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Validity of Automated Threshold Audiometry: A Systematic Review and Meta-Analysis

Mahomed, Faheema1; Swanepoel, De Wet1,2,3; Eikelboom, Robert H.1,2,3; Soer, Maggi1

doi: 10.1097/01.aud.0000436255.53747.a4
Research Articles

Objectives: A systematic literature review and meta-analysis on the validity (test–retest reliability and accuracy) of automated threshold audiometry compared with the gold standard of manual threshold audiometry was conducted.

Design: A systematic literature review was completed in peer-reviewed databases on automated compared with manual threshold audiometry. Subsequently a meta-analysis was conducted on the validity of automated audiometry.

Methods: A multifaceted approach, covering several databases and using different search strategies was used to ensure comprehensive coverage and to cross-check search findings. Databases included: MEDLINE, Scopus, and PubMed; a secondary search strategy was the review of references from identified reports. Reports including within-subject comparisons of manual and automated threshold audiometry were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) on test–retest reliability for automated compared with manual audiometry were determined to assess the validity of automated threshold audiometry.

Results: In total, 29 reports on automated audiometry (method of limits and the method of adjustment techniques) met the inclusion criteria and were included in this review. Most reports included data on adult populations using air conduction testing with limited data on children, bone conduction testing and the effects of hearing status on automated audiometry. Meta-analysis test–retest reliability for automated audiometry was within typical test–retest variability for manual audiometry. Accuracy results on the meta-analysis indicated overall average differences between manual and automated air conduction audiometry (0.4 dB, 6.1 SD) to be comparable with test–retest differences for manual (1.3 dB, 6.1 SD) and automated (0.3 dB, 6.9 SD) audiometry. No significant differences (p > 0.01; summarized data analysis of variance) were seen in any of the comparisons between test–retest reliability of manual and automated audiometry compared with differences between manual and automated audiometry.

Conclusion: Automated audiometry provides an accurate measure of hearing threshold, but validation data are still limited for (1) automated bone conduction audiometry; (2) automated audiometry in children and difficult-to-test populations and; (3) different types and degrees of hearing loss.

Supplemental Digital Content is available in the text.Automated threshold audiometry has existed for many decades. However, there has been a lack of summative evidence supporting its clinical use. This study conducted a systematic review and meta-analysis on the validity (test–retest reliability and accuracy) of automated threshold audiometry. Current evidence demonstrates that automated threshold audiometry provides an accurate measure of hearing threshold, as the differences between automated threshold audiometry fall within typical test–retest and intertester variability. However, validation is still limited in certain populations and forms of testing.

1Department of Communication Pathology, University of Pretoria, Pretoria, South Africa; 2Ear Science Institute Australia, Subiaco, Australia; and 3Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.

ACKNOWLEDGEMENT: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

Address for correspondence: De Wet Swanepoel, Department of Communication Pathology, University of Pretoria, Room 3–5, Level 3, Corner Lynnwood and University Road, Pretoria, South Africa. E-mail:

© 2013 by Lippincott Williams & Wilkins