Early detection of hearing loss in adults with speech-in-noise

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Background

Hearing loss is estimated to affect 33% of adults over the age of 65 years across the world (WHO, 2013a). Sub-Saharan Africa, Asia Pacific and South Asia have the highest estimated prevalence of hearing loss in people over 65 years in the world (WHO, 2013a). An estimated 6.4% of adults older than 15 years of age have a disabling hearing loss in sub-Saharan Africa (WHO, 2013a). Audiology service delivery in sub-Saharan countries is very limited as audiology services have only increased by 2.5% from 2009 to 2015 (Mulwafu, Ensink, Kuper & Fagan, 2017). This means that little progress had been made to implement ear and hearing service delivery across these countries (Mulwafu et al., 2017).
As a result, many people will not be able to access ear and hearing services due to inaccessibility to the health care system (Mulwafu et al., 2017). The latest Global Burden of Disease study (GBD) indicates that 1.33 billion people suffer from hearing loss making it the 2nd most common impairment evaluated (GBD, 2016). Approximately 2.67 million people with a hearing loss reject the use of hearing aids despite the adverse effect that a hearing loss has on health (Smits, Kramer & Houtgast, 2006a; Davis, Smith, Ferguson, Stephens & Gianopoulos, 2007; Kochkin, 2007; Watson, Kidd, Miller, Smits & Humes, 2012). The impact of hearing loss can be reduced effectively by using amplification devices such as hearing aids, FM microphones, assistive listening devices, counselling and aural rehabilitation that have demonstrated the ability to improve quality of life, cognitive functioning and delays the onset of auditory deprivation (Arlinger, 2003; Boothroyd, 2007; Davis et al., 2016; Simpson, Simpson & Dubno, 2016). Early identification of hearing loss in adults is important to ensure opportune diagnosis, counselling, prompt medical referral, assistive listening devices and aural rehabilitation (Kiessling et al., 2003; Swanepoel, Eikelboom, Hunter, Friedland & Atlas, 2013; Willot, 1991; WHO, 2013a).

Early detection of hearing loss in adults with speech-in-noise

tests Hearing loss in adults can be identified at an early stage by using various hearing screening techniques. Some of the techniques include pure-tone audiometry, otoacoustic emissions, self-reported hearing disability questionnaires and speech-in- noise hearing screening tests (Smits, Goverts & Festen, 2013; Swanepoel et al., 2013). Speech-in-noise hearing screening tests have become popular over the last ten years as the greatest difficulty encountered by the hearing impaired is to understand speech in background noise (Jansen, Luts, Wagener, Frachet & Wouters, 2010; Smits et al., 2013; Koole et al., 2016). Conventional pure-tone audiometry is not sufficient to evaluate the everyday speech in noise on account of the poor relationship between the 4FPTA and speech in noise understanding (Smits, et al., 2013). In 2004 the first speech-in-noise hearing screening test that can be performed telephonically was reported (Smits, Kapteyn & Houtgast, 2004). This speech-in-noise hearing screening test presents with several qualities that make it appropriate to be used as a screening test.
Laypersons can conduct the test, a fully automatic test can be developed, tests can be conducted in a few minutes and the test is sensitive to a hearing loss (Jansen et al., 2010; Smits et al., 2004; Zokoll, Wagener, Brand, Buschermöhle & Kollmeier, 2012; Koole et al., 2016). The limitations to the speech-in-noise hearing screening test discussed by Smits & Houtgast (2005) include speech material that may sound distorted to a hearing impaired person. People may respond incorrectly to the test if they do not understand the instructions. Furthermore, the speech-in-noise hearing screening test does not measure pure-tone thresholds, but merely the ability to understand speech in noise (Smits et al., 2013; Koole et al., 2016). The speech-in-noise hearing screening test is operated by varying the speech intensity level while having a fixed noise level at 65 dB sound pressure level (SPL) (Jansen et al., 2010; Smits et al., 2004). The noise starts 500 ms and end 500 ms after the triplet presentation (Jansen et al., 2010). The digits are spoken by a female speaker with natural pauses between digits, for example 2-5-1, spoken as two-five- one. The first digit-triplet speech set is presented repeatedly while raising the speech intensity (step size 4 dB) until the digits is entered correctly. The digit-triplet speech set is automatically increased (incorrect answer) or decreased (correct answer) by 2 dB, depending on the subject’s response (Smits et al., 2004).

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CONTENT :

LIST OF TABLES
LIST OF FIGURES
PUBLICATIONS AND RESEARCH OUTPUTS
ABSTRACT
KEYWORDS
ABBREVIATIONS
CHAPTER 1: INTRODUCTION
- 1.1. Background
- 1.2. Early detection of hearing loss
- 1.3. Rationale
CHAPTER 2: METHODOLOGY
- 2.1. Research objective
- 2.2. Ethical considerations
- 2.3. Research design
- 2.4. Research context
- 2.5. Research participants
- 2.6. Research equipment
- 2.7. Research procedures
- 2.7.1. Data collection material
  - 2.7.2. Data collection procedures
  - 2.7.2.1. Study 1: Data collection procedures
  - 2.7.2.2. Study II: Data collection procedures
  - 2.7.2.3. Study III: Data collection procedures
- 2.8. Statistical analysis
CHAPTER 3: DEVELOPMENT AND VALIDATION OF A SMARTPHONE-BASED DIGITS-IN-NOISE HEARING TEST IN SOUTH AFRICAN ENGLISH
- 3.1. Abstract
- 3.2. Introduction
- 3.3. PHASE I: Recording and equalization of digits
- 3.3.1. Recording and processing the speech material
- 3.3.2. Equalization of speech material
- 3.3.3. Methods
  - 3.3.3.1. Subjects
  - 3.3.3.2. Equipment and measures
  - 3.3.3.3. Results
- 3.4. PHASE II: Development of the smartphone application test procedures
- 3.4.1. Smartphone application
- 3.4.2. Triplet generation and adaptive test procedure
- 3.5. PHASE III: Smartphone digits-in-noise test headphone types, effects and norms
- 3.5.1. Effects of different headphones on the smartphone digits-in-noise test
- 3.5.2. Method
  - 3.5.2.1. Subjects
  - 3.5.2.2. Equipment and measurements
  - 3.5.2.3. Results
- 3.5.3. Normative data for the digits-in-noise hearing test
- 3.5.4. Method
  - 3.5.4.1. Subjects
  - 3.5.4.2. Equipment and measurements
  - 3.5.4.3. Results
- 3.6. Discussion
- 3.7. Conclusion
CHAPTER 4: THE SOUTH AFRICAN DIGITS-IN-NOISE HEARING TEST: EFFECT OF AGE, HEARING LOSS AND LANGUAGE SPEAKING COMPETENCE
- 4.1. Abstract
- 4.2. Introduction
- 4.3. Materials and methods
  - 4.3.1. Listeners
  - 4.3.2. Material and apparatus
  - 4.3.3. Procedures
- 4.4. Results
- 4.4.1. Predictive variables of the digits-in-noise SRT
- 4.4.2. English competence groups
- 4.4.3. Reference scores
- 4.4.4. Screening characteristics
- 4.5. Discussion
CHAPTER 5: EVALUATING A SMARTPHONE DIGITS-IN-NOISE TEST AS PART OF THE AUDIOMETRIC TEST-BATTERY
- 5.1. Abstract
- 5.2. Introduction
  - 5.2.1. Background
  - 5.2.2. Objective
- 5.3. Methodology
  - 5.3.1. Subjects
  - 5.3.2. Methods and materials
  - 5.3.3. Data analysis
- 5.4. Results
- 5.4.1. Comparing the digits-in-noise speech reception threshold, pure-tone audiometry and maximum speech recognition score intensity
- 5.5. Discussion
- 5.6. Conclusion
CHAPTER 6: DISCUSSION, CLINICAL IMPLICATIONS AND CONCLUSION
- 6.1. Summary of findings
- 6.2. Clinical implications
- 6.2.1. South African smartphone-based digits-in-noise test’s suitability as a screening test
- 6.2.2. Clinical application of the South African smartphone-based digits-in noise hearing test
- 6.3. Study limitations
- 6.4. Recommendations for future research
- 6.5. Conclusion
- REFERENCES