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. 2019 Nov/Dec;40(6):1267-1279.
doi: 10.1097/AUD.0000000000000711.

Reliability of Measures Intended to Assess Threshold-Independent Hearing Disorders

Aryn M Kamerer  1 , Judy G Kopun, Sara E Fultz, Stephen T Neely, Daniel M Rasetshwane
Affiliations

Reliability of Measures Intended to Assess Threshold-Independent Hearing Disorders

Aryn M Kamerer et al. Ear Hear. 2019 Nov/Dec.

Abstract

Objectives: Recent animal studies have shown that noise exposure can cause cochlear synaptopathy without permanent threshold shift. Because the noise exposure preferentially damaged auditory nerve fibers that processed suprathreshold sounds (low-spontaneous rate fibers), it has been suggested that synaptopathy may underlie suprathreshold hearing deficits in humans. Recently, several researchers have suggested measures to identify the pathology or pathologies underlying suprathreshold hearing deficits in humans based on results from animal studies; however, the reliability of some of these measures have not been assessed. The purpose of this study was to assess the test-retest reliability of measures that may have the potential to relate suprathreshold hearing deficits to site(s)-of-lesion along the peripheral auditory system in humans.

Design: Adults with audiometric normal hearing were tested on a battery of behavioral and physiologic measures that included (1) thresholds in quiet (TIQ), (2) thresholds in noise (TIN), (3) frequency-modulation detection threshold (FMDT), (4) word recognition in four listening conditions, (5) distortion-product otoacoustic emissions (DPOAE), (6) middle ear muscle reflex (MEMR), (7) tone burst-elicited auditory brainstem response (tbABR), and (8) speech-evoked ABR (sABR). Data collection for each measure was repeated over two visits separated by at least one week. The residuals of the correlation between the suprathreshold measures and TIQ serve as functional and quantitative proxies for threshold-independent hearing disorders because they represent the portion of the raw measures that is not dependent on TIQ. Reliability of the residual measures was assessed using intraclass correlation (ICC).

Results: Reliability for the residual measures was good (ICC ≥ 0.75) for FMDT, DPOAEs, and MEMR. Residual measures showing moderate reliability (0.5 ≤ ICC < 0.75) were tbABR wave I amplitude, TIN, and word recognition in quiet, noise, and time-compressed speech with reverberation. Wave V of the tbABR, waves of the sABR, and recognition of time-compressed words had poor test-retest reliability (ICC < 0.5).

Conclusions: Reliability of residual measures was mixed, suggesting that care should be taken when selecting measures for diagnostic tests of threshold-independent hearing disorders. Quantifying hidden hearing loss as the variance in suprathreshold measures of auditory function that is not due to TIQ may provide a reliable estimate of threshold-independent hearing disorders in humans.

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Figures

Figure 1.
Figure 1.
Exemplar tone-burst ABR waveforms from one participant for both electrode montages: Wave I amplitude was calculated from the tiptrode montage (top) as the absolute difference between the peak and the preceding trough. Wave V amplitude was calculated from the vertex montage (bottom) as the difference between the peak and the following trough.
Figure 2.
Figure 2.
Exemplar speech-ABR waveform from one participant, where the discrete peaks (V, A, C, D, E, & F) are highlighted.
Figure 3.
Figure 3.
Correlation between visits 1 and 2 for z-scores of threshold in noise (TIN) residuals at 1.5 kHz (left) and 4 kHz (right). The dashed line indicates perfect reliability between visits.
Figure 4.
Figure 4.
Correlation between visits 1 and 2 for z-scores of frequency-modulation detection threshold (FMDT) residuals. The dashed line indicates perfect reliability between visits.
Figure 5.
Figure 5.
Correlation between visits 1 and 2 for z-scores of word recognition residuals in four listening conditions: quiet (top-left), noise (top-right), time-compressed plus reverberation (bottom-left) and time-compressed alone (bottom-right). Filled squares indicate participants whose difference in score between visits was considered significant according to the 95% confidence intervals presented by Thornton & Raffin (1978). The dashed line indicates perfect reliability between visits.
Figure 6.
Figure 6.
Correlation between visits 1 and 2 for z-scores of distortion-product otoacoustic emissions (DPOAE) residuals at 1.5 kHz (left) and 4 kHz (right). The dashed line indicates perfect reliability between visits.
Figure 7.
Figure 7.
Pearson correlation coefficients as a function of activator level for the middle ear muscle reflex. Black boxes indicate r-values for the ipsilateral probe and grey circles represent r-values for the contralateral probe.
Figure 8.
Figure 8.
Correlation between visits 1 and 2 for z-scores of middle ear muscle reflex (MEMR) residuals in the contralateral (left) and ipsilateral (right) probe conditions. The activator level was 90 dB SPL for both conditions. The dashed line indicates perfect reliability between visits.
Figure 9.
Figure 9.
Correlation between visits 1 and 2 for z-scores of wave amplitudes of the tone-burst ABR (tbABR) residuals at 1.5 kHz (left) and 4 kHz (right). Wave I amplitude was calculated from the tiptrode montage (top) and wave V from the vertex montage (bottom). The dashed line indicates perfect reliability between visits.
Figure 10.
Figure 10.
Correlation between visits 1 and 2 for z-scores of wave amplitudes of the speech ABR (sABR) residuals. The dashed line indicates perfect reliability between visits.
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