As patient reports of hearing loss can be very subjective, objective measures using conventional audiometry are necessary. The emergence of recent technologies gives patients various options for performing audiometric assessments at their convenience and an affordable cost. For example, several commercial Internet-based hearing tests are available.
These online self-assessments are not expected to replace clinical audiometry; however, they may prove useful, particularly for patients in more rural areas and those who want to perform the examination on their own time.
In the study, we tested whether uHear, a personal electronic device-based hearing application, could provide data on hearing loss that is as accurate as that obtained by conventional audiologic testing.
We found that the uHear software was reliable at 2,000 Hz, 4,000 Hz, and 6,000 Hz. However, the app overpredicted hearing loss at the lower frequency levels of 250 Hz, 500 Hz, and 1,000 Hz compared with standard audiometry.
SIX HEARING THRESHOLD CATEGORIES
This prospective observational study, which was approved by the Texas Tech University Health Sciences Center (TTUHSC) Institutional Review Board, included 60 adults recruited from the TTUHSC Division of Otolaryngology–Head and Neck Surgery or Department of Speech, Language, and Hearing Sciences in Lubbock, TX.
In order to be included in the study, participants had to be at least 18 years old and competent enough to consent to participate.
Since most patients referred to a hearing healthcare clinic will have hearing loss, we had to recruit volunteers with normal hearing for the study.
The audiologist explained the study and its significance to participants and allowed them to ask questions. They were given an information sheet about the study and signed the consent form in order to be included.
An audiologist who was blinded to the results of the uHear test used conventional audiologic techniques to evaluate participants. Patients were tested at one of two sites: the Hearing and Balance Center or the TTUHSC Speech, Language, and Hearing Clinic. Subjects were not compensated for their participation.
Otoscopy was performed to ensure clear visualization of the tympanic membrane prior to testing. If the tympanic membrane could not be visualized, the subject was excluded from the study.
All participants had two hearing evaluations, with subjects serving as their own control. The two audiological tests were conducted consecutively.
First, a certified audiologist administered a conventional audiometric threshold screening assessment in a hearing test booth.
Then, participants were instructed on how to use the uHear app hearing test. They were taken to a quiet, private room with low ambient noise, as per the instructions from the uHear developer.
All clinical audiometers and equipment were up-to-date in terms of calibration, complying with American National Standards Institute (ANSI) 2004 standards, and all uHear testing was done with the same iPod Touch and the same pair of earbuds provided with the device.
The uHear app classifies test results according to six categories: normal hearing (up to 25 dB HL), mild hearing loss (26-40 dB HL), moderate hearing loss (41-55 dB HL), moderately severe hearing loss (56-70 dB HL), severe hearing loss (71-90 dB HL), and profound hearing loss (greater than 90 dB HL).
In our analysis, we described our behavioral testing results according to the uHear categories. For example, if a behavioral audiogram showed a threshold of 50 dB, then we put that patient in the moderate hearing loss category.
ACCURATE AT HIGHER FREQUENCIES
Pure-tone air-conduction thresholds were assessed for the frequencies 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, 4,000 Hz, and 6,000 Hz using traditional audiometry and the uHear application.
For both testing methods, the data for each frequency was averaged across all subjects. The calculated difference of means is shown in the table to illustrate the variation across methods.
In calculating this variation, each category of hearing loss was assigned a number (e.g., normal hearing = 1, mild hearing loss = 2, etc.). As demonstrated in the table, there is a significant difference between traditional audiometry testing (audio) and the uHear application at the frequencies of 250 Hz, 500 Hz, and 1 kHz, indicating that audiometry is a significantly better tool for testing hearing at these low frequencies.
On the other hand, there is no statistically significant difference between audiometry and uHear at the frequencies of 2,000 Hz, 4,000 Hz, and 6,000 Hz, which leads us to recommend that the uHear application be utilized as an initial screening tool for patients who believe that they may have some hearing loss. However, patients should follow up with a hearing healthcare professional.
MOST BENEFICIAL FOR ELDERLY
A traditional audiometric assessment involves the use of a clinical audiometer and a sound-treated room or enclosure. A clinical audiometer must be calibrated annually to meet the ANSI specifications. The sound-treated room is designed to minimize the external noise to which the patient is exposed during testing.
In the traditional assessment, a trained clinician collects audiometric data, while the uHear application is designed for use by the general population with no audiometric training. It is the concern of the hearing healthcare community that patients will rely on the application instead of seeking professional help for their hearing healthcare.
Because of the lack of hearing healthcare professionals and testing centers in remote regions, many people with hearing loss are unable to be tested and obtain proper correction. Personal electronic device-based applications could serve as an alternate way of assessing hearing ( JAMA 1998;279:1071-1075http://jama.jamanetwork.com/article.aspx?articleid=187415; Vital Health Stat 1994;10:188http://www.cdc.gov/nchs/data/series/sr_10/sr10_188.pdf). If accurate data can be obtained with these applications, their use would improve healthcare delivery by providing people who live in remote regions access to testing.
In an earlier study, Szudek et al reported that uHear was able to detect hearing loss at the same frequencies seen in this study and agreed with the conclusion that the app is a reasonable screening tool for moderate hearing loss ( J Otolaryngol Head Neck Surg 2012;41[suppl 1]:S78-S84http://www.ncbi.nlm.nih.gov/pubmed?term=can%20hear%20me%20now?%20validation%20of%20an%20ipod-based%20hearing%20loss%20screening%20test&cmd=correctspelling).
While the uHear application allows air-conduction hearing tests, it does not take into consideration bone-conduction testing or masking. The app has an option to test speech in noise, but it does not give the user a true masking of either ear. Because the uHear application is more accurate at high frequencies, it would be most beneficial for the elderly.
Major potential exists for the use of uHear and other comparable applications by primary care physicians. In the current healthcare environment, it can be cost prohibitive for a primary care physician to purchase the necessary space and equipment to perform audiometry testing. The use of a screening tool like uHear could increase the number of appropriate referrals to hearing healthcare professionals.