4.0 Article

Speech Recognition in Noise Using Binaural Diotic and Antiphasic Digits-in-Noise in Children: Maturation and Self-Test Validity

Journal

JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY
Volume 32, Issue 5, Pages 315-323

Publisher

THIEME MEDICAL PUBL INC
DOI: 10.1055/s-0041-1727274

Keywords

age; children; diotic; antiphasic; speech recognition threshold; binaural intelligibility level difference

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This study established normative data for diotic and antiphasic DIN in children, and assessed its validity as a smartphone self-test. Results showed age was significantly associated with improved SRT and BILD using diotic and antiphasic DINs.
Background Digits-in-noise (DIN) tests have become popular for hearing screening over the past 15 years. Several recent studies have highlighted the potential utility of DIN as a school-aged hearing test. However, age may influence test performance in children due to maturation. In addition, a new antiphasic stimulus paradigm has been introduced, allowing binaural intelligibility level difference (BILD) to be measured by using a combination of conventional diotic and antiphasic DIN. Purpose This study determined age-specific normative data for diotic and antiphasic DIN, and a derived measure, BILD, in children. A secondary aim evaluated the validity of DIN as a smartphone self-test in a subgroup of young children. Research Design A cross-sectional, quantitative design was used. Participants with confirmed normal audiometric hearing were tested with a diotic and antiphasic DIN. During the test, arrangements of three spoken digits were presented in noise via headphones at varying signal-to-noise ratio (SNR). Researchers entered each three-digit spoken sequence repeated by the participant on a smartphone keypad. Study Sample Overall, 621 (428 male and 193 female) normal hearing children (bilateral pure tone threshold of <= 20dB hearing level at 1, 2, and 4kHz) ranging between the ages of 6 and 13 years were recruited. A subgroup of 7-year-olds ( n =30), complying with the same selection criteria, was selected to determine the validity of self-testing. Data Collection and Analysis DIN testing was completed via headphones coupled to a smartphone. Diotic and antiphasic DIN speech recognition thresholds (SRTs) were analyzed and compared for each age group. BILD was calculated through subtraction of antiphasic from diotic SRTs. Multiple linear regressions were run to determine the effect of age on SRT and BILD. In addition, piecewise linear regressions were fit across different age groups. Wilcoxon signed-rank tests were used to determine differences between self- and facilitated tests. Results Age was a significant predictor, of both diotic and antiphasic DIN SRTs ( p <0.05). SRTs improved by 0.15dB and 0.35dB SNR per year for diotic and antiphasic SRTs, respectively. However, age effects were only significant up to 10 and 12 years for antiphasic and diotic SRTs, respectively. Age significantly (p <0.001) predicted BILD, which increased by 0.18dB per year. A small SRT advantage for facilitated over self-testing was seen but was not significant ( p >0.05). Conclusions Increasing age was significantly associated with improved SRT and BILD using diotic and antiphasic DINs. DIN could be used as a smartphone self-test in young children from 7 years of age with appropriate quality control measures to avoid potential false positives.

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