-ET technologies conferred a higher risk of birth defects. WHAT IS NEW: • Premature birth and IVF-ET conception were associated with a higher risk of hearing loss among twin infants. • Twin infants conceived by IVF-ET tended to fail in hearing screening and diagnosed with hearing loss.

Detecting mitochondrial mutations associated with aminoglycoside ototoxicity by noninvasive prenatal testing.

OBJECTIVES: Numerous diseases and disorders are associated with mitochondrial DNA (mtDNA) mutations, among which m.1555A > G and m.1494C > T mutations in the 12 S ribosomal RNA gene contribute to aminoglycoside-induced and nonsyndromic hearing loss worldwide. METHODS: A total of 76,842 qualified non-invasive prenatal (NIPT) samples were subjected to mtDNA mutation and haplogroup analysis. RESULTS: We detected 181 m.1555A > G and m.1494C > T mutations, 151 of which were subsequently sequenced for full-length mitochondrial genome verification. The positive predictive values for the m.1555A > G and m.1494C > T mutations were 90.78% and 90.00%, respectively, a performance comparable to that attained with newborn hearing screening. Furthermore, mitochondrial haplogroup analysis revealed that the 12 S rRNA 1555A > G mutation was enriched in sub-haplotype D5[p = 0, OR = 4.6706(2.81-7.78)]. CONCLUSIONS: Our findings indicate that the non-invasive prenatal testing of cell-free DNA obtained from maternal plasma can successfully detect m.1555A > G and m.1494C > T mutations.

Status of the Newborn Hearing Screening in the 4-Months Age National Infant Health Checkup in Korea: A Nationwide Population-Based Study.

BACKGROUND: The aims of this study are to review data on 4-months age National Health Screening Program for Infants and Children (NHSPIC) using a National Health Insurance Service (NHIS) database, and to analyze the newborn hearing screening (NHS) results and related characteristics of the 4-months NHSPIC for 7 years in South Korea. METHODS: We analyzed a NHIS database of infants who had participated in the 4-month age NHSPIC from 2010 to 2016. According to the results of hearing questionnaires and physical examination, we analyzed the outcomes of NHS and related infantile and socioeconomic factors. RESULTS: Among 3,128,924 of total eligible infants in Korea between the year 2010 and 2016, 69.2% (2,164,621 infants) conducted 4-months age NHSPIC, and 94.4% (2,042,577 infants) of which performed hearing questionnaires regarding NHS. Among the total hearing examinees, premature infants accounted for 3.6%, infants who were hospitalized in the neonatal intensive care unit (NICU) for more than 5 days accounted for 5.6%, and infants with head and neck abnormalities were 0.6%. The NHS performing rate was 79.1% for total hearing examinees in 2010, but gradually increased to 88.9% in 2016. The NHS performing rate in 2016 was 93.4% for premature infants, 91.7% for NICU hospitalized babies. The mean referral rate was 0.6% for total hearing examinees, 1.4% for premature infants, and 2.3% for NICU hospitalized babies. When we analyzed the NHS performing rate and the referral rate according to the household income level, the NHS performing rate of infants in Medical Aid programs was the lowest as 65.6%, and the NHS performing rates in other five levels of NHIS was higher ranging between 85.1% to 86.0%. The referral rate of infants in the Medical Aid program (3.8%) was significantly higher than those of infants in other classes (1.10-1.25%). CONCLUSION: The estimated overall NHS performing rate in Korea gradually increased and was 88.9% in 2016. The overall referral rate was low as 0.6%, and it was significantly different depending on the infant's health condition and household income levels. We assume that our finding would help to establish policies managing hearing impaired children, and to develop the customized hearing care service programs considering the household economic levels.

Newborn hearing screening methodology impacts the timing of diagnosis for auditory neuropathy spectrum disorder.

INTRODUCTION: Auditory Neuropathy Spectrum Disorder (ANSD) accounts for 10 % to 15 % of pediatric hearing loss. In most cases, otoacoustic emissions (OAE) are present as the outer hair cell function is normal, and the auditory brainstem response (ABR) is abnormal. Newborn hearing screen (NBHS) is completed using OAE or ABR depending on the institution. Because OAEs are often present in ANSD, NBHS done solely with OAE can miss and delay diagnosis of patients with ANSD. OBJECTIVES: To assess whether NBHS methodology impacts the age of diagnosis of ANSD. METHODS: This is a retrospective study of patients, 0-18 years of age, diagnosed with ANSD at two tertiary pediatric hospitals from 1/01/2010 to 12/31/2018 after referral from NBHS performed in the community. Data recorded included patient demographics, method of NBHS, NICU stay, and age at ANSD diagnosis. RESULTS: 264 patients were diagnosed with ANSD. Of those, 123 (46.6 %) were female, and 141 (53.4 %) were male. Ninety-seven (36.8 %) were admitted to NICU and the mean stay was 6.98 weeks (STD = 10.7; CI = 4.8-9.1). The majority (244, 92.4 %) of patients had NBHS with ABR, and 20 (7.5 %) had NBHS with OAE. Patients screened with ABR were diagnosed with ANSD earlier than those who screened with OAE, with a mean age of 14.1 versus 27.3 weeks (p = 0.0397, CI = 15.2-39.3). Among those screened with ABR, median age at diagnosis was 4 months for NICU infants and 2.5 months for infants with no history of NICU stay over 5 days. In comparison, median diagnosis age was 8 months for non-NICU infants screened with OAEs. CONCLUSION: Patients with ANSD who had NBHS with ABR were diagnosed earlier than those with OAE. Our data suggest that universal screening with ABR may facilitate earlier diagnosis of ANSD and earlier evaluation for aural rehabilitation, especially in high-risk cohorts such as NICU patients. Further research is needed into factors that contribute to earlier diagnosis among patients screened with ABR.

Referral rate and false-positive rates in a hearing screening program among high-risk newborns.

AIM: More studies exploring referral rates and false-positive rates are needed to make hearing screening programs in newborns better and cost-effective. Our aim was to study the referral and false-positivity rates among high-risk newborns in our hearing screening program and to analyze the factors potentially associated with false-positive hearing screening test results. METHODS: A retrospective cohort study was done among the newborns hospitalized at a university hospital from January 2009 to December 2014 that underwent hearing screening with a two-staged AABR screening protocol. Referral rates and false-positivity rates were calculated and possible risk factors for false-positivity were analyzed. RESULTS: 4512 newborns were screened for hearing loss in the neonatology department. The referral rate for the two-staged AABR-only screening was 3.8% with false-positivity being 2.9%. Our study showed that the higher the birthweight or gestational age of the newborn, the lower the odds of the hearing screening results being false-positive, and the higher the chronological age of the infant at the time of screening, the higher the odds of the results being false-positive. Our study did not show a clear association between the mode of delivery or gender and false-positivity. CONCLUSION: Among high-risk infants, prematurity and low-birthweight increased the rate of false-positivity in the hearing screening, and the chronological age at the time of the test seems to be significantly associated with false-positivity.

Simplified cochlear frequency selectivity measure for sensorineural hearing loss screening: comparison with digit triplet test (DTT) and shortened speech, spatial and qualities of hearing scale (SSQ) questionnaire.

PURPOSE: Pure-tone audiometry (PTA) is the gold standard for screening and diagnosis of hearing loss but is not always accessible. This study evaluated a simplified cochlear frequency selectivity (FS) measure as an alternative option to screen for early frequency-specific sensorineural hearing loss (SNHL). METHODS: FS measures at 1 and 4 kHz center frequencies were obtained using a custom-made software in normal-hearing (NH), slight SNHL and mild-to-moderate SNHL subjects. For comparison, subjects were also assessed with the Malay Digit Triplet Test (DTT) and the shortened Malay Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire. RESULTS: Compared to DTT and SSQ, the FS measure at 4 kHz was able to distinguish NH from slight and mild-to-moderate SNHL subjects, and was strongly correlated with their thresholds in quiet determined separately in 1-dB step sizes at the similar test frequency. Further analysis with receiver operating characteristic (ROC) curves indicated area under the curve (AUC) of 0.77 and 0.83 for the FS measure at 4 kHz when PTA thresholds of NH subjects were taken as ≤ 15 dB HL and ≤ 20 dB HL, respectively. At the optimal FS cut-off point for 4 kHz, the FS measure had 77.8% sensitivity and 86.7% specificity to detect 20 dB HL hearing loss. CONCLUSION: FS measure was superior to DTT and SSQ questionnaire in detecting early frequency-specific threshold shifts in SNHL subjects, particularly at 4 kHz. This method could be used for screening subjects at risk of noise-induced hearing loss.

Middle ear effusion and newborn hearing screening.

PURPOSE: Middle ear effusion (MEE) is one of the reasons for screening failure and may require prolonged follow-up due to conductive hearing loss. We aimed to examine at 1-year follow-up, the fate of MEE. METHODS: From medical charts, computerized data were collected retrospectively of newborns born in the years 2012-2013 in Rambam Health Care Campus, Haifa city, Israel, who failed the Universal Newborn Hearing Screening (UNHS), and follow-up hearing evaluation data were extracted. RESULTS: Of 9527 newborns born in 2012-2013 in our institution, 144 [1.5%] failed the UNHS, and 46 were eventually diagnosed with conductive hearing loss caused by MEE. Spontaneous MEE clearance was recorded in 12 [26%], while 26 [57%] patients had persistent effusion that required further follow-up (10 [22%] required insertion of ventilation tubes and 16 [35%] were referred for further follow-up); 8 [17%] were lost to follow-up. CONCLUSION: Congenital MEE causing conductive hearing loss and UNHS failure is persistent and resolves at lower rates than non-congenital MEE.

Accuracy of automated pure-tone audiometry in population-based samples of older adults.

OBJECTIVE: Automated pure-tone audiometry is frequently used in teleaudiology and hearing screening. Given the high prevalence of age-related hearing loss, older adults are an important target population. This study aimed to investigate the accuracy of automated audiometry in older adults, and to examine the influence of test frequency, age, sex, hearing and cognitive status. DESIGN AND STUDY SAMPLE: In a population-based study, two age-homogeneous samples of 70-year-olds (n = 238) and 85-year-olds (n = 114) were tested with automated audiometry in an office using circum-aural headphones and, around 4 weeks later, with manual audiometry conducted to clinical standards. The differences were analysed for individual frequencies (range: 0.25-8 kHz) and pure-tone averages. RESULTS: The mean difference varied across test frequencies and age groups, the overall figure being -0.7 dB (SD = 8.8, p < 0.001), and 68% to 94% of automated thresholds corresponded within ±10 dB of manual thresholds. The poorest accuracy was found at 8 kHz. Age, sex, hearing and cognitive status were not associated with the accuracy (ordinal regression analysis). CONCLUSIONS: Automated audiometry seems to produce accurate assessments of hearing sensitivity in the majority of older adults, but with larger error margins than in younger populations, and is not affected by relevant patient factors associated with old age.

Optimised adaptive procedures and analysis methods for conducting speech-in-noise tests.

OBJECTIVE: Speech-in-noise testing is a valuable part of audiological test batteries. Test standardisation using precise methods is desirable for ease of administration. This study investigated the accuracy and reliability of different Bayesian and non-Bayesian adaptive procedures and analysis methods for conducting speech-in-noise testing. DESIGN: Matrix sentence tests using different numbers of sentences (10, 20, 30 and 50) and target intelligibilities (50 and 75%) were simulated for modelled listeners with various characteristics. The accuracy and reliability of seven different measurement procedures and three different data analysis methods were assessed. RESULTS: The estimation of 50% intelligibility was accurate and showed excellent reliability across the majority of methods tested, even with relatively few stimuli. Estimating 75% intelligibility resulted in decreased accuracy. For this target, more stimuli were required for sufficient accuracy and selected Bayesian procedures surpassed the performance of others. Some Bayesian procedures were also superior in the estimation of psychometric function width. CONCLUSIONS: A single standardised procedure could improve the consistency of the matrix sentence test across a range of target intelligibilities. Candidate adaptive procedures and analysis methods are discussed. These could also be applicable for other speech materials. Further testing with human participants is required.

Evaluation of a game-based hearing screening program for identifying hearing loss in primary school-aged children.

OBJECTIVES: To evaluate a tablet-based hearing screening game in primary school aged children. To examine the prevalence of middle/outer ear pathology, hearing loss and spatial processing disorder in primary school aged children. DESIGN: The automated hearing test Sound Scouts was used as a screening tool, which measures hearing abnormalities through tests of speech-in-quiet/noise and tone-in-noise. Children who failed the screenings underwent follow up testing with pure tone audiometry, tympanometry, otoscopy, and the Listening in Spatialised Noise-Sentences test. Results of each test were compared to measure efficacy. STUDY SAMPLE: 1256 children aged 4-13 years from 8 primary schools. RESULTS: 111 children (8.84%) presented with evidence of middle/outer ear pathologies. 21 children (1.67%) had hearing loss in at least one ear. 30 children (2.52%) were diagnosed with spatial processing disorder. False positive rate was 5.01%, indicating that a relatively small proportion of the children who failed the screenings were subsequently shown to have normal auditory function. CONCLUSIONS: A game based program testing sound detection and binaural speech processing can be effective in detecting undiagnosed hearing deficits, in large format school-based hearing screenings. Prevalence of hearing abnormalities in Victorian primary school aged children were established, highlighting the value of school hearing screening programs.

Risk-taking propensity as a risk factor for noise-induced hearing loss in the general population.

OBJECTIVES: To examine general risk propensity in relation to perceptions of noise, risk behaviour, and hearing loss in the general population. DESIGN: Participants completed an online survey using the Amazon Mechanical Turk crowdsourcing platform. STUDY SAMPLE: The sample comprised 1274 adults from the United States. RESULTS: Higher general risk propensity was associated with an increased likelihood to engage in noise-risk behaviours. Lower general risk propensity was associated with increased knowledge of noise risks and an increased perception of noise as risky. The frequency of self-reported exposures to hazardous noise resulted in estimated annual noise doses exceeding standard hazard limits in 40% of the surveyed population. CONCLUSIONS: Results revealed limited knowledge of the risks and associated health consequences of noise exposure in the general population Results of this study suggest a high rate of self-exposure to hazardous noise by the general population. Those with higher general risk propensity are more likely to engage in risky noise behaviour. Risky noise behaviour is associated with age, gender, race, ethnicity, and general risk propensity. Intervention programs to modify risky noise behaviour in the general population should focus on both increasing knowledge and establishing accurate perceptions of risk.