1. linical & Experimental Audiology 1 Online speech-in-noise screening test for occupational noise-induced hearing loss M. Sheikh Rashid, MSc, PhD candidate Dr. M. Leensen Dr.ir. J. de Laat Prof.dr.ir. W.A. Dreschler Clinical and Experimental Audiology, ENT department, Academic Medical Center(AMC) Amsterdam, the Netherlands m.sheikhrashid@amc.nl

2. linical & Experimental Audiology 2 Occupational Noise-induced Hearing Loss (NIHL)  One of the most reported occupational diseases in NL  Affects ability to understand speech-in-noise  Permanent damage develops gradually and unnoticed  Important to detect in an early stage healthy damaged

3. linical & Experimental Audiology 3 Occupational hearing screening  EU regulations apply >85 dB(A) Hearing screening is offered by employer  Current practice: Voluntary Infrequent (once every 4 years)  Insufficient screening (up to 50% nonresponse)  Method: Screening audiometry (unmasked AC only) Reference standard, but: Time-consuming and costly Validity issues (soundproof booth not available)

4. linical & Experimental Audiology 4 Internet-based speech-in-noise test  Valuable alternative for occupational NIHL screening: Functional test Independent of absolute presentation level Robust (equipment, environment) Self-administered, easy and fast (5 minutes) Low-cost method

5. linical & Experimental Audiology 5 Internet-based speech-in-noise test  Valuable alternative for occupational NIHL screening: Functional test Independent of absolute presentation level Robust (equipment, environment) Self-administered, easy and fast (5 minutes) Low-cost method  National Hearing test (C. Smits, 2004)  Earcheck  Hearing test for children  Occupational Earcheck (OEC)

6. linical & Experimental Audiology 6 Characteristics original OEC  Both ears tested separately  Simple up-down procedure  9 CVC words Paired vowels High-frequency consonants  Stationary speech shaped noise  35 stimuli Individual starting level Last 30 averaged for SRT

7. linical & Experimental Audiology 7 Evaluation and validation of OEC Phased approach: 1.To evaluate different (noise) versions of OEC in the lab: Discriminative power (sensitivity and specificity) Test validity (correlation with reference standard) Test reliability (test-retest difference and steepness of slope) 2.To validate OEC in noise-exposed workers: Discriminative power (sensitivity and specificity) Test validity (correlation with reference standard) Test reliability (test-retest difference and steepness of slope) 3.The applicability of OEC as a screening method

8. linical & Experimental Audiology 8 Phase I: Methods  Participants: 18 NH subjects (students) 15 subjects with NIHL (noise-exposed workers)  Procedure:  5 noise conditions of OEC  1 ear (randomly assigned)  test-retest  Reference test: pure-tone audiometry

9. linical & Experimental Audiology 9 Phase I: Masking noise conditions #Noise versionDescription Reference 1LTASSBroadband stationary speech-shaped noise Experimental set of low-pass filtered stationary noises 21400_-12Cut-off frequency 1400 Hz, noise floor -12 dB 31400_-15Cut-off frequency 1400 Hz, noise floor -15 dB 41600_-12Cut-off frequency 1600 Hz, noise floor -12 dB 51600_-15Cut-off frequency 1600 Hz, noise floor -15 dB

10. linical & Experimental Audiology 10 Lab performance new OEC (LP_1600_-12) Test-parameters Original*New Slope11.0 %/dB13.0 %/dB Sensitivity92%93% Specificity49%94% Correlation with PTA 3,4,6 r=0.66r=0.83 Mean Δ test-retest0.45 dB0.99 dB SEM1.26 dB1.08 dB ICC test-retest0.680.87 * Leensen, M.C., de Laat J.A., Dreschler, W.A. Speech-in-noise screening tests by internet, part 1: test evaluation for noise-induced hearing loss identification. Int J Audiol. 2011; 50 (11): 823-34.Speech-in-noise screening tests by internet, part 1: test evaluation for noise-induced hearing loss identification.

11. linical & Experimental Audiology 11 Summary  Original OEC not suitable for occupational screening  Improvement of the OEC Homogeneous speech material Improved test procedure LP masking noise  The new OEC > LP 1600 Hz, noise floor of -12 dB High sensitivity and specificity >90% Highly correlated with audiogram Improved test-retest reliability

12. linical & Experimental Audiology 12 Discussion  Two-gate design: healthy controls and known cases  Lab setting > Role of the test in practice  Only 1 ear tested  Clinical audiogram as reference  Representative sample (hearing status unknown)  Occupational setting  Both ear tested separately  Screening audiometry as reference

13. linical & Experimental Audiology 13 Evaluation and validation of OEC Phased approach: 1.To evaluate different (noise) versions of OEC in the lab: Discriminative power (sensitivity and specificity) Test validity (correlation with reference standard) Test reliability (test-retest difference and steepness of slope) 2.To validate OEC in noise-exposed workers: Discriminative power (sensitivity and specificity) Test validity (correlation with reference standard) Test reliability (test-retest difference and steepness of slope) 3.The applicability of OEC as a screening method

14. linical & Experimental Audiology 14 Occupational Earcheck

15. linical & Experimental Audiology 15 Phase II: Methods  Participants: 87 noise-exposed workers Occupational setting (quiet office room) Procedure:  OEC test  Screening audiogram  Retest (subgroup)

16. linical & Experimental Audiology 16 Phase II: Results Pure-tone thresholds

17. linical & Experimental Audiology 17 Phase II: Results Test retest reliability SRT test (dB SNR) SRT retest (dB SNR) Δ test-retest (dB SNR) pSEMICC* -16.6 (sd=2.5)-17.3 (sd=2.2)0.6 (95%-BI: -0.1; 1.3)0.071.040.62

18. linical & Experimental Audiology 18 Phase II: Results Correlation

19. linical & Experimental Audiology 19 Phase II: Results Sensitivity and specificity  Sensitivity and specificity (monaural)

20. linical & Experimental Audiology 20 Discussion  Distinguishes well between NH and NIHL (5 dB difference)  Small mean learning effect and SEM  Valid test: correlation of 0.71 with PTA  Accurate: sensitivity of 84% and specificity of 82% (monaural)  Goal: individual outcome (binaural)

21. linical & Experimental Audiology 21 Sensitivity and specificity on binaural basis BOC results (cut-off value: -19.4 dB SNR) PTA- (both ears) + (at least 1 ear) Total NH (both ears) 481866 NIHL (at least 1 ear) 21921 Total503787 True positive rate (sensitivity): 90% True negative rate (specificity): 73% False positive rate (1-specificity): 27% False negative rate (1-sensitivity): 10%

22. linical & Experimental Audiology 22 Evaluation and validation of OEC Phased approach: 1.To evaluate different (noise) versions of OEC in the lab: Discriminative power (sensitivity and specificity) Test validity (correlation with reference standard) Test reliability (test-retest difference and steepness of slope) 2.To validate OEC in noise-exposed workers: Discriminative power (sensitivity and specificity) Test validity (correlation with reference standard) Test reliability (test-retest difference and steepness of slope) 3.The applicability of OEC as a screening method

23. linical & Experimental Audiology 23 Pathway: Triage Employees suspected of NIHL OEC 1+1+ 2- TA TP/FP OEC 1+1+ 2- 1+1+ TN/FN NH/HI Retest year later Risk classification Retest year later Further investigation HI Action & Monitoring

24. linical & Experimental Audiology 24 What’s next? Phase III: Applicability OEC  Pilot among 100 employees  Screening audiometry and OEC  Automatic retest ear(s) with positive result  Main research objectives: 1. New cut-off value: Test sensitivity and specificity 2. Effect automatic retest on FP/FN 3. Second cut-off value > 3 categories (good, insufficient, poor) 4. Influence total test length 5. Risk classification

25. linical & Experimental Audiology 25 Acknowledgements  Dutch National Hearing Foundation (Nationale Hoorstichting)  Department of Audiology, Leiden University Medical Center, Leiden, the Netherlands  Zicht Online  Audiometrists: Dr. I Brons, L. Ruhaak, MSc., and J. Blom  Dr. K. S. Rhebergen  All occupational test locations, and research participants

26. linical & Experimental Audiology 26 Evaluation and validation of the Occupational Earcheck (OEC) An internet-based speech-in-noise test designed for occupational noise-induced hearing loss screening Marya Sheikh Rashid m.sheikhrashid@amc.nl

27. linical & Experimental Audiology 27 Characteristics Occupational Earcheck

28. linical & Experimental Audiology 28 Phase I: Results  Pure-tone thresholds Frequency (kHz) Hearing threshold (dB HL)

29. linical & Experimental Audiology 29 Phase I: Results  Discriminative power Noise condition

30. linical & Experimental Audiology 30 Phase I: Results  Sensitivity and specificity Noise version Cut-off value SNR (dB) SensitivitySpecificity LTASS-10.780%78% 1400_12-17.587%94% 1400_15-17.380%94% 1600_12-16.993%94% 1600_15-16.387%100%

31. linical & Experimental Audiology 31 Phase I: Results  Test-retest reliability Version Δ (test-retest) pSEMICC LTASS0.250.299 0.690.63 1400_-12-0.450.201 1.010.84 1400_-150.410.324 1.170.87 1600_-120.990.007* 1.080.87 1600_-151.160.004* 1.210.89

32. linical & Experimental Audiology 32 Phase I: Results  Validity: SRT- pure-tone audiometry correlation Noise condition Correlation SRT-PTA 3,4,6 LTASS0.70 1400_-120.79 1400_-150.81 1600_-120.83 1600_-150.82

33. linical & Experimental Audiology 33