Remote monitoring of adult cochlear implant recipients using speech-in-noise testing

Abstract

Tele-audiology has progressed from information sharing and diagnostic testing to remote fitting, programming, and maintenance of hearing aids (HAs) and cochlear implant (CI) devices. The demand for remote service options has increased dramatically as a result of the communicable nature of COVID-19 and the need for social distancing. Remote services have provided a means to continue monitoring outcomes and detect changes in the hearing and speech recognition of CI recipients. The smartphone Digits-in-Noise (DIN) test offers a way to provide clinicians with speech recognition information remotely. The DIN test is a widely used and preferred test due to its reliability, validity, user-friendly self-test applications, time efficiency, and low linguistic demands. The DIN test has also been shown to produce robust results across various sound field transducers, which makes home-based monitoring possible. This study evaluated the reliability and accuracy of the DIN test conducted by adult CI recipients in a simulated home environment compared to a clinic set-up. Perceptions of remote monitoring using speech-in-noise (SIN) testing were also explored.

A retrospective, explorative, within-subjects repeated measures study design was utilised. Thirty-three adult CI recipients (mean age 46.7 years, 20.4 SD) conducted the DIN test in a clinic and simulated home environment setup. Comparisons between test settings and test-retest reliability across the two environments were assessed. The perceptions of adult CI recipients regarding remote monitoring and use of the DIN self-test were explored by means of a self-administered survey.

Results of the study indicated that mean aided speech reception thresholds (SRTs) in the clinic and simulated home environment test conditions (mean 7.9, 10.7 SD) and clinic and simulated home environment retest conditions (mean 5.4, 9.6 SD) did not differ significantly. Mean test-retest SRTs in the clinic (p = .037) and simulated home environment (p = .014) were significantly different. Low standard error of measurement (SEM) and high intraclass correlation coefficient (ICC) scores revealed good and excellent reliability between test–retest measures and between clinic and simulated home environment measures. The majority of the participants were positive about using the DIN test at home to self-assess speech perception although some test adjustments such as including training items and a less adverse starting signal-to-noise ratio (SNR) may be required.

This explorative study indicated that adult CI recipients could use the smartphone DIN test to self-assess aided SIN performance in a home environment with accuracy and reliability relatively similar to clinic testing. DIN self-testing can potentially assist with troubleshooting of CI devices and reduce the need for regular visits to the CI clinic. As a result of the COVID-19 pandemic, CI recipients are more inclined to use remote CI services and tests such as the DIN test to self-assess speech perception at home. With minor changes to testing procedures, the DIN test could possibly be used by clinicians as part of the standard test battery as a reliable and accurate SIN test for adult CI recipients.