Optimizing the Chinese Zodiac-in-Noise Test with antiphasic stimuli

Authors: Yanqing He1, Huali Zhou1, AQinglin Meng1

1South China University of Technology

The Chinese Zodiac-in-Noise Test (ZIN) is a novel remote hearing screening tool designed for large-scale hearing screening in the Mandarin-speaking population. Latest research suggests that using antiphasic presentation in hearing tests can effectively improve screening sensitivity (De Sousa et al., 2020). This study investigates whether antiphasic presentation could boost the ZIN test’s sensitivity. First, the antiphasic version of the ZIN test was developed and normative data were established in 117 individuals with normal hearing (48 females and 69 males, mostly aged 16 to 30). The reference SRT for the Antiphasic ZIN test was -19.0 ± 3.2 dB, with a cutoff value of -13.6 dB, and a test-retest reliability of 1.2 dB. Then, screening performance between diotic and antiphasic presentations was compared in a group of 195 subjects with various degrees of hearing loss (88 females and 107 males, aged 18 to 59). Based on their audiograms, their hearing status was categorized into four types: normal hearing, symmetric hearing loss, asymmetric hearing loss, and unilateral hearing loss. The study found that, overall, the antiphasic ZIN test was more advantageous than the diotic ZIN test in screening for asymmetric hearing loss and unilateral hearing loss. The sensitivity and specificity of the antiphasic ZIN for detecting hearing loss in the poorer ear were 0.79 and 0.90, respectively, while those of the diotic ZIN were 0.49 and 0.97.