Hearing loss in the developing world: Evaluating the iPhone mobile device as a screening tool

Abstract

Background. Developing countries have the world's highest prevalence of hearing loss, and hearing screening programmes are scarce. Mobile devices such as smartphones have potential for audiometric testing. Objectives. To evaluate the uHear app using an Apple iPhone as a possible hearing screening tool in the developing world, and to determine accuracy of certain hearing thresholds that could prove useful in early detection of hearing loss for high-risk populations in resource-poor communities.Methods. This was a quasi-experimental study design. Participants recruited from the Otolaryngology Clinic, Groote Schuur Hospital, Cape Town, South Africa, completed a uHear test in three settings -waiting room (WR), quiet room (QR) and soundproof room (SR). Thresholds were compared with formal audiograms. Results. Twenty-five patients were tested (50 ears). The uHear test detected moderate or worse hearing loss (pure-tone average (PTA) >40 dB) accurately with a sensitivity of 100% in all three environments. Specificity was 88% (SR), 73% (QR) and 68% (WR). It was highly accurate in detecting high-frequency hearing loss (2 000, 4 000, 6 000 Hz) in the QR and SR with 'good' and 'very good' kappa values, showing statistical significance (p<0.05). It was moderately accurate in low-frequency hearing loss (250, 500, 1 000 Hz) in the SR, and poor in the QR and WR. Conclusion. Using the iPhone, uHear is a feasible screening test to rule out significant hearing loss (PTA >40 dB). It is highly sensitive for detecting threshold changes at high frequencies, making it reasonably well suited to detect presbycusis and ototoxic hearing loss from HIV, tuberculosis therapy and chemotherapy. Portability and ease of use make it appropriate to use in developing world communities that lack screening programmes.

Automated Smartphone Threshold Audiometry: Validity and Time Efficiency

“…The uHear, for example, is a smartphone-based application for Apple iOS and is a self-administered air conduction threshold test (Peer & Fagan, 2015). Studies conducted on this application have yielded mixed outcomes.…”

“…Studies conducted on this application have yielded mixed outcomes. In some studies, the uHear™ was said to accurately identify disabling hearing loss, detect early high frequency threshold changes (Peer & Fagan, 2015), rule out moderate hearing losses and determine the degree of hearing loss (Szudek, Ostevik, Dziegielewski, Robinson-Anagor, Gomaa, Hodgetts & Ho, 2012;Abu-Ghanem et al, 2015). However, in other studies, the uHear™ was found to produce elevated thresholds when compared to manual audiometry (Szudek et al, 2012;Khoza-Shangase & Kassner, 2013).…”

“…Additionally, the high cost of audiometric equipment and sound proof booths, in combination with a lack of infrastructure and resources impedes the provision of adequate hearing healthcare services (Fagan and Jacobs, 2009;Swanepoel et al, 2010a;Clark & Swanepoel, 2014;Peer and Fagan, 2015).…”

“…For example, uHear™ (Unitron, Commak, New York), a smartphonebased application for Apple iOS (Apple Inc., Cupertino, California), which is a selfadministered air conduction threshold test (Peer and Fagan, 2015). Several studies have been conducted to compare the uHear™ to conventional audiometry and have yielded mixed outcomes.…”

Editor's Choice

“…[4] Smartphones have the potential to test hearing through audiometric applications. Given the upsurge of mobile technology in Africa, Peer and Fagan [5,6] evaluated the uHear app (using an Apple iPhone) as a possible hearing screening tool in the developing world. They conclude that it is a feasible screening test to rule out significant hearing loss (pure-tone average >40 dB).…”