title: Are false-positive rates leading to an overestimation of noise-induced hearing loss?
abstract: OBJECTIVE
  To estimate false-positive rates for rules proposed to identify early noise-induced hearing loss (NIHL) using the presence of notches in audiograms.
  
  
  METHODS
  Audiograms collected from school-age children in a national survey of health and nutrition (the Third National Health and Nutrition Examination Survey [NHANES III]; National Center for Health Statistics, 1994) were examined using published rules for identifying noise notches at various pass-fail criteria. These results were compared with computer-simulated "flat" audiograms. The proportion of these identified as having a noise notch is an estimate of the false-positive rate for a particular rule.
  
  
  RESULTS
  Audiograms from the NHANES III for children 6-11 years of age yielded notched audiograms at rates consistent with simulations, suggesting that this group does not have significant NIHL. Further, pass-fail criteria for rules suggested by expert clinicians, applied to NHANES III audiometric data, yielded unacceptably high false-positive rates.
  
  
  CONCLUSIONS
  Computer simulations provide an effective method for estimating false-positive rates for protocols used to identify notched audiograms. Audiometric precision could possibly be improved by (a) eliminating systematic calibration errors, including a possible problem with reference levels for TDH-style earphones; (b) repeating and averaging threshold measurements; and (c) using earphones that yield lower variability for 6.0 and 8.0 kHz--2 frequencies critical for identifying noise notches.
authors.affiliation: University of Minnesota, Minneapolis, USA. schla001@umn.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schlauch
authors.forename: Edward
authors.initials: E
authors.lastname: Carney
mesh_terms: D000293:Adolescent; D001301:Audiometry, Pure-Tone / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D001309:Auditory Threshold; D002648:Child; D003198:Computer Simulation; D005189:False Positive Reactions; D006317:Hearing Loss, Noise-Induced / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008954:Models, Biological; D009622:Noise; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014489:United States Occupational Safety and Health Administration / Q000592:standards; D055815:Young Adult