Objectives: The digits-in-noise (DIN) test is a validated tool for assessing speech reception thresholds in noise and is widely used in hearing screening. The diotic DIN condition presents identical digits and noise to both ears, whereas the antiphasic condition uses phase-inverted digits, which may enhance sensitivity to specific types of hearing loss. This study aimed to evaluate whether the antiphasic DIN condition better predicts various types of hearing loss than the diotic condition, with a particular focus on its value in identifying patterns suggestive of noise-induced hearing loss in adolescents. Design: This was a cross-sectional study conducted among 2851 adolescents aged 16 to 22 years participating in a population-based cohort study. All participants underwent pure-tone audiometry, tympanometry, and both diotic and antiphasic DIN tests. Hearing loss was categorized based on audiometric criteria into unilateral or bilateral sensorineural hearing loss (SNHL), conductive hearing loss, notched audiograms, and high-frequency hearing loss (HFHL). Logistic regression models were used to examine associations between DIN outcomes and hearing loss categories. Receiver operating characteristic curve analyses were conducted to assess the discriminative ability of the diotic and antiphasic conditions. Results: Mean DIN speech reception thresholds were −9.0 dB for the diotic condition and −16.1 dB for the antiphasic condition. The antiphasic condition showed stronger correlations with audiometric thresholds and steeper regression slopes, indicating greater sensitivity to hearing loss. It more accurately predicted unilateral SNHL (odds ratio OR = 2.48 versus 1.34 for diotic) and conductive hearing loss (OR = 3.42 versus 2.07). Although there was an association with notched audiograms (OR = 1.09), the discriminative ability of the antiphasic condition for detecting this pattern was low (area under the curve AUC = 0.515). Predictive values for HFHL were comparable between the two conditions (OR = 1.23 antiphasic versus 1.60 diotic). Overall, the antiphasic DIN condition showed a higher AUC (0.789) for detecting any hearing loss than the diotic condition (0.613). Conclusions: Both DIN conditions were associated with hearing loss, but the antiphasic condition demonstrated superior sensitivity, particularly for detecting unilateral SNHL and conductive hearing loss. Its association with notched audiograms was statistically significant, yet the low discriminative value limits its practical use in screening for noise-induced hearing loss. For HFHL, both DIN conditions performed similarly, possibly due to the mild degree of hearing loss in most cases. These findings support the use of the antiphasic DIN condition as a more effective screening tool for specific types of hearing loss in adolescents, though its utility for identifying early signs of noise-induced damage remains limited.
Reijers et al. (Fri,) studied this question.