[2026-03-20] Equalization of the Thai Digits-in-Noise Test: A Study on Young Adults With Normal Hearing Sensitivities

Authors

  • Sittiprapa Isarangura Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0002-3424-0219
  • Anatta Sereewattanakarn Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0006-0465-2796
  • Panyawee Dangsawasd Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • Pichaya Amaraphirakkhit Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0001-2924-6691
  • Samitanan Temworapanya Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0003-8782-962X
  • Somjin Chindavijak Department of Otolaryngology, Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
  • Cas Smits Department of Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands https://orcid.org/0000-0003-1617-1253
  • Carolina Der Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland https://orcid.org/0000-0001-8752-6758
  • Rattinan Tiravanichkul Department of Communication Sciences and Disorders, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33165/rmj.2027.e276573

Keywords:

Thai digits-in-noise test, Speech-in-noise perception, Digit equalization, Hearing screening, Speech reception threshold, Auditory perception

Abstract

Background: By the year 2050, nearly 2.5 billion individuals globally will experience some degree of hearing loss. To facilitate its systematic detection and timely intervention, it is imperative to develop a Thai digits-in-noise (DIN) test for efficient hearing screening.

Objectives: To equalize the intelligibility of recorded Thai digits in the DIN test, ensuring consistent speech perception in noise.

Methods: Twenty-five normally hearing young adults participated in this study (mean [SD] age, 21.68 [1.11] years). Thai digits from 0 to 9 were recorded by a female native speaker, and the best recordings were selected for the experiment. Speech-shaped noise was generated to match the long-term average spectrum of all digits. A custom MATLAB script was used to present digit triplet combinations at fixed signal-to-noise ratios from -20 to -2 dB in 2 dB steps. Antiphasic stimuli were delivered dichotically through insert earphones, and participants responded via a keypad. Speech reception thresholds (SRTs) for each digit were calculated to assess intelligibility. A repeated-measure ANOVA was used to compare the SRTs of all digits.

Results: The average SRT for each digit exhibited slight variability, ranging from -18.1 dB (number 4) to -10.8 dB (number 2). The overall mean SRT across all digits was -14.7 dB. Significant differences in intelligibility were found across the Thai digits. Intensity adjustments were applied to digits, resulting in perceptual equalization with no significant differences post-adjustment.

Conclusions: Variability in digit intelligibility reflects acoustic differences inherent in the Thai language. The equalized Thai digits demonstrated consistent intelligibility, so they are suitable for use in speech-in-noise testing among Thai speakers, supporting clinical and research applications.

References

World Health Organization. Hearing Screening: Considerations for Implementation. World Health Organization; 2021. 3 September 2021. Accessed 13 January 2026. https://www.who.int/publications/i/item/9789240032767

Department of Empowerment of Persons With Disabilities, Ministry of Social Development and Human Security. Statistics of persons with disabilities holding disability identification cards, classified by region and sex, 1 November 1994 to 29 February 2024. 4 March 2024. Accessed 13 January 2026. https://ecard.dep.go.th/nep_all/file/Stat2567/Stat_Feb67.pdf

American Speech-Language-Hearing Association. Guidelines for Manual Pure-Tone Threshold Audiometry. American Speech-Language-Hearing Association; 2005. Accessed 13 January 2026. https://www.asha.org/policy/GL2005-00014

Strategy and Planning Division, Office of the Permanent Secretary, Ministry of Public Health. Health Workforce Ratio, 2021. 10 May 2023. Accessed 13 January 2026. https://moph.gdcatalog.go.th/dataset/health_workforce_ratio/resource/f2b18884-fff5-45ef-8235-bdd2ba49c0b7

Medical Registration Division, Department of Health Service Support, Ministry of Public Health. Number of licensed health professionals as of 30 September 2023. 20 October 2023. Accessed 13 January 2026. https://mrd.hss.moph.go.th/mrd1_hss/?p=8537

Ceccato JC, Duran MJ, Swanepoel DW, et al. French version of the antiphasic digits-in-noise test for smartphone hearing screening. Front Public Health. 2021;9:725080. doi:10.3389/fpubh.2021.725080

Dawes P, Völter C. Do hearing loss interventions prevent dementia? Z Gerontol Geriatr. 2023;56(4):261-268. doi:10.1007/s00391-023-02178-z

Gao J, Zhu D, Deal JA, Lin FR, He P. Hearing impairment, family financial support, and depressive symptoms among Chinese middle-aged and older adults. Int J Geriatr Psychiatry. 2022;37(9):10.1002/gps.5788. doi:10.1002/gps.5788

Nkyekyer J, Meyer D, Pipingas A, Reed NS. The cognitive and psychosocial effects of auditory training and hearing aids in adults with hearing loss. Clin Interv Aging. 2019;14:123-135. doi:10.2147/CIA.S183905

Yadav AK, Ahsan A, Kumar V. Impact of hearing aid usage on emotional and social skills in persons with severe to profound hearing loss. J Audiol Otol. 2023;27(1):10-15. doi:10.7874/jao.2022.00290

World Health Organization. Deafness and hearing loss. 3 March 2026. Accessed 13 January 2026. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

Han JH, Yi DW, Lee J, Chang WD, Lee HJ. Development of a smartphone-based digits-in-noise test in Korean: a hearing screening tool for speech perception in noise. J Korean Med Sci. 2020;35(21):e163. doi:10.3346/jkms.2020.35.e163

Potgieter JM, Swanepoel de W, Myburgh HC, Hopper TC, Smits C. Development and validation of a smartphone-based digits-in-noise hearing test in South African English. Int J Audiol. 2015;55(7):405-411. doi:10.3109/14992027.2016.1172269

Smits C, Theo Goverts S, Festen JM. The digits-in-noise test: assessing auditory speech recognition abilities in noise. J Acoust Soc Am. 2013;133(3):1693-1706. doi:10.1121/1.4789933

De Sousa KC, Swanepoel W, Moore DR, Myburgh HC, Smits C. Improving sensitivity of the digits-in-noise test using antiphasic stimuli. Ear Hear. 2020;41(2):442-450. doi:10.1097/AUD.0000000000000775

Kim S, Kwak C, Han W, Seo JH, Oh Y. Factors influencing the Korean version of the digit-in-noise test. J Audiol Otol. 2023;27(2):88-96. doi:10.7874/jao.2022.00472

Masalski M, Morawski K. The multilingual digits-in-noise (DIN) test: development and evaluation. Int J Audiol. 2025;64(11):1193-1203. doi:10.1080/14992027.2024.2397068

Motlagh Zadeh L, Silbert NH, Sternasty K, Moore DR. Development and validation of a digits-in-noise hearing test in Persian. Int J Audiol. 2021;60(3):202-209. doi:10.1080/14992027.2020.1814969

Viola P, Astorina A, Mancuso A, et al. Development and validation of the Italian digit-in-noise test. Acta Otorhinolaryngol Ital. 2024;44(6):392-399. doi:10.14639/0392-100X-N3064

Wang S, Wong LLN. Development of the Mandarin digit-in-noise test and examination of the effect of the number of digits used in the test. Ear Hear. 2024;45(3):572-582. doi:10.1097/AUD.0000000000001447

Viveros Munoz RA, Fels J. Digit Triplet Test. RWTH Publications, 2019. doi:10.18154/RWTH-2019-06230

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Published

2026-03-20

How to Cite

1.
Isarangura S, Sereewattanakarn A, Dangsawasd P, Amaraphirakkhit P, Temworapanya S, Chindavijak S, Smits C, Der C, Tiravanichkul R. [2026-03-20] Equalization of the Thai Digits-in-Noise Test: A Study on Young Adults With Normal Hearing Sensitivities. Res Med J [internet]. 2026 Mar. 20 [cited 2026 Apr. 30];:e276573. available from: https://he02.tci-thaijo.org/index.php/ramajournal/article/view/276573

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