Validation of a Smartphone-Based Hearing-in-Noise Test (HearMe)

Age-related hearing loss, or presbycusis, is highly prevalent among the elderly. It can have
a major impact on the quality of life due to progressive communication difficulties that may
lead to psychosocial dysfunction and in extreme cases to social isolation and depression.
Hearing aids and cochlear implants have evolved rapidly over the past decades and may
strongly improve quality of life in elderly with hearing loss. Nevertheless, it is estimated
that in the US and Europe only one out of five to six people with substantial hearing loss is
actually using hearing aids. In fact, nearly 50% of people with hearing loss never underwent
a hearing test at all. This may be due to denial of illness associated with aging or to
disbelieve in bene t from hearing aids or cochlear implants. Hearing screening could increase
awareness of hearing loss among elderly and identify those who might bene t from
amplification. However, classical audiometry (i.e. pure- tone thresholds and
speech-recognition in quiet) is not ideal for screening purposes as it is time consuming and
it requires expensive equipment including a soundproof booth and a calibrated audiometer.

Over the past decades, several Speech-In-Noise tests were developed to get a better
assessment of a person's hearing ability in real-life situations. These tests generally
measure the speech reception threshold (SRT) in dB signal to noise ratio (SNR). SRT is
determined as the difference between the level of presented speech and background noise at
which the tested per- son can correctly reproduce 50% of words or sentences. It is now
generally recognized that the SRT is more representative of a patient's hearing ability in
real-life situations than pure- tone audiometry or speech recognition in quiet. The Speech-
In-Noise test, based on spoken sentences, is still being used in clinical practice. However,
its general use for a broad clinical population has been disputed because not every person is
able to understand and repeat complete sentences in noise, regardless of his hearing loss.
This test is there- fore considered as an assessment of the entire auditory system, including
memory and certain linguistic aspects, rather than of hearing loss alone.

In 2013, the Digits-In-Noise (DIN) test was developed, overcoming several shortcomings of the
previous telephone test. It uses, for example, wideband signals instead of the limited
telephone bandwidth and concatenating digits, spoken by a male voice. The DIN test requires
listeners to repeat three spoken numbers (a so-called digit triplet) presented through a
headphone, while a continuous noise is presented synchronously to the same ear. The response
is then scored correct or incorrect automatically by the computer. Depending on the test
setting, the response can either be imputed by the listener him- self or by an administrator.
By using simple digits in a closed set paradigm, the contribution of top-down processing and
thus the influence of cognitive status is thought to be minimized. For this test, no learning
effect was detected, low measurement errors were reported (0.7 dB SNR for normal-hearing
listeners) and high validity was claimed by comparing measured digit- triplet SRTs and
sentence SRTs. Although SRT-in-noise reflects different aspects of hearing acuity than
pure-tone thresholds, both measures are also highly correlated. Previously reported
correlation coefficients vary from 0.77 to 0.86. These studies included populations with a
wide range of hearing losses, varying from severe to no hearing loss at all.

Based on this relationship, the DIN test could potentially be used as a screening instrument
for hearing loss. However, these two studies did not report specifically on a population of
elderly subjects, and this is one of the main target groups for hearing screening. It is
important to validate the assumed relationship between SRT-in-noise and hearing loss for this
particular population with a smartphone, as it may be influenced by general aging, for
example, a decline in cognitive skills.

The purpose of this project is to validate a quick, easy-to-use and administer smartphone
hearing-in-noise test. The app (called HearMe) can potentially be used to easily and quickly
collect hearing-in-noise and speech-in-noise measurements. The smartphone app developed is a
hearing-in-noise test that presents the subject with a series of stimuli consisting of a
spoken three-digit sequence presented at a varying hearing-to-noise ratio. For each stimulus
presentation, the user tap the three-digit sequence. The duration of the app is less than 3
minutes. For this project we will test at least 50 participants with hearing loss and 50
control subjects between the ages of 18-80. The participants will be invited to take the app.
The approach for this pilot study is to characterize hearing-in-noise thresholds (also
referred to as a speech-reception threshold) as measured by the app in both participant
groups, and relate it to the phenotype of each group as a preliminary evaluation of the app
as well as a preliminary validation against their routinely collected measurements of hearing
function (pure-tone audiometry thresholds).

With this study, the investigators aim to evaluate the developed smartphone HINT/DIN test for
its ability to screen the elderly for hearing loss. The investigators hope to examine the
relationship between pure-tone thresholds and SRT-in-noise as measured by the HearMe
smartphone application.

Inclusion Criteria:

- Age-matched (18-100)

- Healthy normal controls with no known hearing loss

- Patients with clinically assessed hearing loss

Exclusion Criteria:

- Complete hearing loss/deafness

- Cognitive decline or dysfunction, dementia