The South African English smartphone digits-in-noise hearing test: Effect of age, hearing loss, and speaking competence

Objectives: This study determined the effect of hearing loss and English-speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers. Design: A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared puretone air conduction thresholds to the speech reception threshold (SRT) recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners' self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 to 90 years), of whom 337 listeners had a best ear four-frequency pure-tone average (4FPTA; 0.5, 1, 2, and 4 kHz) of ≤25 dB HL. Results: A linear regression model identified three predictors of the digits-in-noise SRT, namely, 4FPTA, age, and self-reported English-speaking competence. The NN group with poor self-reported English-speaking competence (≤5/10) performed significantly (p < 0.01) poorer than the N and NN (≥6/10) groups on the digits-in-noise test. Screening characteristics of the test improved with separate cutoff values depending on English-speaking competence for the N and NN groups (≥6/10) and NN group alone (≤5/10). Logistic regression models, which include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operating characteristic curve, 0.962 and 0.903, respectively). Conclusions: Self-reported English-speaking competence had a significant influence on the SRT obtained with the smartphone digits-innoise test. A logistic regression approach considering SRT, self-reported English-speaking competence, and age as predictors of best ear 4FPTA >25 dB HL showed that the test can be used as an accurate hearing screening tool for N and NN English speakers. The smartphone digits-in-noise test, therefore, allows testing in a multilingual population familiar with English digits using dynamic cutoff values that can be chosen according to self-reported English-speaking competence and age.