The Role of Diotic and Antiphasic Digits-in-Noise Tests in Predicting Various Types of Hearing Loss in Adolescents.
Stefanie N H Reijers, Jantien L Vroegop, Bernd Kremer and 1 others
The antiphasic digits-in-noise test outperforms the standard diotic version for detecting unilateral sensorineural and conductive hearing loss in adolescents.
It does not reliably detect early noise-induced notches, and both versions perform similarly for high-frequency loss.
Key findings
1The antiphasic DIN test had a substantially higher overall discriminatory ability than the diotic version (AUC 0.789 versus 0.613), with significantly stronger odds ratios for unilateral sensorineural hearing loss (OR 2.48 versus 1.34) and conductive hearing loss (OR 3.42 versus 2.07).
2For notches (early noise-induced hearing loss), the antiphasic condition showed a small but significant association (OR 1.09) yet a very low discriminatory ability (AUC 0.515), and the authors state it is unlikely to be useful for this purpose in practice.
3For high-frequency hearing loss, both conditions performed comparably (diotic AUC 0.627, antiphasic AUC 0.604), which the authors attribute to the test targeting 500 to 4000 Hz and the losses in the cohort being mostly mild.
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What it does not show
Bone conduction thresholds were not measured, so conductive hearing loss was defined by tympanogram type alone, which may misclassify some participants. Several hearing-loss categories had very small numbers: bilateral sensorineural loss had 7 participants, conductive loss 27, and unilateral sensorineural loss 44, limiting the precision of estimates for those groups. The high-frequency losses in this cohort were mostly mild, so the test's ability to detect more pronounced high-frequency deficits is unknown. The Dutch DIN test targets speech frequencies between 500 and 4000 Hz, which limits its sensitivity to losses above 6 kHz. Single-site cohort from one Dutch birth cohort; generalisability to other populations and age ranges is untested.
Declared interests
Funded by the Erasmus Medical Center, Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw). The funding organisations had no role in study design, data collection, analysis, interpretation, or manuscript preparation. The authors declare no conflicts of interest.
The easy way to misread this
Do not read the significant odds ratio for notches (OR 1.09) as evidence the antiphasic DIN can screen for early noise-induced hearing loss. The AUC was 0.515, the authors state it is unlikely to be useful in practice, and most notched participants still had a normal-range average threshold.
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