Conventional Pure-tone Audiometry Research Articles

Assessing the accuracy and reliability of application-based audiometry for hearing evaluation

Pure-tone audiometry (PTA) is the gold standard for assessing hearing loss. However, traditional PTA tests require specialized equipment, trained personnel, and a soundproof environment. Recently, smartphone-based PTA tests have been developed as an alternative method for hearing assessment. The aim of this study was to validate the accuracy and reliability of a smartphone application-based audiometry test. This study was conducted to assess the performance of application-based audiometry from November 2021 to January 2022. Pure-tone thresholds were measured using a smartphone application-based PTA test and compared with results obtained using a traditional audiometer in a sound-treated booth. The smartphone application used in this study was the "Care4Ear (Care4ear, version 1.0.6, MIJ Co., Ltd.)". Hearing thresholds less than 35 dB HL were classified as group A, 35-64 dB HL as group B, and 65 dB HL or greater as group C for the classification of hearing levels. We evaluated the accuracy of smartphone audiometry for each group and compared the results of frequency-specific hearing tests. Additionally, we examined the results of smartphone audiometry in individuals (n = 27) with asymmetric hearing loss. Seventy subjects completed both conventional audiometry and smartphone application-based hearing tests. Among the ears assessed, 55.7% were classified as group A, while 25.7% and 18.6% were classified as group B and group C, respectively. The average hearing threshold obtained from conventional pure-tone audiometry was 37.7 ± 25.2 dB HL, whereas the application-based hearing test yielded thresholds of 21.0 ± 23.0 dB HL. A significant correlation (r = 0.69, p < 0.01) was found between the average hearing thresholds obtained from the application-based and conventional pure-tone audiometry tests. The application-based test achieved a 97.4% hit rate for classifying hearing thresholds as class A, but lower rates of 22.2% for class B and 38.5% for class C. Notably, a discrepancy was observed between the hearing threshold measured by the application and the conventional audiometry for the worse ear with asymmetric hearing. The smartphone-based audiometry is a feasible method for hearing evaluation especially in persons with normal hearing. In cases of hearing loss or asymmetric hearing loss, the results of the application-based audiometry may be inaccurate, limiting its diagnostic utility.

Accuracy and Pitfalls in the Smartphone-Based Audiometry Examination.

Approximately 466 million people suffer from hearing loss worldwide, with Indonesia ranking fourth in Southeast Asia. However, conventional pure-tone audiometry is not yet available in many areas because of its high cost. Numerous available smartphone-based audiometry applications are potential alternative screening tools for hearing loss, especially in Indonesia. This study examined the findings on the validation of smartphone-based audiometry applications to assess hearing functions available in Indonesia. Based on the established eligibility criteria, this study was conducted by browsing the relevant literature validating smartphone-based audiometry applications in Indonesia. Relevant study data, such as the author, year, location, implementation procedures, and outcomes, were extracted and summarized. This systematic review found 17 relevant and eligible publications. Of the six applications tested, 5 were found to have good validity, such as uHearTM, Audiogram MobileTM, AudCalTM, Hearing TestTM e-audiologia, and WuliraTM. All smartphone-based audiometry was tested only for the air conduction threshold and was influenced by several factors. Because smartphone-based audiometry is inexpensive, simple, and more accessible than conventional audiometric testing, it can be useful as a screening modality or alternative approach to assess hearing function. Unfortunately, smartphone-based audiometry cannot replace conventional audiometry in diagnosing hearing impairment.

Mobile audiometry for hearing threshold assessment: A systematic review and meta-analysis.

Technological advancements in mobile audiometry (MA) have enabled hearing assessment using tablets and smartphones. This systematic review (PROSPERO ID: CRD42021274761) aimed to identify MA options available to health providers, assess their accuracy in measuring hearing thresholds, and explore factors that might influence their accuracy. A systematic search of online databases including PubMed, Embase, Cochrane, Evidence Search and Dynamed was conducted on 13th December 2021, and repeated on 30th October 2022, using appropriate Medical Subject Headings (MeSH) terms. Eligible studies reported the use of MA to determine hearing thresholds and compared results to conventional pure-tone audiometry (CA). Studies investigating MA for hearing screening (i.e. reporting just pass/fail) were ineligible for inclusion. Two authors independently reviewed studies, extracted data, and assessed methodological quality and risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Adults and children, with and without diagnosis of hearing impairment. A meta-analysis was performed to obtain the mean difference between thresholds measured using MA and CA in dB HL. Searches returned 858 articles. After systematic review, 17 articles including 1032 participants were analysed. The most used software application was ShoeboxTM (6/17) followed by Hearing TestTM (3/17), then HearTestTM (2/17). Tablet computers were used in ten studies, smartphones in six, and a computer in one. The mean difference between MA and CA thresholds was 1.36 dB (95% CI, 0.07-2.66, p = 0.04). Significant differences between mobile audiometry (MA) and conventional audiometry (CA) thresholds were observed in thresholds measured at 500Hz, in children, when MA was conducted in a sound booth, and when MA was self-administered. However, these differences did not exceed the clinically significant threshold of 10 decibels (dB). Included studies exhibited high levels of heterogeneity, high risk of bias and low concerns about applicability. MA compares favourably to CA in measuring hearing thresholds and has role in providing access to hearing assessment in situations where CA is not available or feasible. Future studies should prioritize the integration of pure-tone threshold assessment with additional tests, such as Speech Recognition and Digits-in-Noise, for a more rounded evaluation of hearing ability, assesses acceptability and feasibility, and the cost-effectiveness of MA in non-specialist settings.

Evaluation of Noise Exposure and Hearing Threshold Levels Among Call Centre Operators

The aim of this study was to evaluate the hearing status of call centre operators in relation to their noise exposure. Conventional pure-tone audiometry and extended high-frequency audiometry were performed in 49 workers, aged 22–47 years (mean ± SD: 32.0 ± 6.0 years), working in call centre from 1.0 to 16.5 years (mean ± SD: 4.7 ± 2.9 years). Questionnaire inquiry aimed at collecting personal data, the information on ommunication headset usage habits, self-assessment of hearing ability and identification of risk factors for noise-induced hearing loss were also carried out. Sound pressure levels generated by the communication headset were determined using the artificial ear technique specified in CSA Z107.56-13 (2013) standard. The background noise prevailing in offices was also measured according to PN-N-01307 (1994) and PN-EN ISO 9612 (2011). Personal daily noise exposure levels in call centre operators varied from 66 to 86 dB (10–90th percentile). About half of the study subjects had normal hearing in the standard frequencies (from 250 to 8000 Hz) in both ears, while only 27.1% in the extended high-frequencies (9–16 kHz). Moreover, both high-frequency and speech-frequency hearing losses were observed in less than 10% of audiograms, while the extended high-frequency threshold shift was noted in 37.1% of analysed ears. The hearing threshold levels of call centre operators in the frequency of 0.25–11.2 kHz were higher (worse) than the expected median values for equivalent (due to age and gender) highly screened population specified in ISO 7029 (2017). Furthermore, they were also higher than predicted for 500–4000 Hz according to ISO 1999 (2013) based on the results of noise exposure evaluation.

The significance of extended high-frequency audiometry in tinnitus patients with normal hearing as evaluated via conventional pure tone audiometry.

This study was designed to determine whether extended high-frequency audiometry was capable of better differentiating between participants with normal hearing who did or did not have subjective tinnitus. A total of 96 study participants were enrolled: 36 patients with unilateral tinnitus, 28 patients with bilateral tinnitus and 32 volunteers as controls. All 96 participants exhibited normal audiometry findings and hearing thresholds. Extended high-frequency audiometry was used to evaluate these patients. There were differences between the extended high-frequency hearing thresholds of affected and unaffected ears in those with unilateral tinnitus, and in the 20-29-year-old bilateral tinnitus group, at 11.2, 12.5 and 14 kHz. Unilateral tinnitus subgroups had higher extended high-frequency hearing thresholds than those in control subjects, at all extended high frequencies. Extended high-frequency audiometry can offer additional information regarding the hearing status of patients with tinnitus who exhibit normal pure tone thresholds when analysed via conventional hearing thresholds.

A pilot study to validate AMTAS in a specialist outpatient clinic at a public restructured hospital in Singapore

Background The prevalence of age-related hearing loss is expected to increase with the ageing population in Singapore resulting in increased demand for pure tone audiometry (PTA). One way of meeting the increased demand for PTA is the Automated Method of Testing Auditory Sensitivity (AMTAS). Nonetheless, before AMTAS may be implemented, it is important to validate its results by comparing them against those of conventional PTA for the diverse Singaporean population. Methods 100 participants were recruited from the Otorhinolaryngology clinic at a public hospital. PTA was conducted for participants via the conventional method and AMTAS. The hearing thresholds obtained via the two methods were then compared. A feedback questionnaire on the use of AMTAS was also completed by all participants. Results Air and bone conduction threshold results from 80 participants were analysed. The absolute mean difference in air conduction thresholds obtained via the two methods ranged from 3.30 to 9.62 dB. The absolute mean difference in bone conduction thresholds obtained via the two methods ranged from 8.16 to 9.38 dB. Most participants indicated that the machine was easy to use. Other feedback collected indicated that the AMTAS testing environment was noisy and that testing was fast. Conclusion This study finds that despite differences in hearing thresholds obtained via AMTAS and manual PTA, these differences are within the acceptable 10 dB test-retest variation. Nonetheless, existing issues related to the AMTAS software and noise levels in the testing environment will need to be addressed before it can be used in the clinic.

Hearing Outcomes of Stapedotomy In Patients With Otosclerosis

Objective: This study was focused on the assessment of patient’s improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary otosclerosis. Materials and Methods: This prospective clinical study was performed in a total of 156 patients diagnosed with Primary Otosclerosis, who underwent Stapedotomy at the Department of ENT &amp; Head-Neck Surgery, Combined Military Hospital Dhaka between January 2013 to January 2019. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. The bone-conduction &amp; air conduction thresholds and the Air-Bone gap (ABG), were documented and analyzed at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively. The subjective outcomes in hearing were also recorded with a patient satisfaction questionnaire to assess improvement in quality of hearing after stapedotomy. Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 57.5dB at 1 KHz, 55.1dB at 2 KHz and 45.7dB at 4 KHz. The frequency specific post-operative mean averaged Air conduction thresolds were 34.6 dB at 500Hz, 28.9 dB at 1Kz, 30.5dB at 2Kz and 33.3dB at 4Kz.The frequency specific mean average post operative Air Bone Gap (ABG) closure was achieved by 28.7dB at 500Hz, 27.6 dB at 1KHz, 24.6 dB at 2KHz and 12.4 dB at 4KHz by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 83.97% of cases. Overall, the frequency specific bone-conduction thresholds were unchanged postoperatively in all cases except 03, showing that no significant sensori-neural impairment had occured due to the stapedotomy procedure. 04 patients developed post-op severe vertigo which was self-limiting after six weeks. 01 patient developed transient facial weakness which was subsided over a time period of 03 months. Patients included in our study had significant subjective audiological improvement and responded satisfactorily to the questionnaire formulated to assess their hearing quality after stapedotomy. Conclusions: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Our study shows that meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes. J Dhaka Med Coll. 2021; 30(2) : 156-160

Audiological and psychological assessment of tinnitus patients with normal hearing.

This study was performed to assess identifiable abnormalities in tinnitus patients with normal hearing. The medical records of subjective non-pulsatile tinnitus patients with normal hearing confirmed by conventional pure-tone audiometry who visited our tinnitus clinic between March 2020 and May 2022 were reviewed. The loudness discomfort level (LDL), extended high-frequency hearing loss (EHFHL), summating potential (SP)/action potential (AP) ratio, distortion product otoacoustic emission (DPOAE), thresholds of auditory brainstem response (ABR) wave V, somatic modulation, and psychiatric symptoms, such as anxiety, depression, and stress were evaluated by questionnaires. Decreased LDL (n = 48, 59.8%) was the most frequent finding, followed by EHFHL (n = 29, 35.4%), increased SP/AP ratio (n = 27, 32.9%), psychiatric symptoms (n = 24, 29.3%), decreased DPOAE (n = 17, 20.7%), somatic modulation (n = 8, 9.8%), and increased ABR threshold (n = 3, 3.7%); 75.6% of patients had one or more of these findings. The presence of psychiatric symptoms was independently associated with the Tinnitus Handicap Inventory (THI) score. Tinnitus in patients with normal hearing may be accompanied by a combination of various subclinical abnormal audiological findings. However, the presence of psychiatric symptoms alone was independently associated with tinnitus distress.

Extended High-frequency Hearing Loss in Chronic Suppurative Otitis Media Patients Complaining of Tinnitus but with Normal Cochlear Function on Conventional Pure-tone Audiometry

Objective: The aim of the study is to find the incidence of extended high-frequency hearing loss (EHFHL) in chronic suppurative otitis media (CSOM) patients complaining of tinnitus but with normal cochlear function on conventional pure-tone audiometry (PTA). CSOM often results in conductive hearing loss, but recent studies have shown sensorineural hearing loss, thus indicating inner ear damage. Study Design: The stud design was a prospective study. Setting: The study was conducted at a tertiary care hospital. Methods: In a prospective observational study, a total of 141 patients with CSOM were reviewed. Seventy-four CSOM patients presented with tinnitus, and the mean age of presentation was 31.4 ± 6.82 years. Only those with normal cochlear function based on PTA (250 Hz to 8 kHz) were included. They were further tested at extended frequencies of up to 12 kHz. The severity of tinnitus was assessed using the Tinnitus Handicap Index Questionnaire. Results: The prevalence of EHFHL in the normal cochlear function CSOM patients with tinnitus was 68.9%, whereas the prevalence in the tinnitus negative group was 22.38%. EHFHL and tinnitus in CSOM patients show statistically significant association (P &lt; 0.05). Furthermore, there was a significant association between the severity of tinnitus and EHFHL. Conclusion: The findings demonstrate that the patients of CSOM with tinnitus and normal hearing in conventional PTA have EHFHL that indicates damage has occurred in the inner ear. The severity of the tinnitus can be predicted by the degree of higher frequency hearing loss.

Audiological findings of family farmers exposed to pesticides.

To analyze the possible differences among the hearing of farmers and their families when compared to the population not exposed to pesticides. Cross-sectional study with 70 smallholder family farmers (research group), with the mean age of 39.7 years, of both sexes and a mean of 23.7 years of exposure to pesticides. We included a control group with 71 participants of both sexes with the mean age of 39.5 years, not exposed to either noise or chemical substances, to compare the results. In stage 1, both groups were submitted to conventional and high-frequency audiometry, and acoustic immittance. In stage 2, only people with normal hearing were submitted to the evoked otoacoustic emissions and suppression effect on transient otoacoustic emissions. Significant differences were observed between the groups in the conventional pure-tone and in the high-frequency audiometry, as well as in the acoustic reflex. The most affected frequencies in the conventional pure-tone audiometry ranged from 3 to 6 kHz and, in the high-frequency audiometry, from 9000 to 11200 Hz. As for the transient otoacoustic emissions, the worse suppression effect results were found in the research group. There were differences among the hearing of family farmers and the control group. The conventional auditory thresholds are related to the group, age and sex. Farming is associated with impairments in the basal region of the cochlea, absence of acoustic reflex, reduced signal-to-noise ratio of the transient otoacoustic emissions, and dysfunction in the olivocochlear efferents of the auditory system.

Achados audiológicos de agricultores familiares paranaenses expostos a agrotóxicos

ABSTRACT Purpose To analyze the possible differences among the hearing of farmers and their families when compared to the population not exposed to pesticides. Methods Cross-sectional study with 70 smallholder family farmers (research group), with the mean age of 39.7 years, of both sexes and a mean of 23.7 years of exposure to pesticides. We included a control group with 71 participants of both sexes with the mean age of 39.5 years, not exposed to either noise or chemical substances, to compare the results. In stage 1, both groups were submitted to conventional and high-frequency audiometry, and acoustic immittance. In stage 2, only people with normal hearing were submitted to the evoked otoacoustic emissions and suppression effect on transient otoacoustic emissions. Results Significant differences were observed between the groups in the conventional pure-tone and in the high-frequency audiometry, as well as in the acoustic reflex. The most affected frequencies in the conventional pure-tone audiometry ranged from 3 to 6 kHz and, in the high-frequency audiometry, from 9000 to 11200 Hz. As for the transient otoacoustic emissions, the worse suppression effect results were found in the research group. Conclusion There were differences among the hearing of family farmers and the control group. The conventional auditory thresholds are related to the group, age and sex. Farming is associated with impairments in the basal region of the cochlea, absence of acoustic reflex, reduced signal-to-noise ratio of the transient otoacoustic emissions, and dysfunction in the olivocochlear efferents of the auditory system.

Extended high-frequency audiometric analyses of tinnitus patients exhibiting normal hearing on conventional pure-tone audiometry

Background While hearing loss is the greatest risk factor associated with developing tinnitus, some tinnitus patients exhibit no hearing loss on conventional pure-tone audiometry (PTA). Objectives This study was developed to assess whether tinnitus patients with normal hearing as measured via conventional PTA would exhibit differences from normal controls upon extended high-frequency (EHF) audiometric evaluation. Methods In total, 102 tinnitus patients were separated into unilateral and bilateral tinnitus groups. Age- and sex-matched controls without tinnitus were enrolled. Results No significant differences were observed when comparing EHF audiometry results in the 9–14 kHz range between controls and tinnitus patients, with only left-sided tinnitus ears exhibiting higher hearing thresholds than contralateral ears at 9, 10, and 14 kHz. Relative to normal controls, the hearing thresholds in the 2–8 kHz range for tinnitus ears were significantly increased. Conclusions and significance Relative to controls, tinnitus patients with normal hearing did not exhibit any significant hearing loss in the EHF range. Unexpectedly, tinnitus patients with normal hearing exhibited significant hidden hearing loss in the conventional frequency range rather than in the EHF range. For patients with normal hearing, it appears to be unnecessary to conduct EHF examinations to detect hearing loss in the EHF range.

Extended high-frequency audiometry: hearing thresholds in adults

PurposeThis study aimed to determine hearing thresholds in an otologically normal population without occupational noise exposure aged 18 to 64 years using extended high-frequency audiometry (EHFA).MethodsIndividuals from the general population who have never had hearing problems and whose job was not associated with noise exposure were included in the study and classified by age into 5 categories: 18–24 and, further, by 10 years of age. Each of these groups was further divided according to gender. All subjects underwent tympanometry, conventional pure-tone audiometry within the 0.125–8 kHz range, and extended high-frequency audiometry within the 9–16 kHz range, performed according to the standards. The significance level for statistical testing was set at 5%.ResultsHere, we established hearing thresholds in an otologically healthy population within the extended high-frequency (EHF) range (9–16 kHz). We found the EHFA to be a highly sensitive method for early detection of hearing loss, with hearing thresholds decreasing as soon as 35 years of age. In males, the hearing thresholds grew with age more rapidly than in women. The ability to respond at EHF gradually decreased with age and increasing frequency.ConclusionOur results can help improve the knowledge of EHF hearing thresholds for individual sexes and age groups. So far, the standard 7029:2017 is not binding and, moreover, it only reaches up to the frequency of 12.5 kHz. EHFA is a highly sensitive method for the evaluation of hearing loss depending on age and sex.

Audioogical Outcome of Stapedotomy for Primary Otosclerosis

Introduction: To find out the audiometric outcome after stapedotomy patients with clinical diagnosis of otosclerosis. Methods: This prospective observational study was performed in a total of 142 patients diagnosed with primary Otosclerosis, who underwent Stapedotomy at the Department of ENT &amp; Head-Neck Surgery, Combined Military Hospital, Dhaka between January 2013 to January 2018. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre-operative and Post-operative audiometric evaluation were done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 month and 12 month. Results: Overall, the frequency specific pre-operative mean average Air-Bone gap was 51.6 dB at 500Hz, 35.7 dB at 1000 Hz, 40.5 dB at 2000 Hz, 38.9 dB at 4000 Hz and the frequency specific postoperative mean average Air- Bone Gap closure was achieved by 28.1 dB at 500Hz, 30.3 dB at 1000 Hz, 12.5 dB at 2000 Hz, 10.8 dB at 4000 Hz, by the time of 1 years of follow up. The difference was statistically significant (p&lt;0.05) between pre-operative Air-Bone gap and post operative Air-Bone gap. After the surgery 88.7% tinnitus patients reported improvement and 11.3 % noted no change in tinnitus. Postoperative sensorineural hearing loss (SNHL) was seen in 1.4 %, failure rate was found 3.8% and 1.4% patients developed post-operative persistent vertigo. Conclusion: Most of the audiometric Results reveal excellent hearing improvement after stapedectomy surgery and worsened bone conduction (postoperative threshold shifts) for primary otosclerosis. It is safe and successful procedure providing long-term hearing expansion in primary otosclerosis with minimum failure rate. J Bangladesh Coll Phys Surg 2022; 40: 116-120

Aminoglycoside Therapy for Tuberculosis: Evidence for Ototoxicity among Tuberculosis Patients in Ghana.

Background: Hearing impairment (HI) is a major problem in Ghana; however, the few attempts at shedding light on its causes appear to overlook the adverse effects of some medications—a gap that this study sought to fill. Aminoglycoside therapy for tuberculosis (TB) treatment is one of these medications. Aim: The aim of this study was to establish the potential of aminoglycoside as a cause of hearing impairment among patients on anti-TB treatment. Method: This was a case–control study, involving patients receiving treatment for TB with aminoglycoside at the chest clinic of the Tema General Hospital and a control group of age- and gender-matched healthy volunteers. A structured questionnaire was administered to obtain the demographic data and case history of the participants. The hearing sensitivity of the participants was assessed using conventional pure tone audiometry and transient evoked otoacoustic emission tests. Results: A hearing loss prevalence of 20% (12/60) was found among patients receiving treatment for TB, with the intensity of impairment ranging from mild to severe. Hearing thresholds of patients receiving anti-TB medications were significantly elevated (p < 0.05) in comparison to the thresholds of the control group, especially at the high frequencies. Conclusion: This study shows that aminoglycoside therapy for tuberculosis may contribute to hearing impairment among tuberculosis patients in Ghana. Audiological management of these patients should therefore be an essential part of their therapeutic treatment plan.

Diagnostic Accuracy of Smartphone-Based Audiometry for Hearing Loss Detection: Meta-analysis.

BackgroundHearing loss is one of the most common disabilities worldwide and affects both individual and public health. Pure tone audiometry (PTA) is the gold standard for hearing assessment, but it is often not available in many settings, given its high cost and demand for human resources. Smartphone-based audiometry may be equally effective and can improve access to adequate hearing evaluations.ObjectiveThe aim of this systematic review is to synthesize the current evidence of the role of smartphone-based audiometry in hearing assessments and further explore the factors that influence its diagnostic accuracy.MethodsFive databases—PubMed, Embase, Cochrane Library, Web of Science, and Scopus—were queried to identify original studies that examined the diagnostic accuracy of hearing loss measurement using smartphone-based devices with conventional PTA as a reference test. A bivariate random-effects meta-analysis was performed to estimate the pooled sensitivity and specificity. The factors associated with diagnostic accuracy were identified using a bivariate meta-regression model. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsIn all, 25 studies with a total of 4470 patients were included in the meta-analysis. The overall sensitivity, specificity, and area under the receiver operating characteristic curve for smartphone-based audiometry were 89% (95% CI 83%-93%), 93% (95% CI 87%-97%), and 0.96 (95% CI 0.93-0.97), respectively; the corresponding values for the smartphone-based speech recognition test were 91% (95% CI 86%-94%), 88% (95% CI 75%-94%), and 0.93 (95% CI 0.90-0.95), respectively. Meta-regression analysis revealed that patient age, equipment used, and the presence of soundproof booths were significantly related to diagnostic accuracy.ConclusionsWe have presented comprehensive evidence regarding the effectiveness of smartphone-based tests in diagnosing hearing loss. Smartphone-based audiometry may serve as an accurate and accessible approach to hearing evaluations, especially in settings where conventional PTA is unavailable.

Ambient noise limits efficacy of smartphone-based screening for hearing loss in children at risk

ObjectiveTo determine if hearScreen®, a smartphone-based pure tone audiometric screen, serves as an effective hearing screen for identifying hearing loss in children at risk, such as those with chronic otitis media and/or craniofacial anomalies. MethodsA cross-sectional, single-center, prospective study at an urban tertiary care hospital was completed. From June to October 2019, a total of 208 pediatric ears at risk for hearing loss were evaluated by both hearScreen® and conventional pure tone audiometry. The efficacy of hearScreen® for detecting hearing loss in a pediatric population at risk was determined. ResultsA total of 208 pediatric ears at risk for hearing loss were screened. HearScreen® demonstrated a sensitivity of 85%, a specificity of 41%, a positive predictive value of 36%, and a negative predictive value of 87%. Subgroup analysis stratified by hearing loss type showed that hearScreen® screens for conductive hearing loss with increased sensitivity. ConclusionsThis investigation suggests that hearScreen® may serve as a an accessible, low-cost, and sensitive pure tone audiometric screen for hearing loss in children at risk, particularly those with conductive hearing loss, with the caveat that it may generate a high proportion of false positives due to the influence of ambient noise, especially when screening at 500 Hz. Future investigations should weigh the utility of including 500 Hz in the screening protocol as well as assess methods that may mitigate the influence of ambient noise during a pure-tone audiometric screen.

Extended high frequency hearing loss in tinnitus-positive chronic suppurative otitis media patient.

ObjectivesTo determine the association between extended high frequency hearing loss and tinnitus in normal cochlear function based on a conventional audiometry chronic suppurative otitis media (CSOM) patient.Design and methodsA cross‐sectional study was conducted on 220 ears diagnosed as having CSOM with an equal number of tinnitus and without tinnitus groups. Only those with normal cochlear function based on conventional pure tone audiometry (250 Hz to 8 kHz) were included. They were further tested for hearing at extended high frequencies of up to 16 kHz. The severity of tinnitus was tested using a tinnitus questionnaire.ResultsThe prevalence of extended high frequency hearing loss in the normal cochlear function CSOM patients with tinnitus was 81.8% (95% CI 74.5%, 89.1%), whereas the prevalence in the tinnitus negative group was 30.0% (95% CI 21.3%, 38.7%). There was a significant association between extended high frequency hearing loss and tinnitus in CSOM patients (P < .001). The average thresholds were significantly higher in the tinnitus group at all extended high frequencies tested with an increasing trend of significance toward the higher frequencies. However, this study did not observe any association between the severity of tinnitus and extended high frequency hearing loss.ConclusionThe development of tinnitus among normal cochlear function CSOM patients indicates that the damage has occurred at a higher frequency level. However, the severity of tinnitus does not predict the degree of higher frequency hearing loss. Therefore, the presence of tinnitus warrants more aggressive monitoring and treatment to prevent sensorineural hearing loss from developing into the speech frequencies.Level of Evidence4.

Applications of extended high-frequency audiometry: a narrative review

Background and Aim: Hearing loss assessment is typically done using the conventional pure tone audiometry (125 Hz to 8000 Hz). Extended high-frequency audiometry (EHFA), which covers the frequency range of 9000 Hz to 20000 Hz, is a very useful tool for detecting early hearing loss before engaging middle and low frequencies. The involvement of these frequencies significantly affects hearing sensitivity. The purpose of the present study was to review the literature on the early diagnosis of hearing impairment using EHFA.&#x0D; Recent Findings: EHFA has been suggested as a low utilization tool in clinical evaluation. How­ever, in recent years, a great deal of information has been provided in this area. This evaluation has proven to be useful in a variety of areas, including ototoxicity, noise-exposed individuals, and users of personal music devices, hidden hear­ing loss (HHL), middle ear infections, rheuma­toid arthritis, and Sjogren’s syndrome.&#x0D; Conclusion: Given the importance and appli­cation of this clinical tool in the early detection of hearing loss and its use in conjunction with other evaluations, better care planning and pre­vention can be offered to patients in some areas.&#x0D; Keywords: Extended high-frequency audiometry; middle ear infections; hidden hearing loss; ototoxic medications; noise exposure; personal music player

The Immediate and Long-Term Impact of Military Aircraft Noise on Hearing: A Cross-Sectional Comparison of Fighter Pilots and Ground Staff

We examined the immediate and long-term impacts of military aircraft noise exposure on noise-induced hearing loss (NIHL) in fighter pilots and ground staff. We recruited 40 pilots, 40 ground staff, and 136 age-matched controls; all participants underwent hearing tests, including conventional pure-tone audiometry (PTA) (0.25–8.0 kHz), extended high-frequency (EHF) audiometry (9.0–18.0 kHz), and distortion-product otoacoustic emission (DPOAE) as a recent reference. A subsequent hearing test immediately after flight-mission noise exposure was requested. The results revealed higher recent hearing thresholds in pilots and ground staff than in controls. Threshold shifts at many octave band frequencies were also significantly elevated in ground staff. The grouped frequency threshold was significantly elevated in the 4–8 kHz high-frequency range. After a single flight-mission noise exposure, both ground staff and pilots showed decreased signal-to-noise ratios for DPOAE (1–8 kHz), whereas only ground staff showed significantly elevated left-ear hearing thresholds at 3, 11.2, and 12.5 kHz by conventional and EHF PTA. Fighter pilots and ground staff serve in hazardous noise-exposed environments that cause hearing damage and subsequent NIHL, but ground staff may be more vulnerable. A comprehensive hearing conservation program should be implemented to protect high-risk service members, and especially ground staff, from high-intensity noise exposure.