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Hearing Aid Classification Based on Audiology Data

Conference Paper · September 2013

DOI: 10.1007/978-3-642-40728-4_47

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 Hearing aid classification based on audiology data

Christo Panchev1, Muhammad Naveed Anwar2, Michael Oakes1

1
Department of Computing, Engineering and Technology, University of Sunderland
St. Peters Campus, Sunderland SR6 0RD, United Kingdom
{christo.panchev, michael.oakes}@sunderland.ac.uk
2
Knowledge Media Institute, The Open University
Walton Hall, Milton Keynes MK7 6AA, United Kingdom
naveed.anwar@open.ac.uk

Abstract. Presented is a comparative study of two machine learning models

(MLP Neural Network and Bayesian Network) as part of a decision support
system for prescribing ITE (in the ear) and BTE (behind the ear) aids for people
with hearing difficulties. The models are developed/trained and evaluated on a
large set of patient records from major NHS audiology centre in England. The
two main questions which the models aim to address are: 1) What type of
hearing aid (ITE/BTE) should be prescribed to the patient? and 2) Which
factors influence the choice of ITE as opposed to BTE hearing aids? The
models developed here were evaluated against actual prescriptions given by the
doctors and showed relatively high classification rates with the MLP network
achieving slightly better results.
Keywords: Audiology Data Mining, Decision Support System, Multi-layer
Perceptron, Bayesian Network.

1 Introduction

There is a tremendous growth in the amount of data produced in the medical domain
[1] and many approaches, including statistical and neural approaches have been
proposed for medical data mining which produce information that helps in problem
solving and taking decisions [2,3,4].
The work presented here is based on the large data set of patient records from a major
British National Health Service (NHS) audiology centre in England containing
180,000 individual audiology records (from 23,000 patients). The decisions of
whether to prescribe an ITE or BTE hearing aid are typically made by audiology
technicians working in the out-patient clinics, on the basis of audiogram results and in
consultation with the patients. ITE hearing aids are not generally available on the
NHS in England, as they are more expensive than BTE hearing aids. However, both
types of aids are prescribed at the audiology centre providing the data. Usually the
choice is straightforward, but in some cases the technicians could benefit from a
second opinion (e.g one given by a decision support system) with an
explanation/justification of how that second opinion was arrived at.
2 Data Pre-processing

The following attributes were extracted from the raw data:

 Audiograms: the lowest decibel which the patient can hear across a number
of frequencies: Air conduction (AC) for 250, 500, 1000, 2000, 4000 and
8000 Hz; and Bone conduction (BC) for 250, 500, 1000, 2000 and 4000 Hz.
 Personal/diagnostic data: Age, Gender, Diagnosis, Tinnitus Masker, Mould,
Hearing aid.
 A set of keywords from the doctor’s free text notes.
The models presented here were developed and evaluated on the records which had
all fields filled for the right ear: AC (air conduction) and BC (bone conduction)
thresholds, gender, age and text keywords (5,736 records for training/validation and
1433 records for test), of which 128 also had non-null entries for diagnosis, 98 had
non-null entries for masker, and 3983 had non-null entries for mould. In the test set
782 records were given ITE aids, so simply assigning all the patients this type of aid
provides 54.6% agreement - referred to as the ZeroR baseline. Since, the data contains
only audiograms of patients with ITE/BTE hearing, we do not consider 'no aid class'.

3 Bayesian Network for ITE/BTE aids

Figure 1 represents the directed acyclic graph for the ITE/BTE aid the Bayesian
network obtained from Weka v3.4, where nodes represent the.

Fig. 1. Directed acyclic graph for ITE/BTE aid.

The learning of this network involves finding of edges, that is searching through the
possible sets of edges and for each set estimating the conditional probability tables
from the data.
The probability tables for ITE/BTE aid, Age and Gender obtained from the nodes (in
Figure 1) are given in Table 1 and Table 2. The probabilities for ITE/BTE aid are
calculated as 2663/ 5736 = 0.464 for BTE and 3073/ 5736 = 0.536 for ITE, where
2663 and 3073 are the number of instances of BTE and ITE respectively, and 5736
are the total number of instances of ITE/BTE aids.

Table 1. ITE/BTE aid probabilities.

ITE BTE
0.536 0.464

In Table 2, the probability for gender=male, age<=60, and BTE aid, that is, P(gender
= 'male'/age ='<= 60', aid ='BTE' ) is calculated as (339 + 1)/(673 + 2) = 0.504,
where 339 is the number of instances of “gender=male, age<=60, and BTE aid”, 1 is
the initial count for “gender=male, age<=60, and BTE aid”, 673 is the total number of
instances with “age<=60 and BTE aid”, and 2 is the count of different values of
gender (that is, male and female). Using the same method the probabilities for the rest
of the variables are calculated.

Table 2. Gender probabilities.

ITE/BTE aid Age Gender
Female Male
BTE <=60 0.496 0.504
BTE <=70 0.43 0.57
BTE <=78 0.555 0.445
BTE >78 0.71 0.29
ITE <=60 0.503 0.497
ITE <=70 0.403 0.597
ITE <=78 0.494 0.506
ITE >78 0.669 0.331

Testing of these Bayesian network showed that overall there was 93.2% agreement
between the predictions of this model and the actual hearing aid chosen by the
audiologist (as given in the “type” field) as shown in Table 3. The agreement rate was
higher for patients fitted with ITE aids (97.1%) than for those fitted with BTE aids
(88.5%).

Table 3. Confusion matrix of results of Bayesian network for ITE/BTE aids.

Human (expert) decision
Bayesian network ITE BTE Total
ITE 759 (97.1%) 75 (11.5%) 834
BTE 23 (2.9%) 576 (88.5%) 599
Total 782 651 1433 (93.2%)
Considering the ZeroR baseline of the data, which is 54.6%, the agreements found for
ITE and BTE provides a significant boost. The Bayesian network also includes
interaction of variables, for example, the variable gender was associated with
ITE/BTE aid (Figure 1) and also with age and the associated probabilities for gender
are calculated in Table 2. Similarly, other variables (such as, diagnosis, masker,
mould, AC250, BC250, etc.) were also found associated as shown in Figure 1.

4 Neural Network model for ITE/BTE aid

The second model that was deployed is based on a Multi Layer Perceptron. The
network had 21 input and 2 output neurons covering the data attributes (Table 4). The
network had 5 hidden neurons with hyperbolic tangent sigmoid activation function
and was trained using Levenberg-Marquardt backpropagation [5].

Table 4. Input and output attributes of the neural network.

Value Values Output: Values
Attribute
attribute
Age 0 - 78 ITE 0, 1
Male 0, 1 BTE 0, 1
Gender
Female 0, 1
Diagnosis -1, 0, 1
2107 0, 1
V1 0, 1
Mould 2107V1 0, 1
2112 0, 1
Other 0, 1
AC250 0 - 75
AC500 0 - 75
AC1000 0 - 75
AC2000 0 - 75
AC4000 0 - 75
Frequency AC8000 0 - 75
BC250 0 - 75
BC500 0 - 75
BC1000 0 - 75
BC2000 0 - 75
BC4000 0 - 75
Mask 0, 1

Table 5 presents the confusion matrix of the results from the neural network.
Although the neural network shows slightly higher overall performance (93.7%), the
results between the two models are qualitatively the same. As in the Bayesian model,
the highest agreement between the neural network and the medical expert is for the
ITE aids (98.2%). The highest misclassification of the models is for the case where
the model suggests an ITE aid whereas the human decision was to prescribe the BTE
one (11.7%). This is a partially expected result since, as mentioned earlier in the
paper, ITE aids are generally not available on NHS in England and doctors have the
tendency to bias their decisions toward the generally available BTE hearing aids.

Table 5. Confusion matrix of results of Neural network for ITE/BTE aids.

Human (expert) decision
Neural network ITE BTE Total
ITE 768 (98.2%) 76 (11.7%) 844
BTE 14 (1.8%) 575 (88.3%) 589
Total 782 651 1433 (93.7%)

5 Attribute significance for ITE/BTE classification

Following the results presented above, the importance of each of the input
attributes was evaluated for their relative contribution to the correct ITE/BTE
decision. The network trained with the full set of input features were evaluated in
separate tests where one of the input attributes was set to 0. The relative importance
of an attribute was calculated as proportional to the neural network’s misclassification
error during tests with the data of that factor being ignored. The output error was
calculated over the entire dataset (i.e. training, validation and test data). When a
particular input factor is removed, a higher output error will indicate that this attribute
is more significant in the performance of the model, i.e. higher importance/effect on
ITE/BTE classification, whereas a lower error would indicate relatively lesser degree
of relevance.

0.5
0.45
0.4
0.35
Misclassification

0.3
0.25
0.2
0.15
0.1
0.05
Diagno…

0
Age

Mould

AC250

AC500

AC1000

AC2000

AC4000

AC8000

BC250

BC500

BC1000

BC2000

BC4000
Base line

Mask
Gender

Fig. 2. Relative attribute importance of the input attributes toward the ITE/BTE classification.
The base line is 6.0% misclassification error with all input attributes present.

The results presented in Figure 2 show that the Mould is the most significant factor
in determining the ITE/BTE aid. This is another expected result, since medically the
mould type is highly correlated to the hearing aid being used. Leaving the mould
aside, the other significant attributes which can be identified are the Age and Gender
 causing increased misclassification errors of 12.6% and 11.5% respectively. On the
frequencies range, the most significant attributes are shown to be the bone conduction
frequencies BC1000 and BC2000 increasing the error to 11.2% and 10.7%
respectively. These results are similar to [6] where using logistic regression Age was
not found significant factor associated with ITE/BTE hearing aids but Gender,
BC1000 and BC2000 were found significant.

6 Conclusions

We have presented two machine learning models for the classification of ITE/BTE
hearing aids based on audiology data. Both models provide qualitatively similar
results with the Neural Network having slightly better classification rate, indicating
that they are both viable for implementation into a real decision support system for
hearing aid prescriptions. In addition, the disagreement rate between the models and
the audiology experts could provide a quantifiable measure as to what percentage of
patients could have benefited from prescribing the appropriate hearing aid based
purely on diagnostic data rather than considering the availability and costs of the
devices. Furthermore, the discovery of significant attributes (factors) and relationships
in audiology data for hearing aid classification will provide supplementary
information for audiology experts.

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