Development of High-performance Hearing Test System / 中国医疗器械杂志

This paper analyzes the shortcomings of the existing pure tone audiometers, and proposes a system to realize pure tone audiometry and speech audiometry with a new DSP processor. The pure tone test signal produced by the system has accurate frequency, high signal-to-noise ratio, and small harmonic distortion. The noise generator that comes with DSP adds a band-pass filter to realize the generation of narrow-band noise. At the same time, due to the modular structure of software design, the system has good ease of use and scalability. The test results show that the hearing test system has excellent performance and can be better used in hearing medical diagnosis.

Accuracy of smartphone-based hearing screening tests: a systematic review / Acurácia de testes de triagem auditiva baseados em smartphone: uma revisão sistemática

ABSTRACT Purpose To verify the accuracy of smartphone apps to identify hearing loss. Research strategies A systematic review followed the PRISMA-DATA checklist. The search strategies were applied across four databases (Lilacs, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey, and ProQuest Dissertations and Thesis). Selection criteria The acronym PIRD was used in review. This included populations of any gender and all age groups. The Index test is the smartphone-based hearing screening test; the Reference test is the pure-tone audiometry, which is considered the gold reference for hearing diagnostics; the diagnosis was performed via validity data (sensitivity and specificity) to identify hearing loss and diagnostic studies. Data analysis Two reviewers selected the studies in a two-step process. The risk of bias was assessed according to the criteria of the QUADAS-2. Results Of 1395 articles, 104 articles were eligible for full-text reading and 17 were included. Only four met all criteria for methodological quality. All of the included studies were published in English between 2015 and 2020. The applications Digits-in noise Test (5 articles), uHear (4 articles), HearScreen (2 articles), hearTest (2 articles) and Hearing Test (2 articles) were the most studied. All this application showed sensitivity and specificity values between 75 and 100%. The other applications were EarScale, uHearing Test, Free field hearing (FFH) and Free Hearing Test. Conclusion uHear, Digit-in-Noise Test, HearTest and HearScreen have shown significant values of sensitivity and specificity and can be considered as the most accurate methods for screening of hearing impairment.

RESUMO Objetivo Verificar a acurácia dos aplicativos de smartphone para identificar a perda auditiva. Estratégias de pesquisa Uma revisão sistemática seguiu o checklist PRISMA-DATA. As estratégias de busca foram aplicadas nos bancos de dados Lilacs, PubMed, Scopus e Web of Science e na literatura cinzenta (Google Scholar, OpenGrey e ProQuest Dissertations and Thesis). Critérios de seleção O anacrônimo PIRD foi usado na revisão. Incluiu populações de qualquer gênero e todas as faixas etárias. O teste Index foi o de triagem auditiva baseado em smartphone; o teste de referência foi a audiometria tonal; o diagnóstico foi realizado por meio de dados de validade (sensibilidade e especificidade) para identificação da perda auditiva e estudos diagnósticos. Análise de dados Dois revisores selecionaram os estudos em um processo de duas etapas. O risco de viés foi avaliado de acordo com os critérios do QUADAS-2. Resultados De 1395 artigos, 104 artigos foram elegíveis para leitura de texto completo e 17 foram incluídos. Apenas quatro preencheram todos os critérios de qualidade metodológica. Todos os estudos incluídos foram publicados em inglês entre 2015 e 2020. Os aplicativos mais estudados foram: Digits-in-noise (5 artigos), uHear (4 artigos), HearScreen (2 artigos), hearTest (2 artigos) e Hearing Test (2 artigos). Todos apresentaram valores de sensibilidade e especificidade entre 75 e 100%. Os outros aplicativos foram EarScale, uHearing, Free Field Hearing e teste Free Hearing. Conclusão uHear, Digit-in-Noise Test, HearTest e HearScreen apresentaram valores significativos de sensibilidade e especificidade e podem ser considerados os métodos mais precisos para rastreamento de deficiência auditiva.

Accuracy of screening instruments in identifying central auditory processing disorders: an integrative literature review

ABSTRACT Purpose: to assess the literature about the accuracy of screening instruments for identifying the Central Auditory Processing Disorders (CAPD). Methods: search strategies were performed in the following databases: CINAHL, LILACS, PubMed /MEDLINE, Scopus, Speechbite and Web of Science. A search was also carried out in the grey literature. Four independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. Two reviewers independently collected the required information from the included articles. The diagnostic methods were minimal batteries of behavioral tests to assess auditory processing skills. Results: from 1,366 articles found on all databases, after analysis of title and abstract, 36 were selected for the next phase, when 5 articles were finally included. It was found that the studies included were related to five instruments applied in children. The specificity was higher than 70%, but just the Mottier test and Screening Test for Auditory Processing (STAP), and Screening Checklist for Auditory Processing (SCAP) showed sensibility higher than 70%. Conclusion: Mottier was the most accurate CAPD screening test. There was no homogeneity in the presentation of the pass/fail criterion, or in the gold reference test used to establish the presence of CAPD.

The study of responses to auditory processing tests in the elderly / O estudo de respostas a testes de processamento auditivo em um grupo de idosos

ABSTRACT Objective: to generate reference values for different central auditory processing tests, investigating the influence of peripheral hearing and considering education and cognition, in the elderly. Methods: a prospective, quantitative and cross-sectional study. The casuistry consisted of 23 elderly, aged between 60 and 81 years old, being 8 men and 14 women. Regarding the audiological characteristics, the elderly were included with normal auditory thresholds or mild and moderate sensorineural hearing loss, classified by the quadritonal average, proposed by the World Health Organization. All elderly underwent Basic Audiological Evaluation, Edinburgh Handedness Inventory, Mini Mental State Examination, and seven central auditory behavioral tests. Statistical analysis was performed using the nonparametric Mann-Whitney U test. Results: the Adapted Time-Compressed Speech Test was influenced by the peripheral hearing loss, in both ears (p-value = 0,000), and no significant differences were found in the other data analyzed. Conclusion: reference values were generated for the different behavioral tests. Hearing loss influenced the results of the Adapted Time-Compressed Speech Test, suggesting that it should not be applied in the elderly with peripheral alteration. Regarding education and cognition, there was a similarity among the elderly with normal hearing thresholds and those presented with hearing loss.

RESUMO Objetivo: gerar valores de referência para diferentes testes de processamento auditivo central, investigando a influência da audição periférica e considerando escolaridade e cognição, na população idosa. Métodos: pesquisa de caráter prospectivo, quantitativo e transversal. A casuística foi composta por 23 idosos, com idades entre 60 a 81, sendo 8 homens e 14 mulheres. Em relação as características audiológicas, foram incluídos idosos com limiares auditivos normais ou perda auditiva neurossensorial de grau leve e moderado, classificados pela média quadritonal, proposta pela Organização Mundial da Saúde. Todos realizaram avaliação audiológica básica, Teste de Dominância Manual de Edinburgh, Mini Exame do Estado Mental, e sete testes comportamentais de processamento auditivo central. Para a analise estatística, foi utilizado o teste não paramétrico U de Mann-Whitney. Resultados: o Teste de Fala Comprimida Adaptado foi influenciado pela perda auditiva periférica, em ambas as orelhas (p valor 0,000), não tendo sido encontradas diferenças significantes nos outros dados analisados. Conclusão: foram gerados valores de referência para os diferentes testes comportamentais. A perda auditiva influenciou os resultados do Teste Fala Comprimida Adaptado, de modo a sugerir que ele não seja aplicado em idosos com alteração periférica. Em relação a escolaridade e cognição, houve similaridade entre os idosos com limiares auditivos normais e perda auditiva.

Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea / Avaliação da via auditiva periférica e do tronco encefálico na apneia obstrutiva do sono

Abstract Introduction Obstructive sleep apnea causes changes in normal sleep architecture, fragmenting it chronically with intermittent hypoxia, leading to serious health consequences in the long term. It is believed that the occurrence of respiratory events during sleep, such as apnea and hypopnea, can impair the transmission of nerve impulses along the auditory pathway that are highly dependent on the supply of oxygen. However, this association is not well established in the literature. Objective To compare the evaluation of peripheral auditory pathway and brainstem among individuals with and without obstructive sleep apnea. Methods The sample consisted of 38 adult males, mean age of 35.8 (±7.2), divided into four groups matched for age and Body Mass Index. The groups were classified based on polysomnography in: control (n = 10), mild obstructive sleep apnea (n = 11) moderate obstructive sleep apnea (n = 8) and severe obstructive sleep apnea (n = 9). All study subjects denied a history of risk for hearing loss and underwent audiometry, tympanometry, acoustic reflex and Brainstem Auditory Evoked Response. Statistical analyses were performed using three-factor ANOVA, 2-factor ANOVA, chi-square test, and Fisher's exact test. The significance level for all tests was 5%. Results There was no difference between the groups for hearing thresholds, tympanometry and evaluated Brainstem Auditory Evoked Response parameters. An association was observed between the presence of obstructive sleep apnea and changes in absolute latency of wave V (p = 0.03). There was an association between moderate obstructive sleep apnea and change of the latency of wave V (p = 0.01). Conclusion The presence of obstructive sleep apnea is associated with changes in nerve conduction of acoustic stimuli in the auditory pathway in the brainstem. The increase in obstructive sleep apnea severity does not promote worsening of responses assessed by audiometry, tympanometry and Brainstem Auditory Evoked Response.

Resumo Introdução A Apneia Obstrutiva do Sono provoca modificações na arquitetura normal do sono, fragmentando-o de forma crônica com hipóxias intermitentes levando, a longo prazo, a sérias consequências na saúde. Acredita-se que a ocorrência de eventos respiratórios durante o sono como apneia e hipopneia pode prejudicar a transmissão de impulsos nervosos ao longo da via auditiva que são altamente dependentes do fornecimento do oxigênio. Contudo, essa associação não se encontra bem estabelecida na literatura. Objetivo Comparar os achados da avaliação da via auditiva periférica e no tronco encefálico entre indivíduos portadores e não portadores de apneia obstrutiva do sono. Método A casuística foi composta por 38 adultos do sexo masculino, média de idade de 35,8 (±7,2); divididos em quatro grupos experimentais pareados por idade e índice da massa corpórea. Os grupos foram classificados com base na polissonografia em: controle (n = 10), apneia obstrutiva do sono leve (n = 11), apneia obstrutiva do sono moderada (n = 8) e apneia obstrutiva do sono grave (n = 9). Todos os sujeitos do estudo negaram história pregressa de risco para perda auditiva e foram submetidos à audiometria, timpanometria, pesquisa dos reflexos acústicos e Potenciais Evocados Auditivos de Tronco Encefálico. As análises estatísticas foram realizadas por meio de ANOVA 3-fatores, ANOVA 2-fatores, teste de Qui-quadrado e teste exato de Fisher. O nível de significância adotado para todos os testes foi de 5%. Resultados Não houve diferença entre os grupos para os limiares auditivos, timpanometria e parâmetros avaliados do Peate. Observou-se associação entre a presença da apneia obstrutiva do sono e alteração da latência absoluta da onda V (p = 0,03). Observou-se associação entre apneia obstrutiva do sono de grau moderado e alteração da latência da onda V (p = 0,01). Conclusão A presença de apneia obstrutiva do sono está associada à presença de alteração na condução nervosa do estímulo acústico na via auditiva em tronco encefálico. O aumento do grau de severidade da apneia obstrutiva do sono não promove piora das respostas avaliadas pela audiometria, timpanometria e Potenciais Evocados Auditivos de Tronco Encefálico.

Compound effects of inhaling pure oxygen and lifting height on ear baric function in a hypobaric chamber / 解放军医学杂志

Objective To compare the ear baric function between 4000m altitude chamber test with inhaling air and 6900m altitude chamber test with inhaling pure oxygen.Methods Eleven healthy male volunteers attended two tests as two groups by self-comparison. As the air group the volunteers inhaled air at 4000m, while as the pure oxygen group they inhaled pure oxygen at 6900m altitude, and the time interval between the two tests was more than two weeks. During the test, the volunteers breathed air or pure oxygen at random for 1h, and then were exposed at a speed of 20m/s to the target altitude for 5min. Hereafter they were sent back to the ground at the same speed. The changes of subjective symptoms, degree of tympanic congestion, acoustic immitance index and pure-tone auditory threshold were recorded before and after the test. The acoustic impedance index and pure-tone threshold were statistically analyzed.ResultsFour volunteers (4 ears) in air group and 7 volunteers (7 ears) in pure oxygen group reported ear pain in altitude chamber exposures, respectively. The pain-triggering altitude was higher in the pure oxygen group. Immediately after tests, there were 3 (3 ears) and 5 volunteers (5 ears) with Ⅲ degree congestion of the tympanic membrane in the two groups respectively. Four volunteers (6 ears) developed gradually aggravated hemorrhages after altitude exposure. And the tympanic membrane congestion difference between groups was statistically significant at 3 and 24h after tests (P<0.01). The type A tympanogram appeared in 11 (15 ears) and 11 (14 ears) volunteers respectively immediately after tests. The increase of static compliance value was significantly greater in pure oxygen group than in air group immediately after tests (P<0.05), the decrease of middle ear pressure was more significant in pure oxygen group than in air group at 3 and 24h after tests (P<0.05). Both the two altitude exposure tests resulted in eustachian tube dysfunction. At 3 and 24h after the tests, the increase of individual frequency pure-tone threshold was significantly higher in pure oxygen group than in air group (P<0.05).Conclusion Breathing pure oxygen and lifting height could increase the screening degree of ear baric function test in hypobaric chamber, and have greater influence on degree of tympanic congestion, acoustic immittance and pure-tone auditory threshold in 24 hours.

Short Term Follow-Up Result of Unilateral Hearing Loss Referred Patient by Newborn Hearing Screening / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing screening is mandatory for newborns. The management of patients who fail hearing screening is important. This study examined the prognosis of patients who had hearing loss detected on the newborn hearing screening. SUBJECTS AND METHOD: The results of newborn hearing tests, follow-up hearing tests, and risk factors for hearing loss were analyzed retrospectively in prospectively collected data. Newborn hearing screening testing using an auto auditory brain stem (ABR) response was performed for 1296 newborns from January 2010 to December 2012 at Soonchunhyang University Bucheon Hospital. Follow-up hearing tests using ABR and otoacoustic emissions were performed 6 and 12 months after the newborn hearing screening. RESULTS: Of the 1296 newborns who underwent hearing screening tests, 63 were referred and 58 had confirmed hearing loss. The hearing loss was unilateral in 74.2% (43/58). During the 1-year follow-up, about half of the patients showed improved hearing function. Premature birth was related to hearing recovery. CONCLUSION: During the follow-up, some patients with unilateral hearing loss showed recovery. Some premature patients can expect hearing recovery during follow-up testing. Regular follow-up after newborn hearing screening is important to detect hearing changes in this period.

Environment Arrangement for Test Booth of Audiometry / 中国康复理论与实践

This paper represented a recommended arrangement of audiometric test environment, including decoration of sound-isolated room or booth, displacement of the furniture and equipment, optimal location of subjects and audiologists, etc.

The Analysis of Hearing of Tinnitus Patients / 中国基层医药

Objective To investigate the necessity to test the hearing of patients whose initial symptom is tinnitus with pure tone audiometer. Methods To analyze the results of pure tone audiometer of 218 tinnitus patients.Results Among 218 cases of tinnitus patients,a total of 123 patients with abnormal hearing,among 95 cases of patients with normal hearing, except for 50 cases of tinnitus, no other cause of disease. Conclusion Among the normal hearing tinnitus patients, we should do further hearing test for them if they are not identified a clear cause of disease,such as auditory brainstem response,otoacoustic emission and other necessary checks to clear the reasons for tinnitus or the position of the unusual auditory system. It is important for early diagnosis and treatment of tinnitus. But the pure-tone audiometer should be a routine examination when tinnitus patients come for the first visit.

Comparison of 50% Recognition Signal-to-Noise Ratio Using a Multi-Talker Babble Noise in Normal-Hearing and Hearing-Impaired Individuals / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most common complaint of individuals with hearing impairment is the difficulty in understanding speech against background noise. In our previous study, we carried out a speech-in-noise test using multi-talker babble noise and spondee words. In the present study, we compared 50%-signal to noise ratios (SNRs) of hearing-impairment group with that of normal-hearing group, and analyze the effects of age and noise intensity affecting the results. SUBJECTS AND METHOD: Thirty listeners (of which each 10 listeners are in their forties, fifties, and sixties) with normal hearing and thirty listeners (each ten listeners in their forties, fifties, and sixties) with hearing impairment participated. Spondee words and multi-talker babble noise made from recording the voices of 10 males and 10 females were presented by a loudspeaker at a distance of one meter in front of the subject. Fifty percent-SNRs were measured at 50 dB HL, 60 dB HL, 70 dB HL, and 80 dB HL of noise intensity. RESULTS: The mean 50% SNR for normal-hearing listeners in the forties, fifties and sixties of age were -13.4+/-2.1 dB, -11.5+/-2.3 dB, and -12.6+/-2.0 dB, respectively. The mean 50% SNR for hearing-impairment listeners in the forties, fifties and sixties of age were -11.2+/-3.4 dB, -9.5+/-3.0 dB, -8.7+/-2.7 dB, respectively. Hearing-impairment group showed significantly worse results than the normal- hearing group in all ages. CONCLUSION: These results support that our word-in-noise test using multi-talker babble noise is useful in measuring audibility against background noise for individuals with hearing-impairment.

Validity and Reliability of Whispered Voice Test as a Screening Test for Hearing in the Elderly People / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the validity and reliability of the whispered voice test, which has been suggested as a screening test tool for hearing in the elderly group. SUBJECTS AND METHOD: A prospective multicenter trial has been designed. One hundred and seventy two elderly subjects from four university hospitals were included in this study. A whispered voice test using a number list and number/word list was performed by two testers for each elderly subject. To evaluate their test-retest reliability, a second whispered voice test was done 1-2 weeks later. The result of the whispered voice test was analyzed with the criteria of 26 dB and 40 dB hearing level, checked by pure tone audiometry. Sensitivity, specificity, and cut-off point of whispered voice test at each gold standard, inter-observer reliability and test-retest reliability have been investigated. RESULTS: There were significant differences with respect to correctly answered numbers in the whispered voice test between the normal and impaired hearing group at both criteria of 26 dBHL and 40 dBHL. With the 26 dB criteria of hearing level which showed higher inter-observer reliability of the number/word list, the whispered voice test has 86.0% sensitivity and 58.9% specificity with the cut-off point of 3 out of six on the number set. The test-retest reliability of whispered voice test using the number list was as high as 0.9 of correlation coefficient. However, the inter-observer reliability of whispered voice test was less than 0.6 (Cohen's kappa value). CONCLUSION: As a screening test for hearing in the elderly group, the whispered voice test has quite high sensitivity and test-retest reliability. The environmental sound level and test method for each tester, however, should be monitored to get better specificity and inter-observer reliability.

Development of Web-Based Digital Air-Conduction Pure Tone Audiometer with Automated Masking / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, internet-based applications of medicine are in the process of rapid development, where concepts of telemedicine and multimedia are important in these application. Hearing test is one of the essential procedures in the otologic field, especially in telediagnosis. A current study for tele-hearing test has some limitations in masking problems or making fully automated system. The aim of this study is to develop a digital air-conduction pure tone audiometer with automated making, which can be used through web-based or off-line to compare the threshold of hearing using conventional and digitalized audiometer in both normal and handicapped hearer. SUBJECTS AND METHOD: To develop an automated audiometer system, we prepared a test scenario data file according to the pure tone test procedure. This scenario was executed in the audiometer main, which is supported by sound card and keyboard (mouse) for output and feedback, respectively, for the examinee. Pure tone for test and white band noise for masking is generated in audiometer sound generation block. To compare this automated audiometer with the conventional one, 25 normal hearers (50 ears) and 25 handicapped hearers (50 ears) were tested. RESULTS: Easy Audiometer 1.0 was developed. The difference of hearing threshold between the two different system was 3-6 dB in the normal hearer group and 2.5-3.5 dB in the handicapped hearer group. Scatter plots showed a close relationship between these two different systems. CONCLUSION: Easy Audiometer 1.0 showed reliable results of hearing threshold in the patient with unilateral hearing who needs masking procedure. Screening and basic hearing tests may be conducted through this Easy Audiometer 1.0 and it could play a part in telediagnosis in the otologic field.

Development of Sentences for Korean Hearing in Noise Test(KHINT) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing in Noise Test (HINT) is a modified speech reception test using digitally recorded sentences. It is useful in assessing speech communication in noise. This test is easy to set up and to standardize by the commercialized HINT system. We aimed to develop sentences for the Korean HINT system so as to enable international comparative studies. SUBJECTS AND METHOD: Seven hundred fifty natural written sentences were prepared. They were digitally recorded by a professional voice actor, and long-term average spectrum of recorded sentences was calculated for masking noise. The performance-intensity test estimated the relationship between signal-to-noise ratio (S/N ratio) and percent word intelligibility by testing ten normal hearing adults. The next step was to equate the intelligibility of sentences when they were presented in masking noise at a fixed level, and 250 sentences were chosen. Individual phonemes in each sentence were counted after phonemic transcription using international phonemic alphabet. RESULTS: Long-term speech spectrum of Korean sentences showed relatively lower level, especially in high tone, compared to other foreign languages. One dB change of SNR resulted in 9% word intelligibility change. Twenty five lists of ten sentences were formed by adjusting composition of sentences to obtain even phoneme distribution, which were had 9.21.1 syllables. CONCLUSION: Prepared sentences for the Korean HINT will be useful for assessing functional hearing activity as well as international cross-language studies.

Effects of transient threshold shift and ambient noise on sensitivity and specificity of first screening of special health examination for noise / 대한산업의학회지

OBJECT: This study was performed to increase the sensitivity and specificity for screening the examinee of second hearing test. METHODS: Study subjects were 219 workers who exposed more than average 80dB. They were taken the hearing test two times, before noise exposure and at 1 hour to 4 hours after worksite noise exposure. To investigate the ambient noise workers who were taken the hearing test in the test room which ambient noise was less than 45dB were classified Group I and the others were classified Group E. To calculate the sensitivity and specificity we made it gold standard whether worker had noise induced hearing loss. RESULTS: Difference of hearing loss between before and after noise exposure for left and right ear was 11. 4 dB and 11. 7 dB respectively at 500 Hz, 8. 7 dB and 9. 6 dB at 1, 000 Hz, 6. 3 dB and 6. 9 dB at 2, 000 Hz and 6. 9 dB and 7. 4 dB at 4, 000 Hz in Group I. That for left ear and right ear was 5.8 dB and 4.9 dB at 500 Hz respectively, 5.4 dB and 6.4 dB at 1,000 Hz, 6.3 dB and 5.3 dB at 2,000 Hz, and 5.5 dB and 5.8 dB at 4,000 Hz in Group E. The sensitivity was 100 in both Groups and the specificity was increased to 58. 3 and 71. 8 in Group I and Group 3 respectively until 10 dB was deducted from hearing level at 1, 000 Hz and 4, 000 Hz. CONCLUSION: When the screening hearing test was performed at worksite, we might deduct 10 dB from measured hearing level to increase the specificity without reduction of sensitivity.