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Can self-report measures reliably predict audiometric measures in Hong Kong older adults?

Can self-report measures reliably predict audiometric measures in Hong Kong older adults?. 9 Oct 2005 Kevin Yuen 12 , Michael Tong 12 , Alex Lee 12 , Peter Tang 1 , Andrew van Hasselt 12 1 Institute of Human Communicative Research, Division of Otorhinolaryngology, Dept of Surgery,

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Can self-report measures reliably predict audiometric measures in Hong Kong older adults?

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  1. Can self-report measures reliably predict audiometric measures in Hong Kong older adults? 9 Oct 2005 Kevin Yuen12, Michael Tong12, Alex Lee12, Peter Tang1, Andrew van Hasselt12 1Institute of Human Communicative Research, Division of Otorhinolaryngology, Dept of Surgery, The Chinese University of Hong Kong & 2Hear Talk Foundation

  2. Objectives • To compare the prevalence of hearing problem estimated from self-reports and pure-tone audiometry • To investigate the performance of self-reports: (1) a single question, (2) HHIE-S in identifying individuals with hearing loss, against the standards from pure-tone audiometry

  3. Hearing Handicap Inventory for the Elderly – Screening (HHIE-S)(Ventry & Weinstein, 1983) • Self-administered 10-item questionnaire • Aim at detecting emotional and social problems associated with impaired hearing • Subjects respond to questions about circumstances related to hearing by stating whether the situations presents a problem • “no” (score 0) • “sometimes” (score 2) • “yes” (score 4) • Total HHIE-S score range from 0 to 40

  4. HHIE-S questions (English version) • Does a hearing problem cause you to feel embarrassed when you meet new people? • Does a hearing problem cause you to feel frustrated when talking to members of your family? • Do you have difficulty hearing when someone speaks in a whisper? • Do you feel handicapped by a hearing problem? • Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors? • Does a hearing problem cause you to attend religious services less often than you would like? • Does a hearing problem cause you to have arguments with family members? • Does a hearing problem cause you to have difficulty when listening to TV or radio? • Do you feel that any difficulty with your hearing limits/hampers your personal or social life? • Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

  5. HHIE-S questions (Chinese translation version) • 在遇見新相識的人時，聽力問題有否讓你感到尷尬？ • 在和家人交談時，聽力問題有否讓你感到受挫折？ • 當別人喁喁細語時，你有否感到聆聽困難？ • 聽力問題有否令你感到殘缺？ • 聽力問題有否令你在探望朋友,家人或鄰居時感到困難？ • 聽力問題有否令你參加宗教或其他活動較你希望能參加的為少？ • 聽力問題有否引至你和家人或朋友吵架？ • 聽力問題有否令你聆聽電視或收音機時感到困難？ • 你認為任何的聽力問題有否影響你的個人或社交生活？ • 和家人或朋友在餐廳時，聽力問題有否令你感到困難？

  6. Question 8 Does a hearing problem cause you to have difficulty when listening to TV or radio? 聽力問題有否令你聆聽電視或收音機時感到困難？ AnswerScore “yes” ”有”4 “sometimes” “間中有”2 “no” “沒有” 0

  7. Single Question Do you think you have a problem with your hearing? 你覺得你的聽力有問題嗎？

  8. Subjects • 1016 subjects participated in the “Ear and Hearing Assessment Project for the Elderly” (June to Oct 2004) • Data from 911 subjects were analyzed in this study • 99 subjects excluded (reported signs of dementia) • 6 subjects excluded (incomplete data) • Gender distribution • Male (n=369; 40.5%); female (n=542; 59.5%)

  9. Age and gender distribution

  10. Definition of hearing loss vs hearing handicap • Hearing loss by Pure Tone Audiometry • pure tone average (PTA) of 500,1k, 2k & 4kHz of the better ear • Hearing loss defined at 4 cut-off points • PTA ≥ 25dBHL • PTA ≥ 40dBHL • PTA ≥ 55dBHL • PTA ≥ 70dBHL • Hearing handicap by HHIE-S and Single Question • HHIE-S > 8, >10, >12 & >16 • Single Question -> Answered “yes”

  11. Comparison of prevalence rates • Definition of hearing loss • PTA >25dBHL (0.5 – 4kHz) of the better ear

  12. Odds ratios for the presence of hearing loss at different PTA cut-off levels *p < 0.05, **p < 0.01, *** p < 0.0005.

  13. Prevalence of hearing loss (measured) vs hearing handicap (estimation) • Estimated prevalence • -> Single question > HHIE >8 • Prevalence from • HHIE >8 (estimation) similar to PTA ≥ 40 (measured) Hearing loss Hearing handicap 82 63 38 34 13 4

  14. Comparison of measured (audiometry) vs estimated prevalence McNemar Test p < .001 for all comparisons * except for PTA >=40 vs HHIE >8 p = .04 *

  15. Screening performance characteristics Hearing problem from HHIE-S / Single Question? Sensitivity = TP / ( TP + FN) Specificity = TN/ (TN + FP) Positive predictive value (PPV) = TP / (TP + FP) Negative predictive value (NPV) = TN/ ( TN + FN) Hearing problem from audiometry ? Positive likelihood ratio (PLR) = sensitivity/ (1-specificity) Negative likelihood ratio (NLR) = (1-sensitivity)/ specificity

  16. HHIE-S vs Single Question HHIE-S better in ruling IN the presence of hearing loss (FP) Single Question better in ruling OUT the presence of hearing loss (FN)

  17. HHIE-S vs Single Question HHIE-S better in ruling in the presence of hearing loss, with better • PPV and PLR Single Question better in ruling out the presence of hearing loss, with better • NPV and NLR

  18. HHIE >8 HHIE >16 Perfect accuracy AUC = 1 Chance AUC = 0.5 Receiving-operating characteristic curves of different PTA cut-off levels with HHIE-S score • Area undercurve (AUC) = • Discriminating power of an HHIE-S score at each PTA cut-off levels. • Probabilitythat a random person with measured hearing loss (audiometry) has a higher HHIE-S score than a random person without the hearing loss HHIE-S cutoff increase Area under curve 0.83 0.78 0.69 0.67

  19. HHIE-S > 8 vs HHIE-S > 16

  20. Revised HHIE-S cut-off score • HHIE-S > 16 vs HHIE-S > 8 • Better specificity, accuracy, (PPV) and PLR • Worse (sensitivity) • Similar NPV, NLR according to the comparisons between 95% confidence intervals For PTA cut-off levels ≥ 40 & ≥ 55 dBHL

  21. SUPER POWER SCREENER ?! Combined “HHIE-S - Single Question” screening tool P – Pass F – Fail raise sensitivity lower FN raise FP

  22. SUPER POWER SCREENING TOOL ?! HHIE-S – Single Question

  23. Conclusion 1 The prevalence of hearing handicap (HHIE-S >8) is comparable with the prevalence of hearing loss (PTA ≥ 40dBHL)

  24. Conclusion 2 The prevalence of hearing handicap increases with age. The prevalence of hearing handicap is higher in male than in female.

  25. Conclusion 3 • HHIE-S better in ruling IN the presence of hearing loss • Single Question better in ruling OUT the presence of hearing loss • HHIE-S >16 has a better screening characteristics profile than HHIE-S >8 for screening PTA level ≥ 40 and ≥ 55 dBHL

  26. Conclusion 4 For older adults reported • with hearing handicap (HHIE > 16), the probability with PTA ≥ 40dBHL is 69% (Positive predicative value). • without hearing handicap (HHIE ≤ 16), the probability with PTA < 40dBHL is 69% (Negative predicative value). Overall accuracy = 69％

  27. Kevin Yuen Division of Otorhinolaryngology, Department of Surgery The Chinese University of Hong Kong kevinyuen@surgery.cuhk.edu.hk

  28. Screening performance characteristics Hearing problem from HHIE-S / Single Question? Sensitivity = TP / ( TP + FN) Specificity = TN/ (TN + FP) Positive predictive value (PPV) = TP / (TP + FP) Negative predictive value (NPV) = TN/ ( TN + FN) Hearing problem from audiometry ? Positive likelihood ratio (PLR) = sensitivity/ (1-specificity) Negative likelihood ratio (NLR) = (1-sensitivity)/ specificity

  29. HHIE >8 HHIE >16 Receiving-operating characteristic curves of different PTA cut-off levels with HHIE-S score • Area undercurve (AUC) = • Discriminating power of an HHIE-S score at each PTA cut-off levels. • Probabilitythat a random person with measured hearing loss (audiometry) has a higher HHIE-S score than a random person without the hearing loss HHIE-S cutoff increase Area under curve 0.83 0.78 0.69 0.67

  30. Prevalence of HHIE-S >8 with age and gender Prevalence of hearing handicap increases with age Pearson Chi square = 14.2, p <.01 Linear-by-linear association = 6.3, p <.001 higher in Male than in Female Pearson Chi square = 5.2, p <.05

  31. Prevalence of HHIE >8 with degree of hearing loss Prevalence of hearing handicap increases with hearing loss Pearson Chi square = 116.8, p <.001 Linear-by-linear association = 111.1, p <.001

  32. Measured (audiometry) vs estimated prevalence – by gender

  33. Screening performance characteristics of HHIE-S and Single Question

  34. Sensitivity and specificity • Sensitivity • increase with PTA cut-off • Single question better than HHIE-S • Specificity • decrease with PTA cut-off • HHIE-S better than Single question

  35. Positive and negative predictive values (PPV & NPV) • PPV • decrease with PTA cut-off • NPV • increase with PTA cut-off

  36. Positive and negative likelihood ratios (PLR & NLR) • PLR • Increase slightly with PTA cut-off • Increase with HHIE-S cut-off • NLR • decrease with PTA cut-off • Increase slightly with HHIE-S cut-off

  37. Accuracy

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