Diotic and Antiphasic Digits-in-noise Testing as a Hearing Screening and Triage Tool to Classify Type of Hearing Loss.
Karina C De Sousa, Cas Smits, David R Moore and 2 others
PMID 34799493WHAT IT FOUND
Antiphasic digits-in-noise testing detects unilateral or conductive hearing loss better than standard diotic testing.
A two-step screening process classified hearing types with reasonable accuracy, helping triage patients who need medical referral versus those who can proceed with standard audiometric or over-the-counter care.
Key findings
01Antiphasic DIN showed higher sensitivity and specificity for detecting hearing loss in the poorer ear compared to diotic DIN.
02A sequential antiphasic and diotic DIN procedure classified hearing loss types into normal, bilateral sensorineural, or unilateral/conductive groups with 75% to 79% overall accuracy.
03The first method using fixed cut-offs accurately identified 80.9% of unilateral or asymmetric sensorineural or conductive hearing loss cases, though it also referred 32.5% of bilateral sensorineural cases along the same path.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used convenience sampling, which may limit generalizability. The groups with unilateral/asymmetric sensorineural hearing loss (n=42) and conductive hearing loss (n=32) were small compared to the normal hearing (n=243) and bilateral sensorineural (n=172) groups. Mixed hearing loss cases were excluded from the main analysis. The sequential classification method still misclassified a significant proportion of bilateral sensorineural cases as requiring medical referral (32.5% in the recommended method), or failed to identify them (56.1% in the fixed cut-off method). Test-retest reliability was not assessed in this specific study design, though prior literature supports DIN reliability.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health under Award Number R43DC018427.
The easy way to misread this
Do not interpret the 75-79% overall classification accuracy as evidence that this test can definitively diagnose hearing loss types without clinical confirmation. The method still misclassified over half of bilateral sensorineural cases in the fixed cut-off model, and failed to identify 20-35% of unilateral or conductive cases depending on the algorithm used. It should be viewed as a triage tool to prioritize referrals, not a replacement for diagnostic audiometry.