Abstract：
OBJECTIVE: Motivated by the growing need for hearing screening in China, the present study has two objectives. First, to develop and validate a new test, called the Chinese Zodiac-in-noise (ZIN) test, for large-scale hearing screening in China. Second, to conduct a large-scale remote hearing screening in China, using the ZIN test developed.
METHODS: The ZIN test was developed following a similar procedure as the digits-in-noise test but emphasizes the importance of consonant recognition by employing the 12 zodiac animals in traditional Chinese culture as speech materials. It measures the speech reception threshold (SRT) using triplets of Chinese zodiac animals in speech-shaped noise with an adaptive procedure.
RESULTS: Normative data of the test were obtained in a group of 140 normal-hearing listeners, and the performance of the test was validated by comparisons with pure-tone audiometry in 116 listeners with various hearing abilities. The ZIN test has a reference SRT of -11.0 ± 1.6 dB in normal-hearing listeners with a test-retest variability of 1.7 dB and can be completed in 3 minutes. The ZIN SRT is highly correlated with the better-ear pure-tone threshold ( r = 0.82). With a cutoff value of -7.7 dB, the ZIN test has a sensitivity of 0.85 and a specificity of 0.94 for detecting a hearing loss of 25 dB HL or more at the better ear.A large-scale remote hearing screening involving 30,552 participants was performed using the ZIN test. The large-scale study found a hearing loss proportion of 21.0% across the study sample, with a high proportion of 57.1% in the elderly study sample aged over 60 years. Age and gender were also observed to have associations with hearing loss, with older individuals and males being more likely to have hearing loss.
CONCLUSIONS: The Chinese ZIN test is a valid and efficient solution for large-scale hearing screening in China. Its remote applications may improve access to hearing screening and enhance public awareness of hearing health.
METHODS: The ZIN test was developed following a similar procedure as the digits-in-noise test but emphasizes the importance of consonant recognition by employing the 12 zodiac animals in traditional Chinese culture as speech materials. It measures the speech reception threshold (SRT) using triplets of Chinese zodiac animals in speech-shaped noise with an adaptive procedure.
RESULTS: Normative data of the test were obtained in a group of 140 normal-hearing listeners, and the performance of the test was validated by comparisons with pure-tone audiometry in 116 listeners with various hearing abilities. The ZIN test has a reference SRT of -11.0 ± 1.6 dB in normal-hearing listeners with a test-retest variability of 1.7 dB and can be completed in 3 minutes. The ZIN SRT is highly correlated with the better-ear pure-tone threshold ( r = 0.82). With a cutoff value of -7.7 dB, the ZIN test has a sensitivity of 0.85 and a specificity of 0.94 for detecting a hearing loss of 25 dB HL or more at the better ear.A large-scale remote hearing screening involving 30,552 participants was performed using the ZIN test. The large-scale study found a hearing loss proportion of 21.0% across the study sample, with a high proportion of 57.1% in the elderly study sample aged over 60 years. Age and gender were also observed to have associations with hearing loss, with older individuals and males being more likely to have hearing loss.
CONCLUSIONS: The Chinese ZIN test is a valid and efficient solution for large-scale hearing screening in China. Its remote applications may improve access to hearing screening and enhance public awareness of hearing health.
摘要：
目的：由于中国对听力筛查的需求日益增长，本研究有两个目标。首先,开发和验证一个新的测试，称为中国十二生肖噪声（ZIN）测试，在中国进行大规模的听力筛查。第二,在中国进行大规模的远程听力筛查，使用ZIN测试开发。
方法：ZIN测试是按照与噪声数字测试类似的程序开发的，但通过采用中国传统文化中的12种十二生肖动物作为语音材料，强调辅音识别的重要性。它通过自适应程序在语音形状的噪声中使用中国十二生肖动物的三元组来测量语音接收阈值（SRT）。
结果：在140名听力正常的听众中获得了测试的规范数据，通过与116名具有不同听力能力的听众的纯音测听法进行比较，验证了测试的性能。ZIN测试在正常听力听众中的参考SRT为-11.0±1.6dB，测试重测变异性为1.7dB，可在3分钟内完成。ZINSRT与较好的耳朵纯音阈值高度相关（r=0.82）。截止值为-7.7dB时，ZIN检测在较好的耳朵处检测25dBHL或更高的听力损失的敏感性为0.85,特异性为0.94.使用ZIN测试进行了涉及30,552名参与者的大规模远程听力筛查。这项大规模研究发现，在整个研究样本中，听力损失比例为21.0%，在60岁以上的老年人研究样本中，这一比例高达57.1%。还观察到年龄和性别与听力损失有关联，老年人和男性更容易患听力损失。
结论：中国ZIN测试是中国大规模听力筛查的有效解决方案。它的远程应用可以改善听力筛查的访问，并增强公众对听力健康的认识。
方法：ZIN测试是按照与噪声数字测试类似的程序开发的，但通过采用中国传统文化中的12种十二生肖动物作为语音材料，强调辅音识别的重要性。它通过自适应程序在语音形状的噪声中使用中国十二生肖动物的三元组来测量语音接收阈值（SRT）。
结果：在140名听力正常的听众中获得了测试的规范数据，通过与116名具有不同听力能力的听众的纯音测听法进行比较，验证了测试的性能。ZIN测试在正常听力听众中的参考SRT为-11.0±1.6dB，测试重测变异性为1.7dB，可在3分钟内完成。ZINSRT与较好的耳朵纯音阈值高度相关（r=0.82）。截止值为-7.7dB时，ZIN检测在较好的耳朵处检测25dBHL或更高的听力损失的敏感性为0.85,特异性为0.94.使用ZIN测试进行了涉及30,552名参与者的大规模远程听力筛查。这项大规模研究发现，在整个研究样本中，听力损失比例为21.0%，在60岁以上的老年人研究样本中，这一比例高达57.1%。还观察到年龄和性别与听力损失有关联，老年人和男性更容易患听力损失。
结论：中国ZIN测试是中国大规模听力筛查的有效解决方案。它的远程应用可以改善听力筛查的访问，并增强公众对听力健康的认识。
