Air Conduction Audiometry Research Articles

Hearing and Balance Survey in Thai Elders

Objective: To survey hearing and balance problems of a sampling group of Thai elders in the central region of Thailand. Methods: A population study was people aged 60 and over who agreed to join the survey at the 14 elderly social associations. The questionnaires were used as a self-report for hearing and balance problems. After ears examination by ENT specialists, the participants underwent air-conduction audiometry for hearing screening. Results: 828 participants (259 (31.3%) males and 569 (68.7%) females, age ranged from 60 to 97 (median=68, mean ± SD = 69.65 ± 6.89 years), had completed screening program for hearing and balance problems using both questionnaires and examinations. There was a statistically significant correlation between self-report hearing loss and severe or profound hearing loss in both ears (P 70 years old especially in those with underlying diseases. Hearing and balance screening will provide early detection and primary intervention to minimize the negative impact in the elderly’s daily life.

High prevalence of slight and mild hearing loss across mid-life: a cross-sectional national Australian study

ObjectivesAlthough presbycusis typically becomes symptomatic only in older age, slight and mild hearing loss may be detectable well before this. We studied current prevalence and characteristics of hearing loss in Australian mid-life adults. Study designThis was a population-derived national cross-sectional study nested within the Longitudinal Study of Australian Children. MethodsA total of 1485 parents/guardians (87.3% female) aged 30–59 years underwent air-conduction audiometry. Hearing loss was defined in three ways to maximize cross-study comparability: high Fletcher index (mean of 1, 2 and 4 kHz; primary outcome relevant to speech perception), lower frequency (mean of 1 and 2 kHz) and higher frequency (mean of 4 and 8 kHz). Multivariable logistic regression examined how losses vary by age, sex and neighbourhood disadvantage. ResultsOn high Fletcher index, 27.3% had bilateral and 23.8% unilateral thresholds >15 dB hearing level (HL) (slight or worse), and 4.9% had bilateral and 6.3% unilateral thresholds >25 dB HL (mild or worse). Bilateral higher frequency losses were more common than lower frequency losses for thresholds >15 dB HL (30.9% vs. 26.4%) and >25 dB HL (11.0% vs. 4.6%). Age increased the risk of bilateral speech and higher frequency losses (all P for trend < 0.05), but not lower frequency losses >25 dB HL. Although sex was not associated with speech and lower frequency losses, men were more likely to have bilateral higher frequency losses (e.g. >15 dB HL: odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.5–3.2, P < 0.001). ConclusionsBoth slight and mild hearing loss show high and rising prevalence across mid-life. This offers opportunities to prevent progression to reduce the profound later burden of age-related hearing loss.

Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska

IntroductionThe population in rural Alaska experiences a disproprionately high burden of infection-mediated hearing loss. While the state mandates school hearing screening, many children with hearing loss are not identified or...

Prevalence of noise induced hearing loss among Jordanian industrial workers and its associated factors

Exposure to excessive noise is the most common preventable cause of hearing loss. It has been estimated that more than 12% of the global population is at risk for hearing loss from noise and about one-third of all cases can be attributed to noise exposure. Data on occupational noise and its associated hearing loss are lacking in Jordan. This study aimed to determine the prevalence of noise induced hearing loss (NIHL) among industrial workers in Jordan. This study included all workers who had been exposed to noise at least three years or more in three plants in Madaba Governorate in Jordan. A structured questionnaire was used to collect the data. The occupational noise was measured using a portable calibrated sound meter. Pure-tone air conduction audiometry was performed to determine the hearing thresholds in the frequencies of 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz for both ears of all subjectsRESULTS:This study included 196 workers aged between 20 and 54 years with a mean (SD) of 35.9 (7.2) year. Overall, the prevalence of NIHL among workers was 28.6% (35.0% among those exposed to high level of noise (>85 dB) and 12.5% among workers exposed to low level of noise (≤85 dB)). Age >35 years (OR = 2.7; 95% CI: 1.2-6.1), high noise level (OR = 4.2; 95% CI: 1.6-10.5), exposure of more than 10 years (OR = 2.0; 95% CI: 1.1-5.9), and not using hearing protective devices (OR = 2.7; 95% CI: 1.1-6.6) were significantly associated with increased odds of hearing loss. About one quarter of noise-exposed industrial workers in Jordan has NIHL. Age >35 years, high noise level, exposure of more than 10 years, and not using hearing protective devices were significantly associated with increased risk of NIHL.

A Prospective Analysis of Ototoxicity in Modern Radiation Therapy Treatments for Head and Neck Squamous Cell Carcinoma (HNSCC) Patients Receiving Concomitant Chemo-Radiation (CRT) with Weekly or Tri-weekly Cisplatin (Cis)

Radiation therapy can be ototoxic and dose constraints to the cochlea – mean <45Gy will give ∼<30% sensory-neural hearing loss. Cis is one of the most ototoxic chemotherapy drugs, resulting in a permanent and irreversible hearing loss in up to 50% of patients. Little is known about the incidence of hearing loss when using different cisplatin regimens in patients receiving concomitant CRT with modern day radiation therapy techniques. Therefore, we assessed prospectively the incidence of ototoxicity in patients receiving weekly or tri-weekly Cis concomitantly with volumetric modulated arc radiotherapy (VMAT). HNSCC patients receiving definitive or adjuvant cis-based CRT were included. Cis was administered weekly (40 mg/m2 weekly, total 7 cycles) or tri-weekly (100 mg/m2 every three weeks, total 3 cycles). Radiation was administered to a total dose of 70 Gy for definitive treatment or 66 Gy for adjuvant treatment (2 Gy/fraction). Intensity-modulated radiation therapy was used in all cases. Pure-tone air-conduction audiometry was performed in all patients before and after completion of CRT. The primary endpoint of the analysis was Common Terminology Criteria for Adverse Event (CTCAE v4.0) hearing change ≥3 at the completion of CRT. The cochlea was contoured by one dosimetrist and assessed by two physicians for accuracy. A total of 96 patients (M:77/F:19) were included (56 oropharynx patients and 40 non-oropharynx HNSCC)). The median age was 55 years (range 26-78) 68 patients received weekly cis and 28 received the tri-weekly regimen. 58 patients received definitive treatment and 38 adjuvant treatment. Nine patients (13%) receiving weekly cis experienced G3 ototoxicity vs 14 patients (50%) who received tri-weekly cis (p<0.001, OR=6.4, 95% CI= 2.1-20.7). Risk of ototoxicity was not associated with age, cis cumulative dose, sex, tumor primary site, or CRT modality (definitive vs. adjuvant). After adjusting for these factors in a multivariable model cis schedule remained significant (OR=8.7, 95% CI 2.31-32.75, p=0.001). With a minimum follow-up of three months, the complete response rate after treatment was 84% for weekly CRT and 86% for tri-weekly CRT (p=NS). Cochlear mean dose of 13.76 Gy +/- 8.5 Gy to bilateral cochlea was achieved. With mean cochlear doses of ≤ 22Gy bilaterally, tri-weekly Cis-based CRT increased the risk of grade 3 irreversible severe ototoxicity compared to weekly Cis. This risk of ototoxicity should be discussed with patients that are candidates for cis-based CRT.

Accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss: incorporating automatic conditional rescreening

PurposeTo validate the accuracy of an internet-based speech-in-noise hearing screening test for high-frequency hearing loss (HFHL) ‘Occupational Earcheck (OEC)’ incorporating an automatic conditional rescreening, in an occupationally noise-exposed population. Secondary objectives were to assess the effects of age on test accuracy measures, and to assess the test accuracy for different degrees of HFHL.MethodsA study was conducted on cross-sectional data of occupational audiometric examinations, including the index test OEC and reference standard pure-tone air conduction audiometry, of 80 noise-exposed workers. Sensitivity, specificity, and likelihood ratios were calculated for the OEC, after automatic conditional rescreening, for a younger and an older age group, and for two degrees of HFHL (HFHL25: PTA3,4,6 ≥ 25 dB HL, and HFHL35: PTA3,4,6 ≥ 35 dB HL, both for at least one ear).ResultsTest specificity for HFHL25 after a single test was 63%, and improved to 93% after the automatic conditional rescreen. Test sensitivity for HFHL25 decreased from 65% to 59%. Test sensitivity and specificity including automatic conditional rescreening for HFHL35 was 94% and 90%, respectively. The positive likelihood ratio for HFHL25 was 8.4, and for HFHL35 9.4. The negative likelihood ratio for HFHL35 was below 0.1.ConclusionsThe OEC is an appropriate screening test, especially for HFHL35. Normal-hearing workers who obtained a positive test result for the first test for one or two ears, benefit from having an automatic rescreen, resulting in an improvement of the test specificity, and hence prevent unnecessary referral.

Cross-sectional epidemiology of hearing loss in Australian children aged 11–12 years old and 25-year secular trends

ObjectiveIn a national study of Australian children aged 11–12 years old, we examined the (1) prevalence and characteristics of hearing loss, (2) its demographic risk factors and (3) evidence for...

Auditory fatigue among call dispatchers working with headsets.

To determine whether call center dispatchers wearing headsets are subject to auditory fatigue at the end of a work shift. Data was gathered at times when call centers were busiest. All call operators wore a headset for up to 12 h. Acoustic environment and noise exposure under the headset were continuously recorded during the entire work shift. Variations in auditory parameters were assessed using pure-tone air-conduction audiometry and an objective test based on distortion product otoacoustic emissions - contralateral suppression of distortion product otoacoustic emission (DPOAE) amplitudes (EchoScan test). Thirty-nine operators and 16 controls, all volunteers, were selected from 3 call centers (sales, assistance, and emergency) where all cognitive tasks were accomplished by phone and on computers. No acoustic shock was detected during the investigation. The highest normalized noise exposure (daily noise exposure level - LEX,8 h) measured was 75.5 dBA. No significant variation in auditory performances was detected with either pure-tone air-conduction audiometry or the EchoScan test. Nevertheless, dispatchers expressed a feeling of tiredness. For an equivalent diffuse field noise exposure, the use of a headset does not seem to worsen auditory fatigue for call center operators. The dispatcher's fatigue was probably due to the duration of the work shift or to the tasks they performed rather than to the noise exposure under a headset. Int J Occup Med Environ Health 2018;31(2):217-226.

Centre-level variation in outcomes and treatment for otitis media with effusion and hearing loss and the association of hearing loss with developmental outcomes at ages 5 and 7years in children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 2.

To explore centre-level variation in otitis media with effusion (OME), hearing loss and treatments in children in Cleft Care UK (CCUK) and to examine the association between OME, hearing loss and developmental outcomes at 5 and 7years. Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. Children had air and bone conduction audiometry at age 5. Information on grommet and hearing aid treatment was obtained from parental questionnaire and medical notes. Hearing loss at age 5 was defined as >20 dB in the better ear and history of OME and hearing loss was determined from past treatment. Children with sensorineural hearing loss were excluded. Associations were examined with speech, behaviour and self-confidence at age 5 and educational attainment at age 7. Centre variation was examined using hierarchical models and associations between hearing variables and developmental outcomes were examined using logistic regression. There was centre-level variation in early grommet placement (variance partition coefficient (VPC) 18%, P=.001) and fitting of hearing aids (VPC 8%, P=.03). A history of OME and hearing loss was associated with poor intelligibility of speech (adjusted odds ratio=2.87, 95% CI 1.42-5.77) and aspects of educational attainment. Hearing loss is an important determinant of poor speech and treatment variation across centres suggest management of OME and hearing loss could be improved.

Evaluation of the Ototoxicity Potential of OnceDaily, Single-Entity Hydrocodone in Patients with Chronic Pain: Results of Two Phase-3 Clinical Studies

Use/misuse of the opioid combination hydrocodone-acetaminophen has been associated with permanent hearing loss. Although reports have been rare, this potential effect can have significant detrimental effect on patients' overall quality of life. To date, the ototoxic effect of hydrocodone alone has not been systematically investigated. In this report, we aimed to evaluate the potential ototoxicity of a novel, single-entity, once-daily, extended-release hydrocodone tablet (Hysingla® ER; HYD). Clinical study. Audiology clinics in US. Results from 1207 patients in two phase 3 clinical studies were evaluated: A placebo-controlled study with an enriched enrollment, randomized withdrawal design in patients with chronic low back pain, and an open-label, long-term, safety study in patients with chronic nonmalignant and non-neuropathic pain. Comprehensive audiologic assessments (comprising pure-tone air-conduction audiometry in the conventional [0.25-8 kHz] and ultra-high [10-16 kHz] frequencies, pure-tone bone-conduction audiometry, tympanometry, speech reception thresholds, and word recognition) were conducted at baseline and end-of-studies; air-conduction audiometry was conducted periodically during the studies. All audiologic assessments were performed in audiology clinics in the United States by licensed audiologists. The primary endpoint was changes from baseline in pure-tone air-conduction thresholds in the conventional frequencies during the studies. These trials are registered with ClinicalTrials.gov, identifiers NCT01400139 and NCT01452529. During the studies, mean changes from baseline in air-conduction thresholds were clinically unremarkable. Bidirectional variability across all test frequencies was observed; 82% of patients did not experience significant threshold changes during the studies, 7% had potential hearing decrement, and 10% experienced hearing sensitivity improvement. No notable differences were observed between patients receiving HYD and placebo or between different HYD doses. No ototoxic signal was observed for single-entity hydrocodone tablets at the dosages and treatment durations investigated. Key words: Audiologic monitoring, clinical trials, hydrocodone, opioids, ototoxicity monitoring, sensorineural hearing loss.

Clinical Evaluation of Transcranial Attenuation in Bone Conduction Audiometry

Purpose: It is commonly known that there is no significant transcranial attenuation across the cranium through bone conduction. The aim of this study was to evaluate transcranial attenuation for bone conduction as a function of each frequency by hearing loss types on subjects of unilateral hearing loss or unilateral with bilateral hearing loss. Methods: A total of 82 subjects with sensorineural (40 ears), conductive (20 ears) and mixed hearing loss (22 ears), were enrolled and then were analyzed prospectively. The transcranial attenuation was analyzed for 82 ears with the differences over 10 dB HL in all frequencies (0.25-4 kHz) by air conduction audiometry. The transcranial attenuation at each frequency was obtained by bone conduction threshold without masking. Results: We observed a significant in the mean of transcranial attenuation for bone conduction of the overall subjects. It was closed to 0-9 dB HL at 0.25 kHz to 2 kHz and 13 dB HL at 3 to 4 kHz. There are more difference in principal the transcranial attenuation for bone conduction in high frequency than a low frequency. Conclusion: Therefore, the conductive and mixed hearing loss always need to consider about the masking by crosshearing. The cross-hearing, however, needs to consider by type of hearing loss because the transcranial attenuation of bone conduction as a function of each frequency depends on hearing loss types. Further research should work for the transcranial attenuation of bone conduction by degrees of hearing loss.

Validation of a Self-Administered Audiometry Application: An Equivalence Study.

To compare hearing measurements made at home using self-administered audiometric software against audiological tests performed on the same subjects in a clinical setting Prospective, crossover equivalence study In experiment 1, adults with varying degrees of hearing loss (N = 19) performed air-conduction audiometry, frequency discrimination, and speech recognition in noise testing twice at home with an automated tablet application and twice in sound-treated clinical booths with an audiologist. The accuracy and reliability of computer-guided home hearing tests were compared to audiologist administered tests. In experiment 2, the reliability and accuracy of pure-tone audiometric results were examined in a separate cohort across a variety of clinical settings (N = 21). Remote, automated audiograms were statistically equivalent to manual, clinic-based testing from 500 to 8,000 Hz (P ≤ .02); however, 250 Hz thresholds were elevated when collected at home. Remote and sound-treated booth testing of frequency discrimination and speech recognition thresholds were equivalent (P ≤ 5 × 10(-5) ). In the second experiment, remote testing was equivalent to manual sound-booth testing from 500 to 8,000 Hz (P ≤ .02) for a different cohort who received clinic-based testing in a variety of settings. These data provide a proof of concept that several self-administered, automated hearing measurements are statistically equivalent to manual measurements made by an audiologist in the clinic. The demonstration of statistical equivalency for these basic behavioral hearing tests points toward the eventual feasibility of monitoring progressive or fluctuant hearing disorders outside of the clinic to increase the efficiency of clinical information collection. 2b. Laryngoscope, 126:2382-2388, 2016.

Smartphone threshold audiometry in underserved primary health-care contexts

Objective: To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. Design: A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. Study sample: A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18–88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. Results: In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of −1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of −1.0 dB ± 7.1 SD. Conclusions: Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

An Investigation of the Impact of Tinnitus Perception on the Quality of Life

Purpose: the aim of this study is to assess the impact of tinnitus perception on the quality of life of tinnitus sufferer’s. Materials and methods: 34-tinnitus sufferers were recruited in this study with a wide range of hearing loss thresholds (HLT) and tinnitus severity status. Pure tone air conduction audiometry was performed to assess the hearing level of the participants in this study. Anxiety and depression were assessed in this study using the hospital anxiety and depression scale (HADS). Tinnitus severity was assessed using tinnitus handicap inventory (THI) and tinnitus functional index (TFI). Results: The impact of tinnitus perception on the quality of life was found higher in suffering group comparing to coping group. A significant positive correlation was found between the age of tinnitus subjects and their hearing loss thresholds (r=0.36, P=0.037). The TFI score was found significantly higher (P=0.007) in the unilateral tinnitus group compared to the bilateral tinnitus group. In TFI subscales ‘Intrusiveness’ scored the highest (58%), while Quality of Life scored the lowest 20%). A significant positive correlation was found between hearing loss and tinnitus duration (r=0.40, P=0.019). Also, the correlation between tinnitus severity and anxiety and depression was identified in this study. Conclusion: These findings revealed that tinnitus perception has negative impacts on the quality of life. Tinnitus laterality may seem to play a factor on the tinnitus severity.

Safety of the HyperSound® Audio System in Subjects with Normal Hearing.

The objective of the study was to assess the safety of the HyperSound® Audio System (HSS), a novel audio system using ultrasound technology, in normal hearing subjects under normal use conditions; we considered pre-exposure and post-exposure test design. We investigated primary and secondary outcome measures: i) temporary threshold shift (TTS), defined as >10 dB shift in pure tone air conduction thresholds and/or a decrement in distortion product otoacoustic emissions (DPOAEs) >10 dB at two or more frequencies; ii) presence of new-onset otologic symptoms after exposure. Twenty adult subjects with normal hearing underwent a pre-exposure assessment (pure tone air conduction audiometry, tympanometry, DPOAEs and otologic symptoms questionnaire) followed by exposure to a 2-h movie with sound delivered through the HSS emitter followed by a post-exposure assessment. No TTS or new-onset otological symptoms were identified. HSS demonstrates excellent safety in normal hearing subjects under normal use conditions.

Audiometric profile of civilian pilots according to noise exposure.

OBJECTIVE To evaluate the audiometric profile of civilian pilots according to the noise exposure level.METHODS This observational cross-sectional study evaluated 3,130 male civilian pilots aged between 17 and 59 years. These pilots were subjected to audiometric examinations for obtaining or revalidating the functional capacity certificate in 2011. The degree of hearing loss was classified as normal, suspected noise-induced hearing loss, and no suspected hearing loss with other associated complications. Pure-tone air-conduction audiometry was performed using supra-aural headphones and acoustic stimulus of the pure-tone type, containing tone thresholds of frequencies between 250 Hz and 6,000 Hz. The independent variables were professional categories, length of service, hours of flight, and right or left ear. The dependent variable was pilots with suspected noise-induced hearing loss. The noise exposure level was considered low/medium or high, and the latter involved periods > 5,000 flight hours and > 10 years of flight service.RESULTS A total of 29.3% pilots had suspected noise-induced hearing loss, which was bilateral in 12.8% and predominant in the left ear (23.7%). The number of pilots with suspected hearing loss increased as the noise exposure level increased.CONCLUSIONS Hearing loss in civilian pilots may be associated with noise exposure during the period of service and hours of flight.

One-day measurement to assess the auditory risks encountered by noise-exposed workers

Noise is one of the most pervasive hazards in the workplace. Despite regulations and preventive measures, noise-induced hearing loss is common. The current reference test is pure-tone air-conduction audiometry (PTA), but this test cannot be used to detect early hearing loss. Objective: In this study, we assess one-day auditory fatigue using both PTA and efferent reflexes (ER) measured using DPOAEs associated with contralateral acoustic stimulation (CAS DPOAEs). Design: The noise exposure history, PTA, and ER detection were performed in seven different companies where the LEX,8h was 85 dB(A). Hearing was tested before and at the end of the working day. Study sample: Forty-six volunteers were selected to carry out this study. Results: After a single working day, a greater impact of noise was measured using ER thresholds than PTA or DPOAEs. ER measurements are objective, easy to perform, and do not require a sound-attenuated booth. Conclusion: Screening workers by periodically measuring ER thresholds using CAS DPOAEs helps detect early changes in hearing status, before the onset of noise-induced hearing loss. These tests can be readily applied as part of a hearing conservation program.

Identification of Conductive Hearing Loss Using Air Conduction Tests Alone

The primary objective of this study was to determine whether a combination of automatically administered pure-tone audiometry and a tone-in-noise detection task, both delivered via an air conduction (AC) pathway, could reliably and validly predict the presence of a conductive component to the hearing loss. The authors hypothesized that performance on the battery of tests would vary according to hearing loss type. A secondary objective was to evaluate the reliability and validity of a novel automatic audiometry algorithm to assess its suitability for inclusion in the test battery. Participants underwent a series of hearing assessments that were conducted in a randomized order: manual pure-tone air conduction audiometry and bone conduction audiometry; automatic pure-tone air conduction audiometry; and an automatic tone-in-noise detection task. The automatic tests were each administered twice. The ability of the automatic test battery to: (a) predict the presence of an air-bone gap (ABG); and (b) accurately measure AC hearing thresholds was assessed against the results of manual audiometry. Test-retest conditions were compared to determine the reliability of each component of the automatic test battery. Data were collected on 120 ears from normal-hearing and conductive, sensorineural, and mixed hearing-loss subgroups. Performance differences between different types of hearing loss were observed. Ears with a conductive component (conductive and mixed ears) tended to have normal signal to noise ratios (SNR) despite impaired thresholds in quiet, while ears without a conductive component (normal and sensorineural ears) demonstrated, on average, an increasing relationship between their thresholds in quiet and their achieved SNR. Using the relationship between these two measures among ears with no conductive component as a benchmark, the likelihood that an ear has a conductive component can be estimated based on the deviation from this benchmark. The sensitivity and specificity of the test battery vary depending on the size of this deviation, but increase with increasing ABG size, with decreasing test frequency, and when results from multiple test frequencies are taken into account. The individual automatic tests comprising the battery were found to be reliable and valid, with strong, significant correlations between the test and retest results (r = 0.81 to 0.99; p < 0.0001) and between automatic and manual audiometry procedures (r = 0.98 to 0.99; p < 0.0001). The presence of an ABG can be predicted with a reasonably high degree of accuracy using AC tests alone. Applications of such a test battery include any clinical context in which bone conduction audiometry or specialized diagnostic equipment is unavailable or impractical. Examples of these include self-fitting hearing aids, whose efficacy relies on the ability of the device to automatically administer an in situ hearing test; self-administered adult hearing screenings in both clinical and home environments; large-scale industrial hearing conservation programs; and test environments in which ambient noise levels exceed the maximum permissible levels for unoccluded ears.

Validity of Automated Threshold Audiometry

A systematic literature review and meta-analysis on the validity (test-retest reliability and accuracy) of automated threshold audiometry compared with the gold standard of manual threshold audiometry was conducted.A systematic literature review was completed in peer-reviewed databases on automated compared with manual threshold audiometry. Subsequently a meta-analysis was conducted on the validity of automated audiometry.A multifaceted approach, covering several databases and using different search strategies was used to ensure comprehensive coverage and to cross-check search findings. Databases included: MEDLINE, Scopus, and PubMed; a secondary search strategy was the review of references from identified reports. Reports including within-subject comparisons of manual and automated threshold audiometry were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) on test-retest reliability for automated compared with manual audiometry were determined to assess the validity of automated threshold audiometry.In total, 29 reports on automated audiometry (method of limits and the method of adjustment techniques) met the inclusion criteria and were included in this review. Most reports included data on adult populations using air conduction testing with limited data on children, bone conduction testing and the effects of hearing status on automated audiometry. Meta-analysis test-retest reliability for automated audiometry was within typical test-retest variability for manual audiometry. Accuracy results on the meta-analysis indicated overall average differences between manual and automated air conduction audiometry (0.4 dB, 6.1 SD) to be comparable with test-retest differences for manual (1.3 dB, 6.1 SD) and automated (0.3 dB, 6.9 SD) audiometry. No significant differences (p > 0.01; summarized data analysis of variance) were seen in any of the comparisons between test-retest reliability of manual and automated audiometry compared with differences between manual and automated audiometry.Automated audiometry provides an accurate measure of hearing threshold, but validation data are still limited for (1) automated bone conduction audiometry; (2) automated audiometry in children and difficult-to-test populations and; (3) different types and degrees of hearing loss.

Automated Audiometry Using Apple iOS‐Based Application Technology

The aim of this study is to determine the feasibility of an Apple iOS-based automated hearing testing application and to compare its accuracy with conventional audiometry. Prospective diagnostic study. Setting Academic medical center. An iOS-based software application was developed to perform automated pure-tone hearing testing on the iPhone, iPod touch, and iPad. To assess for device variations and compatibility, preliminary work was performed to compare the standardized sound output (dB) of various Apple device and headset combinations. Forty-two subjects underwent automated iOS-based hearing testing in a sound booth, automated iOS-based hearing testing in a quiet room, and conventional manual audiometry. The maximum difference in sound intensity between various Apple device and headset combinations was 4 dB. On average, 96% (95% confidence interval [CI], 91%-100%) of the threshold values obtained using the automated test in a sound booth were within 10 dB of the corresponding threshold values obtained using conventional audiometry. When the automated test was performed in a quiet room, 94% (95% CI, 87%-100%) of the threshold values were within 10 dB of the threshold values obtained using conventional audiometry. Under standardized testing conditions, 90% of the subjects preferred iOS-based audiometry as opposed to conventional audiometry. Apple iOS-based devices provide a platform for automated air conduction audiometry without requiring extra equipment and yield hearing test results that approach those of conventional audiometry.