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Audiometric threshold shift definitions: simulations and suggestions.

Robert A Dobie1

  • 1Department of Otolaryngology, University of California at Davis, Davis, California 95817, USA.

Ear and Hearing
|February 5, 2005
PubMed
Summary
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Choosing a hearing loss definition requires careful consideration of frequency range and acceptable false positives. Current evidence does not strongly support changing the OSHA significant threshold shift (STS) definition.

Area of Science:

  • Audiology and Occupational Health
  • Hearing Conservation
  • Statistical Modeling in Health

Background:

  • Accurate identification of hearing threshold shifts is crucial for occupational hearing conservation.
  • The Occupational Safety and Health Administration (OSHA) uses a specific definition for significant threshold shift (STS).
  • Evaluating the accuracy of different STS definitions and analysis methods is essential for effective hearing loss detection.

Purpose of the Study:

  • To compare the accuracy of pure-tone average (PTA) and any frequency (AF) definitions for detecting significant threshold shift (STS).
  • To assess whether applying STS definitions twice improves accuracy compared to a single application.
  • To evaluate the reliability of surrogate analysis methods for measuring STS definition accuracy and review existing evidence regarding the OSHA STS definition.

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Main Methods:

  • Computer simulations of audiograms with simulated hearing shifts and test-retest variability were used.
  • Receiver operating characteristic (ROC) area analysis was employed to determine the relative accuracy of PTA and AF variables.
  • Three surrogate analysis methods (confirmation, variability, comparison) were tested against ROC areas to assess their ability to measure accuracy.

Main Results:

  • Both PTA and AF definitions can be effective, with optimal choice depending on whether the hearing shift is at a single frequency or across multiple frequencies.
  • Applying STS definitions twice showed only a marginal improvement in accuracy compared to a single application.
  • Surrogate methods have limitations: comparison is best with a control group, variability requires multiple criterion values, and confirmation is least accurate and can exaggerate benefits.

Conclusions:

  • Selecting an STS definition involves subjective judgments regarding frequency range, repeated application, and acceptable false-positive rates.
  • Once these judgments are made, analytical techniques can help choose appropriate decision variables (PTA or AF) and criteria.
  • Further research with existing or new audiometric data is needed to definitively determine if any STS definition is superior to the current OSHA standard.