The wide availability of free or inexpensive hearing test applications for mobile devices such as smartphones and tablets has created a potential for more affordable and accessible hearing health care for patients and providers (Am J Audiol. 2015;24(3)]:293). Smartphone ownership among adults 65 years old and over has more than doubled in the past five years (Pew, 2017). Surveys show that older adults have become more technologically savvy and are increasingly using their smartphones for medical care management (AARP, 2018). Research indicates that in addition to a high prevalence of hearing loss among older adults, there is a high percentage of those who delay treatment or leave their hearing loss untreated. Untreated hearing loss in older adults has been associated with poorer psychosocial, communication, and cognitive function and a higher risk for developing dementia (Oyler. ASHA, 2012). As such, self-administered hearing test apps can be advantageous for older adults, who may not have access or are disinclined to seek audiological services. However, of the many hearing test apps available, few have been validated or have shown mixed findings in accuracy (JMIR Rehabil Assist Technol. 2016;3(2):e13). In this study, we evaluated the accuracy and clinical potential of two free iOS self-hearing test apps (Am J Audiol. 2018 Sep 13:1).
The self-test apps, uHear (App 1: Version 2.0.2, Unitron) and uHearingTest (App 2: Version 1.0.3, WooFu Tech, LLC.), are capable of measuring hearing sensitivity across frequencies. The app instructions included earphone image prototypes (e.g., earbuds or headphones) but did not specify an earphone make or model to use for the test. We explored the accuracy of these apps in threshold assessment and their validity in screening using different transducers (earbud earphones, supra-aural headphones, and circumaural headphones). The transducers were selected to match styles that a typical older adult might use with a self-hearing test app that doesn't provide earphone specifications.
Twenty-two individuals (44 ears; 9 men; 13 women) participated in the study. Ten had normal hearing <15 dB (M = 31.5 years) and 12 had bilateral mild-to-profound flat or sloping sensorineural hearing loss (M = 63 years). In a quiet test room, each participant received a conventional pure tone hearing test and conducted six self-hearing tests using the two hearing test apps and three transducers. The participants were asked to perform the self-hearing tests following the app instructions with the investigator present to randomize the order of test apps and transducers used. After the test, the hearing sensitivity outcomes obtained with the smartphone apps across frequencies and transducers were compared with conventional audiometry.
APPS VS. CONVENTIONAL AUDIOMETRY
Differences were observed in the accuracy of hearing sensitivity measures of the two hearing test apps compared with standard audiometry across frequencies among transducers (earbud earphones, supra-aural headphones, and circumaural headphones). However, both hearing test apps were found to be accurate (p >.002) with standard audiometry using specific earphones at mid- to high-frequencies. App 1 was accurate using the device-compatible earbuds at 1,000, 2,000, 4,000, and 6,000 Hz; App 2 was accurate using supra-aural headphones at 2,000, 4,000, and 8,000 Hz.
In addition, differences were noted in the validity of the test apps as a screening tool when using the three transducers. Both apps were found valid for screening mild or greater (>25 dB HL) hearing loss using specific earphones, showing high (81%–100%) sensitivity, specificity, positive, and negative predictive values. App 1 with earbuds showed validity as a screening tool across frequencies (500, 1,000, 2,000, 4,000, and 6,000 Hz); App 2 with supra-aural headphones was valid for screening at 2,000, 4,000, and 8,000 Hz.
CLINICAL POTENTIAL IN ADULTS
Our study determined that self-hearing test apps can be accurately used for hearing threshold assessment and screening of mild or greater hearing loss (>25 dB HL) in adults when using appropriate transducers. However, the study showed that without specific instructions, these apps could render inaccurate outcomes when used with certain transducers.
Though further research is needed on larger and diverse populations, and with additional apps and device platforms, these findings have positive implications for the clinical utility of self-hearing test apps when used appropriately. In older adults, self-hearing test apps can be advantageous for providing easy and personal access to a screening tool that can provide quick information on their risk for hearing loss. Conducting a self-hearing test might serve as the first step for older adults toward seeking services for untreated hearing loss.