Evaluation of an Internet-Based Hearing Test—Comparison with Established Methods for Detection of Hearing Loss

Abstract

Background Hearing impairment is most accurately measured by a clinical pure-tone audiogram. This method is not suitable for large-scale, population-based epidemiological studies as it requires that study participants visit a clinic with trained personnel. An alternative approach to measuring hearing ability is self-estimation through questionnaires, but the correlation to clinical audiometric tests varies.Objective To evaluate an Internet-based hearing test pilot compared to a question about self-estimated hearing and the feasibility of using an Internet-based hearing test and an Internet-based questionnaire in a population of 560 members of the Swedish Hunters’ Association in the age group 20-60 years.Methods An invitation was mailed to the participants in March 2007 together with the URL to the study Web site, a personal username, and a password. The Web site included the questionnaire, the hearing test, and instructions for participating in the study. The hearing test resembles a clinical audiogram presenting 6 tones between 500 and 8000 Hz. Tones are presented between 0 and 60 dB, and the participant responds to the tones by pressing the space bar. The hearing test requires headphones and is based on JAVA programming. Before the participant can start the hearing test, it has to be calibrated against a reference person with good hearing between 15 and 35 years of age.Results After 5 months, 162 out of 560 (29%) had answered the questionnaire, out of which 88 (16%) had completed the hearing test. Those who actively declined participation numbered 230 out of 560 (41%). After removing duplicates and hearing tests calibrated by unreliable reference data, 61 hearing tests remained for analysis. The prevalence of hearing impairment from the Internet-based hearing test was 20% (12 out of 61), compared to 52% (32 out of 61) from the self-estimated question. Those who completed the hearing test were older than the non-participants, and more had headphones (P = .003) and the correct version of the JAVA program (P = .007) than those who only answered the questionnaire.Conclusions Though an Internet-based hearing test cannot replace a clinical pure-tone audiogram conducted by a trained audiologist, it is a valid and useful screening tool for hearing ability in a large population carried out at a low cost.

Comparison between web-based and paper versions of a self-administered anthropometric questionnaire

“…Although online data collection may not solve traditional problems faced for reaching the population sample [22], several studies argue in favor of high acceptability and feasibility of web-based questionnaires [23][24][25]. Moreover, the latter, particularly usable for analytical studies that focus on associations between variables [26], have major advantages.…”

Telehealth in audiology: The need and potential to reach underserved communities

“…Internet-based hearing tests have been proposed as a means of hearing testing although there are serious practical concerns such as calibration accuracy and lack of control on environmental noise levels (Bexelius et al, 2008). This application although controversial, may well serve a purpose of increasing public awareness and as a preliminary 14 screening for hearing loss.…”

A Systematic Review of Telehealth Applications in Audiology

“…Three reports described self-test screening procedures; two of these used speech-in-noise screening and one described pure tone audiometric screening. [16][17][18] Smits and colleagues 16 reported on the development and validation of a speechin-noise screening procedure using triple digits and an adaptive procedure that can be used reliably over the telephone and computer headsets. They subsequently reported on a national self-screening program in the Netherlands using this test to screen large numbers of adolescents and adults using the telephone (n ¼ 6,351) or Internet (n ¼ 30,260).…”

“…A self-test, Internet-based, pure tone audiometry screening procedure was reported by Bexelius and colleagues. 18 This proof-ofconcept study screened patients by determining threshold frequencies between 500 and 8,000 Hz as against a more conventional screening criterion that assesses hearing at a preset intensity across a limited range of frequencies. This study tested the members of a hunting organization and reported poor participation in the self-test, but demonstrated that Internet-based hearing screening tests can be performed.…”