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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 25  |  Issue : 4  |  Page : 206-209

Comparison of hearing thresholds using audiometric versus android-based application


Department of Audiology, All India Institute of Speech and Hearing, Mysuru, Karnataka, India

Date of Submission19-Jun-2019
Date of Acceptance04-Oct-2019
Date of Web Publication4-Dec-2019

Correspondence Address:
Dr. Chandni Jain
Department of Audiology, All India Institute of Speech and Hearing, Mysuru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_70_19

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  Abstract 


Background: Hearing loss is a highly widespread problem worldwide and early identification of hearing loss through screening is important to overcome the negative effects of untreated hearing impairment. Screening can be done using handheld device app technologies for the hearing assessments that would be easy to be used by any individual. Aims and Objectives: The aim of the present study was to compare the hearing thresholds with smartphone application and conventional audiometer. Materials and Methods: A total of 52 participants were included in the study. They were divided into two groups. Group 1 included 36 participants (72 ears) in the age range of 7 to 35 years with normal hearing sensitivity. Group 2 included 16 participants (32 ears) in the age range of 18-68 years with varying degree of hearing loss ranging from minimal hearing loss to severe hearing loss. Thus, a total of 104 ears were tested. Air Conduction thresholds were obtained at octave frequencies from 250 Hz to 4000 Hz using conventional audiometer in a sound treated room and through the android application (Hearing test version 1.1.) using a smart phone (Micromax Xpress Canvas) in a quiet room. The noise levels for hearing assessment through smart phone app ranged between 70-75 dB A, which was measured prior to the testing session. The thresholds were obtained for both right and left ear of the participants. The hearing thresholds obtained from both the measures was subjected to appropriate statistical analysis. Results: The results showed that there was a significant difference in the thresholds across the procedures for all the frequencies in Group 1. However, there was no significant difference in thresholds across the procedures for all the frequencies in Group 2. Conclusion: It can be concluded that hearing screening through mobile application is user-friendly and cost-effective, but it might lead into under referrals.

Keywords: Audiometry, hearing screening, mobile applications


How to cite this article:
Prithivi T, Nayak CK, Kavitha G S, Shoban B, Jeevan G, Pruthvik S P, Jain C. Comparison of hearing thresholds using audiometric versus android-based application. Indian J Otol 2019;25:206-9

How to cite this URL:
Prithivi T, Nayak CK, Kavitha G S, Shoban B, Jeevan G, Pruthvik S P, Jain C. Comparison of hearing thresholds using audiometric versus android-based application. Indian J Otol [serial online] 2019 [cited 2020 Sep 23];25:206-9. Available from: http://www.indianjotol.org/text.asp?2019/25/4/206/272229




  Introduction Top


Hearing loss is a highly widespread problem worldwide, and according to the World Health Organization (WHO), 360 million people worldwide are affected with hearing loss, and among them, around 32 million are children (Updated February 2017 source: WHO). Early identification of hearing loss is important to overcome the negative effects of hearing loss. The WHO estimates that disabling hearing impairment (DHI) affects approximately 360 million people or 5.3% of the global population.[1] The definition of DHI is a pure-tone average of thresholds at 500, 1000, 2000, and 4000 Hz in the better hearing ear of >30 dB in children and >40 dB in adults.

Further, children with hearing loss are at risk for developing delayed speech, language, and cognitive skills, which, in turn, results in poor literacy, academic and socioemotional development, and higher risks of failure and fallout in schools.[1] The unidentified childhood hearing loss has historically been shown to dramatically deteriorate educational achievement and ultimately vocational outcomes.[2] Even minimal and unilateral permanent hearing losses may result in poorer educational test performance, higher incidence of failed grades, and greater dysfunction in areas such as behavior, energy, stress, social support, self-esteem, and socioemotional aspects.[3],[4],[5] Early identification through hearing screening is thus essential to overcome the negative effects of hearing loss. This challenge may be solved by the utilization of increasingly available handheld device app technology for the hearing assessment that would be easy to be used by an individual.

The gold standard for hearing screening for people ≥4 years of age is pure-tone audiometry. Due to several financial, poor educational, parental, and geographic obstacles, it is hard to obtain timely audiometric data. These obstacles could lead to a delay in the diagnosis of hearing loss and to provide appropriate management procedures. These challenges may be solved by the utilization of increasingly available handheld device app technologies for hearing assessments.[6]

Audiometers are widely used for hearing screening. With the advent of technology, audiometers have increasingly become smaller, with greater applications available on each machine. Although the audiometers have substantially advanced, visually it still looks rather intimidating (particularly underscreening environments) and remains costly. Further, audiometer still requires a professional to perform the hearing screening.

More recently, mobile health, often seen as a subset of e-Health, has also emerged as a possible means of hearing assessment.[7] This area is particularly attractive because of the widespread penetration of mobile phones and cellular network reception globally, even in underserved world regions. Over the years, several applications are developed for handheld devices that facilitate earlier diagnosis of hearing loss and various screening measures. They are subject-operated, less cost/open source, and easily accessible.

Due to an increase in science and technology, the use of various handheld devices with various applications has increased, and people have started using various android-based applications to fulfill their needs. Mobile applications for hearing screening have gained much interest in the past few years. However, there are few existing online hearing screening methods available in some of the hearing aid websites, which include screening through questionnaires and tonal testing. Kam et al.[8] have developed an automated pure-tone hearing test system for screening schoolgoing children. The system uses a tablet computer and a pair of noise-canceling headphones. Hearing screening is carried out in the form of an interactive listening game to sustain children attention. However, this system has low sensitivity and specificity.

Thus, smartphone application provides easy, user-friendly operation with simple commands, and a self-threshold estimation can be performed anytime and anywhere in a day-to-day life. In the present study, hearing thresholds were assessed using a smartphone application (Hearing test version 1.1.3) and audiometer in individuals with hearing impairment and with normal hearing sensitivity.


  Methods Top


Participants

A total of 52 participants were included in the study. They were divided into two groups: Group 1 include 36 participants (72 ears) in the age range of 7–35 years with normal hearing sensitivity and Group 2 include 16 participants (32 ears) in the age range of 18–68 years with varying degree of hearing loss ranging from minimal hearing loss to severe hearing loss. Thus, a total of 104 ears were tested. None of the participants had a history head trauma, ototoxic drug intake, and ear surgery or speech-language problems, and cognitive decline. Participants were chosen based on purposive convenient sampling. Furthermore, none of them reported any illness during the time of testing. The study adhered to the ethical guidelines of the institute.

Procedure

An otoscopic examination was carried out on each participant before testing. This was followed by tympanometry. Tympanometry was done to get information regarding the middle ear status using a 226 Hz probe tone at 85-dB sound pressure level. Following which air conduction (AC) thresholds were obtained for octave frequencies from 500 Hz to 4000 Hz at every octave using conventional diagnostic audiometer in a sound-treated room and through the android application (Hearing test version 1.1.) using a smartphone (Micromax Xpress Canvas) with the mobile headset in a quiet place. The noise levels from hearing assessment through app ranged between 70–75 dBA, which was measured before the testing session. The thresholds were obtained for both the right and left ear of the participants. It was also ensured that for a few participants, the threshold estimation was done first with the audiometer followed by the android app, and for other participants, it was vice versa. The hearing thresholds were noted for both the measures and analyzed using an appropriate statistical method. [Figure 1] shows a screenshot of the smartphone app.
Figure 1: The screenshot of the smartphone app

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  Results Top


The mobile app used for the present study required minimal expertise to conduct the test. It also has the facility for digital storage of data for offline review. The hearing screening was performed on a total of 104 ears using both mobile app software and audiometer. All the participants could complete the test successfully. The average time required for testing through software was around 3 to 5 min.

Shapiro–Wilks test of normality was done to determine if the data were normally distributed. The result of the test of normality showed that the data were not normally distributed (P < 0.01). Hence, nonparametric statistics were done. A Wilcoxon signed-rank test was done to compare the AC thresholds obtained from both the methods. The data of the right and left ear were combined for this purpose. [Figure 2] shows the mean and standard deviation of the thresholds obtained from the audiometer and mobile-based app for octave frequencies from 500 Hz to 4000 Hz for Group 1. [Figure 3] shows the individual data of the hearing thresholds of the participants in Group 2 wherein the participants are arranged in the increasing order of thresholds. The results showed that there was a significant difference in the thresholds across the procedures for all the frequencies in participants with normal hearing sensitivity. However, there was no significant difference in thresholds across the procedures for all the frequencies in participants with hearing impairment [Table 1]. It can also be noted that the thresholds obtained using the mobile app were lower compared to those obtained through audiometer in all the participants for frequencies 1000, 2000, and 4000 Hz.
Figure 2: Mean and standard deviation of hearing thresholds using audiometer and mobile app in participants with normal hearing sensitivity

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Figure 3: Scatter plot representing hearing thresholds of participants through audiometer and mobile app wherein the participants are arranged in the increasing order of thresholds

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Table 1: The results of the Wilcoxon signed-rank test to compare the threshold of mobile app and audiometer

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  Discussion Top


The result of the present study showed a significant difference between the AC thresholds obtained from the Android app application (Hearing test version 1.1.) and audiometer in participants with normal hearing sensitivity. This suggests that performing initial hearing screening through the Android-based application might mislead the participants. The study suggests that screening through the mobile app would result in under referrals as the thresholds obtained from the app were better compared to that of an audiometer. However, it was also noted in the present study that the participants with normal hearing sensitivity still fell under normal hearing criteria using the Android-based application. However, if the participants have some amount of hearing loss, especially of milder degree, it might get missed out on the app screening. Further, it was also noted in the present study that there was no significant difference in the thresholds obtained from the Android app application and audiometer in participants with hearing loss. However, it was always seen that the thresholds obtained through the app were better compared to that of the audiometer.

Yeung et al.[9] demonstrated a strong sensitivity (93.3%) and specificity (94.5%) of using mobile application-based audiometry for threshold estimation. Another study by Ellaham et al.[10] demonstrated that the use of android application-based hearing tests could be used to screen the school children who are at potential risk of hearing loss. In a study by Swanepoel de et al.[11] investigated that the screening outcomes demonstrated no significant differences between smartphone and conventional audiometry with an overall referral rate of 4.3% and 3.7%, respectively. Referral rates of a tablet-based screening system recently reported by Wu et al.[12] were 6.5% and 4% for 5- and 6-year-old children, respectively.

Thus, it can be concluded that though with the increasing availability of the mobile application, it provides an opportunity to integrate their use into screening for ear and hearing conditions in user-friendly handling of application in a cost-effective way, it might lead to under referrals. We recommend that the study needs to be done in a larger population for the better validity of the mobile screening app. Further, in the present study, the output of the stimulus from the app was not measured using the sound level meter, though it has the option of calibrating the headsets or headphones by the participants.

Acknowledgments

The investigators would like to acknowledge the Director, All India Institute of Speech and Hearing. We would like to acknowledge the HOD, Department of Audiology, the resources from the department for testing. We also would like to extend our appreciation to the accounts section for providing support in maintaining the accounts. Our heartfelt gratitude also extends to all the participants involved in this study for their kind cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. WHO Methods and Data Sources for Global Burden of Disease Estimates 2000-2011. Geneva: Department of Health Statistics and Information Systems; 2013.  Back to cited text no. 1
    
2.
Holden-Pitt L, Albertorio J. Thirty years of the annual survey of deaf and hard-of-hearing children and youth: A glance over the decades. Am Ann Deaf 1998;143:72-6.  Back to cited text no. 2
    
3.
Tharpe AM, Bess FH. Identification and management of children with minimal hearing loss. Int J Pediatr Otorhinolaryngol 1991;21:41-50.  Back to cited text no. 3
    
4.
Bess FH, Dodd-Murphy J, Parker RA. Children with minimal sensorineural hearing loss: Prevalence, educational performance, and functional status. Ear Hear 1998;19:339-54.  Back to cited text no. 4
    
5.
McKay S, Gravel JS, Tharpe AM. Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Trends Amplif 2008;12:43-54.  Back to cited text no. 5
    
6.
World Health Organization, Ear WH. Hearing Disorders Survey Protocol (Part 1: Survey Methods). Geneva: World Health Organization; 1999.  Back to cited text no. 6
    
7.
Clark JL, Swanepoel de W. Technology for hearing loss – As we know it, and as we dream it. Disabil Rehabil Assist Technol 2014;9:408-13.  Back to cited text no. 7
    
8.
Kam AC, Gao H, Li LK, Zhao H, Qiu S, Tong MC. Automated hearing screening for children: A pilot study in China. Int J Audiol 2013;52:855-60.  Back to cited text no. 8
    
9.
Yeung J, Javidnia H, Heley S, Beauregard Y, Champagne S, Bromwich M. The new age of play audiometry: Prospective validation testing of an iPad-based play audiometer. J Otolaryngol Head Neck Surg 2013;42:21.  Back to cited text no. 9
    
10.
Ellaham N, Yilma Y, Jourdan GV, Bromwich MA. New iPad application for hearing screening in children. Can Acoust 2011;39:118-9.  Back to cited text no. 10
    
11.
Swanepoel de W, Myburgh HC, Howe DM, Mahomed F, Eikelboom RH. Smartphone hearing screening with integrated quality control and data management. Int J Audiol 2014;53:841-9.  Back to cited text no. 11
    
12.
Wu W, Lü J, Li Y, Kam AC, Fai Tong MC, Huang Z, et al. Anew hearing screening system for preschool children. Int J Pediatr Otorhinolaryngol 2014;78:290-5.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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