The effect of experience on the sensitivity and specificity of the whispered voice test: a diagnostic accuracy study

David McShefferty, William M Whitmer, Iain R C Swan, Michael A Akeroyd, David McShefferty, William M Whitmer, Iain R C Swan, Michael A Akeroyd

Abstract

Objectives: To determine the sensitivity and specificity of the whispered voice test (WVT) in detecting hearing loss when administered by practitioners with different levels of experience.

Design: Diagnostic accuracy study of WVT, through acoustic analysis of whispers of experienced and inexperienced practitioners (experiment 1) and behavioural validation of these recordings (experiment 2).

Setting: Research institute with a pool of patients sourced from local clinics in the Greater Glasgow area.

Participants: 22 people had their whispers recorded and analysed in experiment 1; 4 older experienced (OE), 4 older inexperienced (OI) and 14 younger inexperienced (YI). In experiment 2, 73 people (112 individual ears) took part in a digit recognition task using 2 OE and 2 YI whisperers from experiment 1.

Main outcome measures: Average level (dB sound pressure level) across frequency, average level across all utterances (dB A) and within/across-digit deviation (dB A) for experiment 1. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WVT for experiment 2.

Results: In experiment 1, OE whisperers were 8-10 dB more intense than inexperienced whisperers across all whispered utterances. Variability was low and comparable regardless of age or experience. In experiment 2, at an optimum threshold of 40 dB HL, sensitivity and specificity were 63% (95% CI of 58% to 68%) and 93% (92% to 94%), respectively, for OE whisperers. PPV was 56% (51% to 61%), NPV was 95% (94% to 96%). For YI whisperers at an optimum threshold of 29 dB HL, sensitivity and specificity were 80% (78% to 82%) and 52% (50% to 55%), respectively. PPV was 65% (63% to 67%) and NPV was 70% (67% to 72%).

Conclusions: WVT is an effective screening test, providing the level of the whisperer is considered when setting the test's hearing-loss criterion. Possible implications are voice measurement while training for inexperienced whisperers.

Figures

Figure 1
Figure 1
Average level (dB sound pressure level) for each digit across three sessions as a function of frequency for three whisperer groups (older experienced, older inexperienced and younger inexperienced) showing±1 SD. Clinic-room noise superimposed to show possible masking effects.
Figure 2
Figure 2
Mean per cent correct over 15 simulated whispered voice test trials as a function of three-frequency pure-tone average (PTA) hearing loss for 112 individual ears tested with the recordings of 2 older experienced and 2 younger inexperienced whisperers. Data points above the 50% threshold indicate a pass.
Figure 3
Figure 3
Receiver operating characteristic analysis for experienced and inexperienced whisperers, showing sensitivity as a function of false-positive rate for each whisperer (separate panels). Points along the curve are labelled in 5 dB HL increments, and the total area under the curve is given below the diagonal.

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