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NEUROLOGY 2009;72:1595-1600
© 2009 American Academy of Neurology

Calibrated finger rub auditory screening test (CALFRAST)

D. Torres-Russotto, MD, W. M. Landau, MD, G. W. Harding, MSE, B. A. Bohne, PhD, K. Sun, BS and P. M. Sinatra, AB

From the Departments of Neurology (D.T.R., W.M.L., K.S., P.M.S.) and Otolaryngology–Head and Neck Surgery (G.W.H., B.A.B.), Washington University in St. Louis School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Dr. Diego Torres-Russotto, Department of Neurological Sciences–Movement Disorders Program, University of Nebraska Medical Center, 982045 Nebraska Medical Center, Omaha, NE 68198-2045 drtorres{at}unmc.edu

Background: Determination of auditory function is a fundamental part of a complete neurologic examination. Disability from permanent hearing loss is common in the general population. Current bedside auditory tests are unreliable and cumbersome. We evaluated the calibrated finger rub auditory screening test (CALFRAST) as a routine diagnostic tool.

Methods: The sound spectrum and mean peak intensities of standard finger rub were measured, as well as background noise. CALFRAST overlapped the frequency spectrum of normal speech. Patients and companions were recruited from a neurology clinic. With arms extended, two stimulus intensities were presented: strong finger rub (CALFRAST–Strong 70) and the faintest rub that the examiner could hear (CALFRAST–Faint 70). With subjects’ eyes closed, each ear’s CALFRAST threshold was ascertained and then compared with its audiometric measure. The normal threshold was considered to be 25 dB. Validity, reliability, and discrimination abilities were obtained using standard methods.

Results: Two hundred twenty-one subjects (442 ears; 58% women) were examined. Ages ranged from 18 to 88 years, with a mean of 46 years. Eighty-five subjects (39%) had some degree of hearing loss. Both specificity and positive predictive value of CALFRAST–Strong 70 were 100%. Both sensitivity and negative predictive value of CALFRAST–Faint 70 were 99%, with a negative likelihood ratio <0.1. Area under the receiver operating characteristic curve was 0.94, consistent with excellent discrimination ability. Both intrarater and interrater reliability were excellent, both {kappa} >0.8. Subjects’ self-assessment of hearing was unreliable.

Conclusion: The calibrated finger rub auditory screening test (CALFRAST) is simple, accurate, inexpensive, and reliable. As a routine screening tool, CALFRAST may contribute to more efficient identification of auditory impairment.

Abbreviations: AHL = aging-related hearing loss; AT = auditory threshold; AUC = area under the curve; CALFRAST = calibrated finger rub auditory screening test; CI = confidence interval; FN = false negative; FP = false positive; LR = likelihood ratio; NIHL = noise-induced hearing loss; NLR = negative likelihood ratio; NPV = negative predictive value; PLR = positive likelihood ratio; PPV = positive predictive value; ROC = receiver operating characteristic; Sens = sensitivity; Spec = specificity; TN = true negative; TP = true positive.

Supported in part by NIH grants P30 NS057105 (Washington University Neuroscience Blueprint Translational Neuroscience Grant) and RR024992 (Washington University Institute of Clinical and Translational Sciences–Brain, Behavioral and Performance Unit).

Disclosure: The authors report no disclosures.

Medical Devices: Portable audiometer (Earscan3®; Micro Audiometrics, Murphy, NC); microphone (ER10-B+®; Etymotic Research, Elk Grove Village, IL); soundproof booth (120A-1®; Industrial Acoustics, Bronx, NY); sound level meter (no. 2203®; Brüel and Kjær, Nærum, Denmark).

Received November 5, 2008. Accepted in final form February 9, 2009.






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