(1024) Exploring Pediatric Diagnostic Thresholds for Digits-in-Noise Audiometric Tablet Testing

Introduction: The purpose of this study was to establish unique pediatric cut-off criteria for differentiating conductive from sensorineural hearing loss in children ages 3-18 using a diotic and antiphasic digits-in-noise tablet-based testing, given that prior data suggests that adult criteria are ineffective in children.

Methods: Between June 2022 and August 2023, a prospective cohort of children aged 3-18 scheduled for an audiometric soundbooth evaluation with an audiologist and a same-day otolaryngologist exam were recruited for the study. Following a conventional audiogram, 159 subjects underwent diotic (same-phased stimuli) and antiphasic (out-of-phase stimuli) digits-in-noise testing on a HearX Samsung galaxy tablet with over-the-ear headphones, for a total of 318 measurements. Digits-in-noise test results were analyzed to determine whether a unique pediatric cut-off exists.

Results: The average age of children having ‘good’ understanding of the digits-in-noise test was 10.8 years of age, ‘fair’ understanding was 6.5 years, ‘poor’ was 6.1 years. Average age of children with ‘good’ understanding of the test was significantly higher than those with ‘fair’ and ‘poor’ understanding (p < 0.05). All 7 of the 3-year-olds enrolled had a ‘poor’ understanding of the test. Combined diotic and antiphasic SRT results did not have a clear delineation allowing the determination of CHL versus SNHL as compared to adults. Age and understanding of the test may be factors in reproducibility compared to adult data.

Conclusions: The use of diotic and antiphasic DIN is not as consistent in determining CHL from SNHL in the pediatric population as in adults, even when attempting to define a new pediatric-specific algorithm.