Validity of diagnostic pure-tone audiometry without a sound-treated environment in older adults

Abstract

Objective: To investigate the validity of diagnostic pure-tone audiometry in a natural environment using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. Design: A within-subject repeated measures design was employed to compare air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure-tone thresholds measured in retirement facilities with thresholds measured in a sound-treated booth. Study sample: 147 adults (average age 76 ± 5.7 years) were evaluated. Pure-tone averages were normal in 59%, mildly (>40 dB) elevated in 23% and moderately (>55 dB) elevated in 6% of ears. Results: Air-conduction Validity of diagnostic pure tone audiometry without a sound-treated…/ 2 thresholds (n=2259) corresponded within 0 to 5 dB in 95% of all comparisons between the two test environments. Bone-conduction thresholds (n=1669) corresponded within 0 to 5 dB in 86% of comparisons. Average threshold differences (-0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Thresholds recorded showed no statistically significant differences (Paired Samples T-test:p˃0.01) except at 8000 Hz in the left ear. Conclusion: Valid diagnostic pure-tone audiometry can be performed in a natural environment with recently developed technology, offering the possibility of access to diagnostic audiometry in communities where sound-treated booths are unavailable.

Clinical validation of automated audiometry with continuous noise-monitoring in a clinically heterogeneous population outside a sound-treated environment

“…Participants in this study had their automated audiometry thresholds tested in a room that was not sound-treated, whilst the manual audiometry testing was performed in a sound-treated environment, potentially introducing further accuracy variation from previous studies (Maclennan-Smith et al, 2013;Storey et al, 2014). The placement of the bone-conductor also differed, with mastoid placement used for the reference test and forehead placement used for the index test and ambient noise levels for the reference test also exceeded the recommended ISO 8253-1:2010 standard.…”

“…The device used in this study (KUDUwave 5000) has previously been validated in an environment that is not sound-treated using its manual-mode (Maclennan-Smith et al, 2013), and in a controlled noise environment in automated-mode (Storey et al, 2014). The present study therefore aims to address a gap in the evidence-base by combining automated testing in an uncontrolled environment that is not sound-treated, using an unselected clinical population of patients attending otolaryngology and audiology appointments at a tertiary public hospital.…”

“…The ability to provide automated audiometric testing in the absence of a sound-treated environment has a great potential to increase service provision to low and middle-income countries, and rural and remote areas of high-income countries that do not have these facilities. At least two of the contemporary clinically available automation-capable audiometers use audiocups to provide attenuation from environmental sounds (Margolis et al, 2010;Swanepoel & Biagio, 2011), and studies have demonstrated their potential feasibility in environments that are not soundtreated Maclennan-Smith et al, 2013).…”

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

“…[20] Portable audiometers are also becoming more advanced, and provide good-quality diagnostic audiometry in any environmental setting. [21] Global mobile phone penetration of the world's population is at 85%, [22] and 1 in 5 Africans own smartphones. Automated hearing screening apps, using commercially available technology, present an opportunity to address the global problem of hearing loss.…”

Technology for hearing loss – as We Know it, and as We Dream it

“…Recently developed audiometry equipment has reported the use of integrated microphones to monitor environmental noise in real-time during testing [18,19,20]. This feature allows for diagnostic testing outside of conventional sound isolating booths that are typically very expensive to install and often prohibitive in resource-constrained localities.…”