Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.
SummaryWe evaluated the validity of remote pure-tone audiometric testing conducted from North America on subjects in South Africa. Desktop-sharing computer software was used to control the audiometer in Pretoria from Dallas, and PC-based videoconferencing was employed for clinician and subject communication. Thirty adult subjects were assessed, comparing the pure tone audiometric thresholds (125-8000 Hz) obtained through conventional face-to-face and remote testing. Face-to-face and remote audiometry thresholds differed by 10 dB in only 4% of cases overall. The limits of agreement between the two techniques were -8 and 7 dB with a 90% confidence interval of -5 to 5 dB. The average reaction times to stimulus presentations were similar, within -108 and 121 ms. The average test duration was 21% longer for remote testing (10.4 vs. 8.2 min). There were no clinically significant differences between the results obtained by remote intercontinental audiometric testing and conventional face-to-face audiometry. It may therefore be possible to expand the reach of audiological services into remote underserved regions of the world. IntroductionHearing loss is the most common chronic disabling condition globally and in 2005 was estimated to affect 642 million people to some degree.[1,2] A range of interventions can reduce the consequences of hearing loss,[1] but the basis for intervention is early identification and accurate diagnosis.
1 reported the maximum output levels of a vuvuzela at various distances from the horn. In response to enquiries, we provide additional information on the method and results reported in the earlier paper.One commercial vuvuzela was used in the recording of sound levels at 4 different positions: (i) at the ear of the person blowing the vuvuzela; (ii) at the bell end; (iii) 1 m from the bell end; and (iv) 2 m from the bell end. All measurements were made approximately 1.6 m from the ground, in an openair setting. Sound levels were measured twice at a single instance while the vuvuzela was being blown by one of the investigators. Measurements were made using a calibrated Type 1 Larson Davis SLM 824 sound level meter with a 2559 normal sensitivity microphone fitted with a manufacturersupplied windscreen (WS001). Measurements were made using the fast response time option, which corresponds to a time constant of 0.125 s that is intended to approximate the time constant of human hearing. for measuring individual sound events. A-weighting was used for all measurements to compensate for the non-linear sensitivity of the human ear, which is differentially sensitive to sound across the frequency spectrum (least sensitive at very high and very low frequencies). A breakdown of the average intensities at individual frequencies across the frequency spectrum is provided in Table I. A characteristically flat frequency spectrum was evident between 250 and 8 000 Hz. The average intensity difference between the individual frequency measurements (Table I) of the 2 recordings at each of the 4 respective distances from the bell of the vuvuzela was 0.6 dB (±3.2 dB standard deviation).These measures provide an indication of the sound levels and frequency spectrum of a typical vuvuzela. There are now numerous types of vuvuzela made by several manufacturers, which may all produce varying intensity and frequency outputs. In addition to these variables, individuals blowing a vuvuzela will produce varying intensities depending on their technique and the pressure exerted. Also, the sound level produced by multiple individuals simultaneously blowing vuvuzelas within a limited space cannot be predicted from these data.
Purpose This study aimed to investigate the accuracy of bilateral simultaneous tympanometric measurements using a tympanometer with two pneumatic systems inside circumaural ear cups. Method Fifty-two adults (104 ears), with a mean age of 32 years ( SD = 12.39, range: 18–60 years) were included in this study. A within-subject repeated-measures design was used to compare tympanometric measurements yielded with the investigational device in unilateral and bilateral simultaneous conditions compared with an industry-standard tympanometer. Results No significant bias ( p > .05) was found between the mean of the differences of tympanometric measurements yielded by the two devices, except for a significant bias ( p < .05) of the mean of the differences for ear canal volume measurements (0.05 cm 3 ). The Bland–Altman plots showed overall good agreement between the tympanometric measurements between the two instruments. In all 104 ears, the tympanogram types of the KUDUwave TMP were compared with the reference device. The results were highly comparable with a sensitivity and specificity of 100% (95% CI [86.8%, 100%]) and 92.3% (95% CI [84.0%, 97.1%]), respectively. Conclusions The investigational device is a suitable instrument for unilateral or bilateral simultaneous tympanometric measurements in adults and demonstrates the potential of decentralized and accessible tympanometry services.
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