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Hearing Journal:
doi: 10.1097/01.HJ.0000407398.79717.4f
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There's a hearing app for that

Coleman, Matthew

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Matthew Coleman is an editorial assistant with The Hearing Journal.

The trademarked catchphrase, “There's an app for that,” now has a place in hearing health care as the number of applications created to help individuals who suffer from hearing loss continues to grow daily.

Figure. Ear Trumpets...
Figure. Ear Trumpets...
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Apps are downloadable programs on mobile devices that provide individuals with a service, whether it's a game to pass the time, a recipe creator, or a convenient flashlight. These apps have become one of the most popular features of Apple and Android mobile devices, and now the hearing impaired have access to apps extending from hearing tests to actual hearing aids. The uncomplicated accessibility of these apps has increased usage among patients and has sparked the curiosity of practitioners.

“I think this is really exciting,” said Brian Fligor, ScD, Director of Diagnostic Audiology at Children's Hospital Boston. “It's exciting that any apps have been developed because it shows that people care about hearing. People care about sound and people's perception of sound. It's showing that the appropriate attention is being given to this topic.”

Josef Shargorodsky, MD, an otolaryngologist at the Massachusetts Eye and Ear Infirmary, who wrote an article on hearing apps with Fligor (Hearing Health Magazine, April 13, 2011), agreed that the increased attention on hearing loss, particularly among adoslescents, has assisted in making apps more popular.

“The problem is so prevalent,” said Shargorodsky. “Depending on the age groups, starting with adolescents, 20 percent of them have some sort of hearing loss. You go up to, for example, men in their 60s, and there is evidence that over 90 percent have high frequency hearing loss. It's such a widespread problem that people are more in tune with.”

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CAN YOU HEAR ME NOW?

Because of the increased attention on hearing loss, the most popular and widespread apps have been downloads that can test whether individuals have hearing loss.

Siemens, a large manufacturer of hearing aids, has created a free hearing test app for mobile Apple products. The five-minute screening program tests whether the participant can detect words in background noise. Another hearing aid manufacturer, Unitron, developed uHear, a hearing loss screening application. Unitron created the product because of the dearth of general hearing loss screening, said Director of Audiology Donald Hayes, PhD, who helped develop uHear.

“Family doctors are great at screening for diabetes and eye problems, but when it comes to screening for hearing loss, they crinkle paper and they have you look away when they talk to you. They don't do anything scientific at all, so the whole point of the uHear app was to say, “Look, you can easily do something that is properly controlled and will give you a good scientifically based screening.’”

The app contains three tests: a hearing sensitivity test, speech-in-noise test, and a questionnaire about common listening situations. Despite the name of the app, it is important to understand the distinction between a screen and a full-blown test, Hayes said. “Each one of the various three components of the uHear app is a screening tool,” he said. “People look at the Puretone test and they see that it functions as a regular hearing test and they are inclined to think that they are getting their hearing tested, [but] technically it is still a screener.”

As screens, these hearing tests make participants aware of potential hearing loss and then direct them to hearing professionals near their location by employing the phone's GPS feature.

“Encouraging individuals to visit professionals should be the goal of any of these online applications,” said Eric Branda, a Senior Manager of Product Management at Siemens. “None of these apps can take the place of any audiologist. People need to get further evaluation.”

Have hearing test apps sparked more visits to audiologists? So far, Fligor and Shargordosky have not encountered patients who have used the apps. A likely reason, Fligor said, is the lack of validation and data supporting them.

Figure. Unitrons uHe...
Figure. Unitrons uHe...
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“We know to a great extent that they are not accurate. Some of them may be accurate under certain circumstances,” he said.

“It's good as long it is something to get started, learn something about yourself, and see, for the most part, if you need to go see a professional, and as a screen measure.”

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THE PROTOTYPE

Supposing one does test positive for hearing loss and visits an audiologist, hearing aids are still expensive, and according to Hamid Djalilian, MD, Director of Otology and Neurotology at the Otolaryngology School of Medicine at the University of California, Irvine, the cost of aids is a big reason why less-costly apps have become popular. Djalilian is the co-creator of EarTrumpet, a $3 app that provides an audiogram and a sound amplification function, if needed.

Djalilian stresses that EarTrumpet is only a low-cost alternative to a hearing aid and a trip to a licensed audiologist is still crucial if one tests positive for hearing loss.

“This is not meant to diagnose hearing loss or to be an ENT or audiologist because there are subtleties that could be missed by using an iPhone app,” he said. “This is for someone who has been to an audiologist and cannot afford a hearing aid.”

EarTrumpet, though, does break the mold as a hearing aid app, making one question whether such applications could ever replace true hearing aids. Because of the highly variable needs of people who have hearing loss and the fact that the devices themselves are trying to anticipate what each and every hearing impaired individual needs, Fligor said this isn't likely.

“I have a hard time believing that an iPad or iPhone app is going to be able to replace the sophistication of some of these really advanced technologies,” he said.

Hearing aids, for example, Shargordosky said, are customized to the individual and apps are more general. While hearing test apps may be accurate puretone screeners, they do not test subtleties, like bone conduction testing, a necessary part of a standard hearing test.

Fligor added that the audiologist's role in making decisions for the individual and maximizing their use of technology can't be replaced by an app. “That's something that a lot of hearing professionals struggle with as it is, I don't see how a lay person can possibly do it themselves.”

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BEYOND SCREENING

Hearing apps do extend beyond the realm of testing and amplification. SpeechTrans, an independent speech-to-speech translation app for $99, allows people to record conversations that the app will transcribe into real-life subtitles.

Starkey, a hearing aid and protection company, has produced several hearing apps for consumers. The T2 Remote is a free app that allows one to control his hearing aid with a stroke on the iPhone or iPod touch by taking advantage of dual-tone multi-frequency signaling. Starkey also has a Hearing Loss Simulator app for $2 that allows users to experience what it is like to have hearing loss.

“Putting this kind of tool into the hands of the significant other of someone with hearing loss can help him better understand what the person is going through,” said Chris Howes, a Senior Software Product Manager at Starkey. “It's like walking a mile in somebody's shoes. “Being able to experience the hearing loss when you are a significant other helps you relate better to the issues that are facing your loved ones.”

The uHear app has been downloaded more than 600,000 times while Starkey's apps have racked up just more than 60,000 downloads. EarTrumpet has secured positive ratings and 2,400 downloads, and Speechtrans is currently the third highest-grossing travel App on iTunes.

Figure. Patients who...
Figure. Patients who...
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“When you look at mobile devices, they are ubiquitous,” said Hayes. “Everyone has them. And when you look at the people who have them, they have relatives who are older than them.

Figure. Starkeys Sou...
Figure. Starkeys Sou...
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“If I gave you an application that is really simple to use and fun, you'll download it and you'll use it once or twice, and then go to your dad and say, ‘You know dad, you haven't been hearing me well. Mom's been complaining. Why don't you try this out?’ It not only raises awareness, but also allows you to open the conversation with the person who is hearing impaired to say, “Look, this isn't me telling you that you have a problem; this is an app that doesn't care whether you can hear or not.”

Many of the app developers are also continuing to update and develop newer applications. Djalilian is currently working with John F. McGuire, MD, on developing a sound therapy app for their project, www.beyondtinnitus.com. Starkey is also working on a kid-friendly app for pediatrics that helps professionals guide children and their parents through the process of obtaining a hearing aid and understanding hearing loss.

“I think these hearing apps are just like adding extra tools to one's professional's toolbox,” said Howes. “It is adding the ability for any average consumer out there to gain information about hearing aids, loss, products, and then what options they might have for pursuing help.”

© 2011 Lippincott Williams & Wilkins, Inc.

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