An Argument for Self-Report as a Reference Standard in Audiology

Area of Science:

• Audiology
• Diagnostic Accuracy Studies
• Hearing Science

Background:

• Pure-tone thresholds are traditionally the gold standard in audiology.
• Discrepancies exist between audiogram results and perceived hearing ability, particularly in noisy environments.
• This highlights a need for alternative reference standards in audiology diagnostics.

Purpose of the Study:

• To advocate for the use of self-report as a reference standard in audiology diagnostic accuracy studies.
• To review literature on pure-tone thresholds and self-report as reference standards.
• To assess the diagnostic accuracy of pure-tone thresholds and the Hearing-in-Noise Test (HINT) for identifying speech-recognition-in-noise disorders.

Main Methods:

• Literature review on reference standards in audiology.
• Evaluation of two groups: King-Kopetzky syndrome (KKS) with self-reported hearing difficulties and a control group.
• Diagnostic accuracy assessment using self-report as the reference standard, comparing pure-tone thresholds and HINT performance via sensitivity, specificity, and ROC curves.

Main Results:

• Self-report has been previously utilized as a reference standard for individuals with normal audiograms experiencing speech-in-noise difficulties.
• The HINT demonstrated statistically significant differences between KKS and control groups, unlike pure-tone thresholds.
• The HINT Composite score showed higher sensitivity (88%) and a larger area under the curve (AUC=0.87) compared to pure-tone average (PTA; 28% sensitivity, AUC=0.51).

Conclusions:

• Self-report is a justifiable reference standard for evaluating the diagnostic accuracy of speech-recognition-in-noise tests.
• In individuals with normal pure-tone thresholds, the HINT is more accurate than pure-tone thresholds for diagnosing speech-recognition-in-noise disorders.