Hannah Guest

Purpose: Pediatric data in Arabic are largely absent from the digits-in-noise (DIN) literature, representing a critical gap in knowledge. This study aimed to describe the developmental patterns of Arabic antiphasic DIN thresholds in children aged 5–17 years, determine the age at which DIN thresholds converge with adult levels, and characterize age-related changes in task performance metrics, including response time, response time variability, psychometric function slopes, and digit-position effects. Method: Audiometrically normal Arabic-speaking children ( n = 65) and adults ( n = 33) completed antiphasic DIN testing. Age-related trends were analyzed to identify the onset of adultlike performance, with thresholds beyond this point compared to adults using equivalence testing. Exploratory analyses estimated developmental inflection points via segmented regression and reported effect sizes with confidence intervals. Further supplementary analyses examined age-related trends in response times, response time variability, psychometric slopes, and effects of digit position (1/2/3) on response accuracy. Results: Most 5-year-olds were unable to complete the DIN task, but thresholds approached adultlike levels from the age of 10 years, with evidence of equivalence from the age of 13 years within predefined bounds. Exploratory segmented regression suggested inflection points near the ages of 6 and 10 years, although confidence intervals were wide for the latter. Increasing age was linked to faster and more consistent responses with less consistent evidence for changes in psychometric slope. Response accuracy in the youngest children varied by digit position. Conclusions: Findings indicate rapid maturation of antiphasic Arabic DIN performance, with task acquisition emerging in early school age and near-adult thresholds observed in early adolescence. The observed developmental pattern likely reflects a combination of auditory and task-related cognitive and linguistic factors; however, these processes were not directly assessed in the present study and should be interpreted cautiously. These results provide provisional developmental reference points and require validation and test optimization in children with hearing loss before pediatric hearing screening implementation.

Purpose: Listening differences, particularly difficulties listening to speech in background noise, are well documented in autism. They can significantly affect individuals' well-being, social participation, and opportunities. Autistic people report that clinical guidance on managing these difficulties is lacking, meaning that they are left to develop their own strategies through trial and error. Underlying this limited support is limited research on the topic. The present study was co-produced with the autistic community to address this crucial gap in knowledge, gathering data on the listening strategies used by autistic adults, including their costs and benefits. Method: Through an online survey, 65 autistic adults described the strategies they used to manage difficult listening situations. A subset of participants provided supplementary data via an e-mail “interview” on the costs and benefits of their strategies, and how they were learnt or devised. This approach allowed interactive questioning without the stresses associated with conventional interview techniques. Results: Content analysis identified 91 strategies, organized thematically into six categories: shaping the listening situation, disclosing differences, requesting and encouraging adaptations, using internal strategies, using technology, and using vision. Most were rated “quite” or “very” useful by their users but were not without their costs. Nearly all were devised without clinical support. Conclusions: Autistic participants were able and willing to articulate the behaviors and technologies they rely on to manage challenging auditory environments. The evident need for tailored resources for both the community and clinicians makes these user-generated strategies a valuable foundation for developing effective guidance. This community-driven approach is especially relevant given the risks associated with clinical advice that may inadvertently promote masking behaviors. Overall, our data support a person-centered approach to this critical, yet often overlooked, domain.

Research into the long-term effects of noise on hearing is often confounded by health and lifestyle differences between individuals. UK police radio ear-pieces are capable of emitting high sound levels and, crucially, are worn in one ear, allowing between-ear comparisons which control for individual-level confounding factors. Low volume-control settings are recommended to reduce risk to police hearing, yet actual usage patterns and auditory effects remain unexamined. This study used a large-scale survey ( N = 4,498) to assess ear-piece noise exposure and the associated hearing health. Most participants reported using high volume-control settings and 45.2% reported experiencing signs of temporary threshold shift (TTS) in the exposed ear. Estimated weekly-averaged noise exposures frequently exceeded the UK's 85 dBA Upper Exposure Action Value. Ear-piece use was associated with 73% (95% confidence interval [CI] 46–106%) increased risk of persistent tinnitus, which on mediation analysis appeared to be driven by a subset of users who experienced signs of TTS. Importantly, tinnitus location was associated with the side of exposure, suggesting tinnitus related to device use rather than to other factors. In contrast, Digits-In-Noise thresholds showed no relation with noise exposure; potential explanations include compensatory auditory training effects, but limitations of Digits-In-Noise data must also be considered. Findings highlight a need for further investigation into hearing risks in police personnel, including in-person auditory testing. Risk mitigation strategies might involve improved device design, training on safe use, and expanded hearing health surveillance. Given the potential for cumulative auditory damage, TTS may serve as an early warning sign, warranting attention in broader noise-exposed populations.

Digit-perception tasks are widely used to assess auditory function in clinical and research settings, but performance may also be shaped by non-auditory participant characteristics. This study examined whether educational attainment, forward digit span, socioeconomic deprivation, and musical experience predicted performance on three digit-perception tasks that differed in masker type and spatial demands: digits in speech-shaped noise (SSN), digits in spatially separated babble, and a spatial-selective-attention task in which digit streams were separated by 15°. Participants were 220 young adults (aged 16-17 years at baseline) with bilaterally normal audiometric thresholds, each tested twice. The narrow age range and normal hearing constrained variation in peripheral auditory function, increasing sensitivity to non-auditory influences. Linear mixed-effects models were used to examine single-predictor and multivariate associations between the predictors and each outcome. Digits-in-SSN performance was unrelated to all predictors. Digits-in-babble thresholds showed modest associations with deprivation and educational attainment in single-predictor models, but neither survived multivariate adjustment. By contrast, spatial-selective-attention performance showed robust independent associations with educational attainment, deprivation, and musical experience after mutual adjustment. Forward digit span was not a significant predictor of any task. These findings indicate that spatially demanding digit-perception tasks are vulnerable to non-auditory confounds, and that controlling for short-term memory may be insufficient to address this problem. A secondary analysis examined whether the association between musical experience and spatial selective attention might reflect confounding rather than auditory training. The musician advantage was attenuated by approximately one third after adjustment for sociodemographic factors, consistent with a substantial contribution of confounding.

Noise-induced and age-related hearing loss involve partially similar pathophysiology, but their combined effects remain poorly understood, especially in under-regulated occupational settings. This study investigated the independent and interaction effects of lifetime noise exposure and age on audiometric, speech-in-noise, and tinnitus outcomes in Palestinian workers. Ninety-eight adult workers aged 18 – 75 years completed standard (0.25 – 8 kHz) and extended high-frequency (10 – 14 kHz) audiometry, Arabic diotic and antiphasic digits-in-noise (DIN) testing, and an Arabic Noise Exposure Structured Interview. Regression models tested age × noise interactions, adjusting for sex (and education for DIN), with Bonferroni–Holm correction applied for multiple comparisons. The protocol was pre-registered (Open Science Framework; https://osf.io/v2c9z ). There was no significant age × noise interaction for standard audiometric thresholds (3 – 8 kHz; β = 0.23 dB/year per log ₁₀ [noise], 95% CI 0.03 – 0.42; p = 0.02), after correction for multiple comparisons. Age-stratified analyses showed greater exposure was associated with worse standard audiometric thresholds in older adults (≥44 years; β = 8.1 dB per 10-fold increase, 95% CI 2.5 – 13.6; p = 0.005) but not younger adults. No interaction or main effects of noise were observed for extended high-frequency thresholds, DIN, or tinnitus ( p > 0.05). Age was significantly associated with standard and extended high-frequency audiometric thresholds and diotic and antiphasic DIN thresholds. Auditory outcomes were primarily age-driven, with limited noise effects. Greater noise-related threshold loss appeared in older adults, but age effects were larger, suggesting ageing as the dominant determinant. Hearing conservation should address age-related vulnerability alongside exposure control.

Adult auditory brainstem response (ABR) amplitudes are employed by both researchers and clinicians, but exhibit substantial between-subject variability, reducing their sensitivity as measures of underlying auditory health. One source of variability is sex, for which a number of mechanisms have been proposed. The present analysis aimed to determine whether ear-canal size influences ABR wave I amplitude, independent of sex. ABR wave I amplitudes and estimates of ear-canal diameter and volume were obtained from 220 otologically healthy teenagers. Multiple linear regression models tested for independent effects of sex and ear-canal size on ABR amplitudes. Participants were enrolled in a longitudinal study conducted by the Manchester Centre of Audiology and Deafness. The present data were gathered at baseline (age 16-17 years). The size of the sex effect on wave I amplitude was reduced by adding ear-canal diameter or volume to the model, but it remained significant. Ear canal diameter contributed modestly to wave I amplitude, independent of sex. Ear-canal volume produced null results. Findings are preliminary and strictly exploratory, but suggest that women's larger ABR amplitudes may be explained in part by their smaller ear canals, with implications for the sensitivity, comfort, and safety of ABR testing.

Background: Noise exposure is the main cause of preventable hearing loss worldwide. Findings from animal studies suggest that even moderate noise exposure can cause substantial damage to the cochlear nerve without any noticeable hair cell damage. Crucially, such damage need not affect sensitivity to quiet sounds and therefore may be difficult to diagnose. It is currently unclear which are the most sensitive physiological measures for early identification of noise-induced damage to the auditory system. The NExpo Study is a cross-sectional cohort study focussing on physiological, behavioural, and magnetic resonance imaging (MRI) measures of the effects of noise exposure. Objective: This paper introduces the NExpo Study, which aims to determine the functional and structural consequences of damage to the human peripheral and central auditory system resulting from cumulative lifetime noise exposure. The primary objective is to determine the neural correlates of noise exposure in the peripheral (cochlear nerve) and central (auditory brainstem and auditory cortex) auditory system. Secondary objectives are to assess the relative contributions of age and elevated audiometric thresholds to these observed neural correlates of damage, and the degree of association between structural and functional MRI measures of the auditory pathways and measures of peripheral and central auditory function. Methods and Analysis: Lifetime noise exposure is estimated using the Noise Exposure Structured Interview. Auditory function is assessed using extended high-frequency audiometry, distortion-product otoacoustic emissions, middle ear muscle reflexes, the auditory brainstem response, and speech reception thresholds in noise. MRI measures include magnetic resonance neurography and diffusion tensor imaging (DTI) of the cochlear nerve, and central measures of T1 myelination mapping, brain morphometry, DTI, and resting state functional MRI. The primary analyses employ between-group comparisons for these measures. Sample Description: The project plans to recruit 200 healthy adult volunteers, in four groups of 50 participants, based on their pure-tone hearing thresholds and lifetime noise exposure. Group 1: 18-19 years, normal hearing and low noise exposure; Group 2: 30-50 years, normal hearing for their age and low noise exposure; Group 3: 30-50 years, normal hearing for their age and high noise exposure; Group 4: 30-50 years, suspected noise-induced hearing loss and high noise exposure. Conclusion: Our comprehensive study, combining behavioural, physiological, and neuroimaging data, will contribute to the understanding of the mechanisms of auditory damage due to noise exposure. Results may inform diagnostic procedures, enabling the early identification of noise-induced auditory damage by detecting early changes in central auditory structure and processing. This approach could facilitate the provision of personalised advice regarding ear defence and monitoring for further damage, thus reducing the global impact of noise-induced auditory damage.

The study set out to acquire validation data for Arabic versions of the Digits-in-Noise (DIN) test, measured using browser-based software suitable for home hearing screening. DIN and pure-tone audiometric (PTA) thresholds were obtained from a sample of 155 Arabic-speaking participants, varying widely in age and in degree and type of hearing loss. DIN thresholds were measured using both diotic and antiphasic stimuli, with the goal of determining whether antiphasic testing provides superior prediction of poorer-ear hearing loss. A comprehensive study protocol was publicly pre-registered via the Open Science Framework. Both types of DIN threshold correlate with poorer-ear PTA thresholds after controlling for age, but the correlation is significantly stronger for antiphasic than diotic stimuli. Antiphasic DIN thresholds increase more steeply than diotic DIN thresholds as poorer-ear PTA thresholds increase, and are superior binary classifiers of hearing loss. Combined with previous results based on DIN data measured in participants’ homes, the present findings suggest that the browser-based Arabic DIN test may be effective in remote hearing screening, when combined with antiphasic digit presentation.

Purpose: The Digits-in-Noise (DIN) test is used widely in research and, increasingly, in remote hearing screening. The reported study aimed to provide basic evaluation data for browser-based DIN software, which allows remote testing without installation of an app. It investigated the effects of test language (Arabic vs. English) and test environment (lab vs. home) on DIN thresholds and test–retest reliability. It also examined the effects of test language on the correlations between DIN and audiometric thresholds. Method: Fifty-two bilingual adults with normal hearing aged 18–35 years completed Arabic and English diotic DIN tests (two sessions in the lab and two sessions at home via the web). Effects of language and environment on DIN thresholds were assessed via paired t tests, while intraclass and Pearson's/Spearman's correlation coefficients quantified test–retest reliability and relations to audiometric thresholds. Results: DIN thresholds were 0.74 dB higher (worse) for Arabic than English stimuli. Thresholds were 0.52 dB lower in the lab than at home, but the effect was not significant after correction for multiple comparisons. Intraclass and Pearson's correlation coefficients were too low for meaningful analysis due to the use of a normal-hearing sample with low between-subject variability in DIN and audiometric thresholds. However, exploratory analysis showed that absolute test–retest differences were low (< 1.2 dB, on average) for both languages and both test environments. Conclusions: Arabic DIN thresholds were a little higher than English thresholds for the same listeners. Employing home-based rather than lab-based testing may slightly elevate DIN thresholds, but the effect was marginal. Nonetheless, both factors should be considered when interpreting DIN data. Test–retest differences were low for both languages and environments. To support hearing screening, subsequent research in audiometrically diverse listeners is required, testing the reliability of DIN thresholds and relations to hearing loss.

Background & aims: Communicative and sensory differences are core autistic traits, yet speech-perception abilities and difficulties among autistic individuals remain poorly understood. Laboratory studies have produced mixed and inconclusive results, in part because of the lack of input from autistic individuals in defining the hypotheses and shaping the methods used in this field of research. Little in-depth qualitative research on autistic experiences of speech perception has been published, yet such research could form the basis for better laboratory research, for improved understanding of autistic experiences, and for the development of interventions. Existing qualitative research describes widespread autistic listening differences with significant impacts, but these results rely on data gathered via oral interviews in a small sample. The present study addresses these limitations and employs a mixed-methods approach to explore autistic listening experiences.Methods: We gathered survey data from 79 autistic individuals aged 18–55 without diagnosed hearing loss. The questionnaire included 20 closed-set questions on listening abilities and difficulties and three free-text questions on listening experiences. The free-text questions underwent deductive content analysis using a framework composed of themes from previous interview data on listening experiences (including auditory differences, contributing factors, impacts, and coping strategies). Concepts in the free-text data that were not part of the analysis framework were analyzed inductively.Results: In the closed-set data, participants reported listening difficulties in most specified environments, but complex background sounds and particularly background voices caused the most difficulty. Those who reported listening difficulties expressed having substantially greater difficulties than other people the same age. Participants indicated multiple impacts from listening difficulties, most prominently in their social lives. Concepts in the free-text data strongly supported previous interview data on listening differences and factors that affect listening ability, especially the diversity of types of listening difficulties. Consistent with the closed-set data, background-sound complexity and concurrent voices were especially troubling. Some concepts in the free-text data were novel, particularly difficulties with remote, broadcast, and recorded audio, prompting the creation of new themes.Conclusions: Both forms of data indicate widespread listening differences—predominantly listening difficulties—affecting most autistic adults. Diverse types of listening difficulty are evident, potentially indicating heterogeneous underlying mechanisms, and complexity of background noise is consistently identified as an important factor. Listening difficulties are said to have substantial and varied impacts. Autistic adults are keen to share coping strategies, which are varied and usually self-devised.Implications: Based on both the quantitative and qualitative results, we provide recommendations to improve future research and support the autistic community. The data-revealing types of listening difficulties can guide better quantitative research into underlying mechanisms. Such research should take into account potential heterogeneity in listening difficulties. Suggestions for optimized collection of self-report data are also offered. Additionally, our results could be used to improve societal understanding of autistic listening differences and to create beneficial interventions for and with autistic individuals. Moreover, given the willingness of the autistic community to share coping strategies, systematic collation of these strategies could form the basis for self-help and clinical guidance.