A home hearing test was found to be a reliable alternative to manual audiometry, highlighting the possibility of accurately evaluating audiometric thresholds without the need for a full in-clinic assessment, especially in this time of pandemic-related audiology office closures. A study published in the Journal of the American Academy of Audiology compared air conduction thresholds obtained using manual audiometry and the Etymotic Home Hearing Test (HHT) and found that the HHT is comparatively an accurate and cost-effective method of establishing pure-tone air conduction thresholds. “Therefore, the HHT can be used as a tool to acquire accurate hearing thresholds from older adults, in-group settings, without the use of a sound-attenuated booth or a certified audiologist,” the authors noted (J Am Acad Audiol. 2019 Mar; 30: 208).
THE NEED FOR PORTABLE HEARING TESTS
“We conducted this study to better understand how the Home Hearing Test and AMTAS systems compared to conventional audiometry,” corresponding author Cornetta L. Mosley, AuD, PhD, told The Hearing Journal. “This was of particular importance to our research group because we were planning to test over 2,000 participants across four different countries and needed portable hearing tests that could be administered in a classroom or conference room rather than an audio booth.”
Nothing the projected increase in the aging population and a shortage of audiologists, “[t]here is a need to develop different ways of assessing hearing sensitivity that can be conducted accurately and inexpensively when a certified audiologist and/or sound-attenuated booth is unavailable,” the study authors said. “More specifically, there is a need to determine if the HHT can yield accurate and reliable data from older adults with varying degrees of hearing loss.”
The study examined 112 English-speaking participants aged 60 years and older, excluding those with cerumen impaction and/or suspected ear pathology. All participants completed manual audiometry in a double-walled sound-attenuated booth, and the tablet-computer HHT in a carpeted classroom. Both measures used insert earphones and were completed in the same test session.
“Thresholds obtained using the HHT significantly correlated with thresholds using manual audiometry at octave frequencies from 0.5 to 8 kHz in each ear,” the study found. “This relationship held true across different degrees of hearing loss, despite the fact that background noise was not strictly regulated and multiple (up to eight) people completed testing at the same time, in the same room.”
REMOTE EVALUATIONS & COVID-19
Mosley emphasized the setting of the tests as a salient feature of the study.
“An interesting aspect of our experience testing the HHT was that testing was not always completed in a noise-free environment,” she said. “Participants would sometimes enter or exit the testing room, cough, and whisper while others were completing the HHT. Still, our results yielded a very high correlation to thresholds obtained in the sound booth. Thus, even if the patient isn't in an optimal sound environment, it is likely that the results will not vary beyond normal test/retest differences (5-10dB).”
This may be helpful for audiologists who had to temporarily close their offices due to the COVID-19 pandemic.
“With the COVID-19-related office closures and limitations, audiologists could combine the functionalities of the HHT and newer hearing aid remote programming technology to complete a routine pure-tone evaluation and hearing aid adjustment without being in the same physical space as the patient. The HHT could also be used to determine whether or not a comprehensive evaluation is warranted,” said Mosley.
“With the right equipment and under the right conditions, audiologists can complete reliable pure-tone air-conduction hearing evaluations. I think a system like the HHT can be an inexpensive alternative to in-office hearing evaluations, particularly for established patients and those who are unsure as to whether or not they might need a full audiologic evaluation.”
The study also suggested that the use of HHT can help promote awareness of hearing loss and improve the uptake of hearing health care services among older adults.
“For example, portable tools like HHT could be used in many community centers, retirement facilities, and for administering hearing healthcare in remote locations using teleaudiology,” the authors noted. HHT can also be used in locations with limited or no internet access, as the device does not require an internet connection, only a tablet computer.
Mosley, however, reminds that the HHT system still has some limitations.
“One of our main challenges was the fact that the HHT only allowed for insert earphone transducers,” she said. “If a patient has collapsing canals, cerumen impaction, or active otorrhea, I would not advise using the HHT system. Instead, patients with these issues should receive an in-person appointment or complete the screening using a different automatic system with a headphone transducer.”
Mosley also suggested guiding patients closely when remotely administering an HHT.
“I would advise the audiologist to provide written and/or verbal instructions on how to complete the HHT and (if possible) monitor the patient as they complete it to provide feedback as problems arise.”