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Ear Hear. 2018 Jul/Aug;39(4):656-663. doi: 10.1097/AUD.0000000000000522.

The South African English Smartphone Digits-in-Noise Hearing Test: Effect of Age, Hearing Loss, and Speaking Competence.

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Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa.
Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.



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.


A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone 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.


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).


Self-reported English-speaking competence had a significant influence on the SRT obtained with the smartphone digits- in-noise 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.

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