Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Reliability of Measures Intended to Assess Threshold-Independent Hearing Disorders

Kamerer, Aryn M.; Kopun, Judy G.; Fultz, Sara E.; Neely, Stephen T.; Rasetshwane, Daniel M.

doi: 10.1097/AUD.0000000000000711
Research Articles

Objectives: Recent animal studies have shown that noise exposure can cause cochlear synaptopathy without permanent threshold shift. Because the noise exposure preferentially damaged auditory nerve fibers that processed suprathreshold sounds (low-spontaneous rate fibers), it has been suggested that synaptopathy may underlie suprathreshold hearing deficits in humans. Recently, several researchers have suggested measures to identify the pathology or pathologies underlying suprathreshold hearing deficits in humans based on results from animal studies; however, the reliability of some of these measures have not been assessed. The purpose of this study was to assess the test–retest reliability of measures that may have the potential to relate suprathreshold hearing deficits to site(s)-of-lesion along the peripheral auditory system in humans.

Design: Adults with audiometric normal hearing were tested on a battery of behavioral and physiologic measures that included (1) thresholds in quiet (TIQ), (2) thresholds in noise (TIN), (3) frequency-modulation detection threshold (FMDT), (4) word recognition in four listening conditions, (5) distortion-product otoacoustic emissions (DPOAE), (6) middle ear muscle reflex (MEMR), (7) tone burst-elicited auditory brainstem response (tbABR), and (8) speech-evoked ABR (sABR). Data collection for each measure was repeated over two visits separated by at least one week. The residuals of the correlation between the suprathreshold measures and TIQ serve as functional and quantitative proxies for threshold-independent hearing disorders because they represent the portion of the raw measures that is not dependent on TIQ. Reliability of the residual measures was assessed using intraclass correlation (ICC).

Results: Reliability for the residual measures was good (ICC ≥ 0.75) for FMDT, DPOAEs, and MEMR. Residual measures showing moderate reliability (0.5 ≤ ICC < 0.75) were tbABR wave I amplitude, TIN, and word recognition in quiet, noise, and time-compressed speech with reverberation. Wave V of the tbABR, waves of the sABR, and recognition of time-compressed words had poor test–retest reliability (ICC < 0.5).

Conclusions: Reliability of residual measures was mixed, suggesting that care should be taken when selecting measures for diagnostic tests of threshold-independent hearing disorders. Quantifying hidden hearing loss as the variance in suprathreshold measures of auditory function that is not due to TIQ may provide a reliable estimate of threshold-independent hearing disorders in humans.

Boys Town National Research Hospital, Omaha, Nebraska, USA.

Received September 20, 2018; accepted January 6, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

This research was supported by the National Institutes of Health/National Institute on Deafness and Other Communication Disorders grants R01 DC016348 and P30 DC004662. This research was funded by NIH 5R01DC016348-02.

A.K. analyzed data and wrote the article; J.K. and S.F. collected and managed data; S.N. and D.R. conceptualized and designed the study, designed and wrote software for data collection, and analyzed data. All authors discussed the results and implications and commented on the article at all stages.

The authors have no conflicts of interest to disclose.

Address for correspondence: Aryn M. Kamerer, Boys Town National Research Hospital, 555 N. 30th St, Omaha, NE 68131, USA. E-mail:

Online date: March 14, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.