Hearing Aid Fitting Research Articles

"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services.

Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

Predictors of cochlear implant outcomes in pediatric auditory neuropathy: A matched case-control study.

Current evidence supports the benefits of cochlear implants (CIs) in children with hearing loss, including those with auditory neuropathy spectrum disorder (ANSD). However, there is limited evidence regarding factors that hold predictive value for intervention outcomes. This retrospective case-control study consisted of 66 children with CIs, including 22 with ANSD and 44 with sensorineural hearing loss (SNHL) matched on sex, age, age at CI activation, and the length of follow-up with CIs (1:2 ratio). The case and control groups were compared in the results of five open-set speech perception tests, and a Forward Linear Regression Model was used to identify factors that can predict the post-CI outcomes. There was no significant difference in average scores between the two groups across five outcome measures, ranging from 88.40% to 95.65%. The correlation matrix revealed that younger ages at hearing aid fitting and CI activation positively influenced improvements in speech perception test scores. Furthermore, among the variables incorporated in the regression model, the duration of follow-up with CIs, age at CI activation, and the utilization of two CIs demonstrated prognostic significance for improved post-CI speech perception outcomes. Children with ANSD can achieve similar open-set speech perception outcomes as children with SNHL. A longer CI follow-up, a lower age at CI activation, and the use of two CIs are predictive for optimal CI outcome.

Chapter 4: Introduction and Getting Ready for Real-Ear Probe Microphone Measures.

Probe microphone measurements are an essential step in an individualized hearing aid fitting. These measurements allow audiologists to account for the individual's hearing and ear canal acoustics when programming hearing aids. An evidence-based hearing aid fitting includes matching the measured output of the hearing aids to targets for each input level and frequency. This allows the audiologist to confidently counsel the patient that the acoustic fitting is accurate, and the next step is for the individual to use the amplification during all waking hours to adapt to the newly amplified sounds. This also avoids mistakes such as overamplification or insufficient gain, which can endanger the patient and/or lead to a compromised fitting.

Chapter 5: Setting the Hearing Aid Response and Verifying Signal Processing and Features with Real-Ear Probe Microphone Measures.

The real-ear probe microphone system provides a powerful tool to individual hearing aid fittings accounting for your patient's hearing and ear canal characteristics. The primary treatment for hearing loss is audibility, returning an audible signal across frequencies and input levels given the constraints of the hearing loss. This chapter will provide detailed information on the measures needed to individualize the hearing aid fitting and will present various clinical scenarios that will allow you to work with this information and see how you apply this knowledge clinically. You will explore the verification of signal processing and features that allow you to support your patients.

Chapter 6: What Else Can I Do with This Equipment?

AbstractIf there is sound in the ear canal, you can measure it with a probe microphone in the ear. The following are a few examples of how you might use your real-ear probe microphone measures beyond verifying hearing aid fittings, signal processing, and function of features. A process to simulate hearing loss to educate and support family members and patients is described.

Chapter 3: Setting the Hearing Aid Response and Verifying Signal Processing and Features in the Test Box.

The test box can be used for fitting hearing aids (verifying audibility for the individual), for setting and fine-tuning specific signal processing (e.g., directional microphones, noise reduction, frequency lowering, telecoil responses), and for setting the response for specific accessories (e.g., remote microphones). If you have selected these features for your patient, it is important to make sure they are working properly and turned on. In addition, these tests can help you address specific patient complaints. Let us start by using the test box to pre-set a hearing aid and then we will move on to speech tests of signal processing and features.

Remote or in-clinic? The effect of service delivery mode on hearing aid output: study protocol for a double-blinded, randomised trial in adults with mild to moderate sensorineural hearing loss

BackgroundTeleaudiology can potentially improve access to hearing healthcare services. Remote hearing aid fittings offer a new mode of service delivery that removes barriers of geography and access to an audiologist. Real-ear measurements (REMs) are the gold standard for hearing aid output verification but require in-clinic appointments. This study will investigate whether remote hearing aid fittings can provide clinically equivalent outcomes when compared to current, in-clinic, best practice guidelines.Research designA repeated measure, double-blinded crossover design will be used. Participants will be randomly allocated to one of two groups to determine order of intervention, balanced for degree of hearing loss.Study sampleSixty adults with mild to moderate hearing loss and at least 1 year of experience with hearing aids will be recruited.Data collection and analysisParticipants will complete two hearing aid fitting protocols, one using an in-clinic fitting process and the other using a remote (at-home) fitting process. In-clinic fittings will include REMs with adjustments to standard (NAL-NL2) prescription targets. The two fitting protocols will then be randomly assigned to participants in a crossover design, so participants and researchers will be blinded to the order of the two fitting protocols. Participants will then have a 4-week period with follow-up appointments for participant-directed gain adjustment. For each fitting protocol, participants will complete objective measurements of final hearing aid output with REMs, speech-in-noise testing, subjective measurements of hearing aid performance, and quality of life measurements. They will then begin an identical period of living with, adjusting, and objective assessment with the other fitting protocol. Data will be analysed as repeated measures with statistical control for potential confounding variables.ResultsData will compare the four-frequency average real-ear aided response (4FREAR) for hearing aids programmed in-clinic and hearing aids programmed remotely, after participant-directed gain adjustments. Secondary measures will assess clinically significant differences in estimated speech intelligibility, hearing-related quality of life, hearing aid benefit, sound quality and preference, and speech-in-noise ability.ConclusionsThis study will inform the development of best practice guidelines for remote hearing aid fittings. If no clinically significant differences are found between in-clinic and remote fit hearing aids, it has the potential to expand teleaudiology initiatives.Trial registrationAustralian New Zealand Clinical Trial Registry, ACTRN12623000028606p. Date of registration: 12 January 2023.

Digits-in-Noise Test as an Assessment Tool for Hearing Loss and Hearing Aids.

The aim of this study was to examine the relationship between an American English Digits in Noise (DIN) test and commonly used audiological measures to evaluate the DIN test's ability to detect hearing loss and validate hearing aid fitting. QuickSIN and DIN tests were completed by participants with untreated hearing loss (n = 46), prescription hearing aids (n = 15), and over-the-counter (OTC) hearing aids (n = 12). Performance on the QuickSIN showed moderate positive correlations with DIN for untreated hearing loss participants and prescription hearing aid users, but not for OTC hearing aid users. For untreated hearing loss participants, both QuickSIN and DIN tests showed positive moderate to strong correlations with high frequency puretone averages. In OTC users, DIN scores did not significantly change over a 6-month time period and were better when conducted remotely compared to in-person testing. Our results suggest that the DIN test may be a feasible monitoring option for individuals with hearing loss and those fitted with hearing aids. However, due to small sample size in this pilot study, future research is needed to examine DIN test's utility for fitting and validating OTC hearing aids.

Hearing Aid Fitting and Fine-tuning Strategies Implemented by Certified Audiologists in India

Background: Management of hearing-impaired individuals using hearing aids requires expertise in fitting formulas, compression methods, frequency adjustments, microphone directionality, noise reduction algorithms, and feedback management. There are abundant online resources/guidelines for programming and fine-tuning hearing aids. The fitting strategies for hearing aids can differ among professionals based on their expertise and convenience. Aims and Objectives: The survey study aimed to gain comprehension of the methods used by audiologists practicing in Indian subcontinent in choosing, fitting, and tuning hearing aids for adults with hearing impairment. Materials and Methods: A web-based survey with a 25-item questionnaire was carried out among audiologists nationwide, addressing topics such as hearing aid selection and fitting techniques. Among the audiologists practicing in India, 77 audiologists from various workplaces across India responded to the survey. The data gathered were then subjected to descriptive analysis. Results: The study showed that the selection of hearing aids depended on the extent of hearing loss and the main listening needs of the person. Audiologists generally used manufacturers’ initial fit and their expertise to adjust different signal processing features and considered patient feedback for additional adjustments. Most audiologists use only pure-tone audiometry for the initial evaluation of hearing abilities. Conclusion: The findings of the research underscore the absence of standardized procedures for audiologists in the fitting of hearing aids, considering the numerous signal-processing approaches present in contemporary hearing technology. Despite exponential advancements in hearing aid technology, there remains a scarcity of concise and accessible information that would enable audiologists to utilize such sophisticated technologies during fitting and tuning effectively.

Towards ASSR-based hearing assessment using natural sounds

Objective. The auditory steady-state response (ASSR) allows estimation of hearing thresholds. The ASSR can be estimated from electroencephalography (EEG) recordings from electrodes positioned on both the scalp and within the ear (ear-EEG). Ear-EEG can potentially be integrated into hearing aids, which would enable automatic fitting of the hearing device in daily life. The conventional stimuli for ASSR-based hearing assessment, such as pure tones and chirps, are monotonous and tiresome, making them inconvenient for repeated use in everyday situations. In this study we investigate the use of natural speech sounds for ASSR estimation. Approach. EEG was recorded from 22 normal hearing subjects from both scalp and ear electrodes. Subjects were stimulated monaurally with 180 min of speech stimulus modified by applying a 40 Hz amplitude modulation (AM) to an octave frequency sub-band centered at 1 kHz. Each 50 ms sub-interval in the AM sub-band was scaled to match one of 10 pre-defined levels (0–45 dB sensation level, 5 dB steps). The apparent latency for the ASSR was estimated as the maximum average cross-correlation between the envelope of the AM sub-band and the recorded EEG and was used to align the EEG signal with the audio signal. The EEG was then split up into sub-epochs of 50 ms length and sorted according to the stimulation level. ASSR was estimated for each level for both scalp- and ear-EEG. Main results. Significant ASSRs with increasing amplitude as a function of presentation level were recorded from both scalp and ear electrode configurations. Significance. Utilizing natural sounds in ASSR estimation offers the potential for electrophysiological hearing assessment that are more comfortable and less fatiguing compared to existing ASSR methods. Combined with ear-EEG, this approach may allow convenient hearing threshold estimation in everyday life, utilizing ambient sounds. Additionally, it may facilitate both initial fitting and subsequent adjustments of hearing aids outside of clinical settings.

Binaural hearing in monaural conductive or mixed hearing loss fitted with unilateral Bonebridge.

To determine the benefits of binaural hearing rehabilitation in patients with monaural conductive or mixed hearing loss treated with a unilateral bone conduction implant (BCI). This monocentric study includes 7 patients with monaural conductive or mixed hearing loss who underwent surgical implantation of a unilateral BCI (Bonebridge, Med-El). An ITA Matrix test was performed by each patient included in the study - without and with the BCI and in three different settings - to determine the summation effect, squelch effect and head shadow effect. Subjective hearing benefits were assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. The difference in signal to noise ratio of patients without and with BCI was 0.79 dB in the summation setting (p < 0.05), 4.62 dB in the head shadow setting (p < 0.05) and 1.53 dB (p = 0.063) in the squelch setting. The APHAB questionnaire revealed a subjective discomfort in the presence of unexpected sounds in patients using a unilateral BCI (aversiveness score) compared to the same environmental situations without BCI, with a mean discomfort score of 69.00% (SD ± 21.24%) with monaural BCI versus 25.67% (SD ± 16.70%) without BCI (difference: -43.33%, p < 0.05). In terms of global score, patients wearing a unilateral Bonebridge implant did not show any significant differences compared to those without hearing aid (difference: -4.00%, p = 0.310). Our study shows that the use of a unilateral BCI in patients affected by monaural conductive or mixed hearing loss can improve speech perception under noise conditions due to the summation effect and to the decrease of the head shadow effect. However, since monaural BCIs might lead to discomfort under noise conditions in some subjects, a pre-operative assessment of the possible individual benefit of a monaural BCI should be carried out in patients affected by unilateral conductive or mixed hearing loss in order to investigate the possible additional effect of the fitting of hearing aids.

External auditory canal reconstruction using a novel mastoidoplasty technique during canal wall down mastoidectomy: how I do it.

While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative. Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC. The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy.

Interactive effects of hearing aid use and cognitive function in patients with hearing loss.

There has been a significant increase in scientific investigations of the hearing-dementia association among the research on potentially modifiable risk factors for cognitive impairment. We tested two clinical questions. Analysis 1: does persistent hearing aid (HA) use decrease the decline in cognitive function caused by ageing? Analysis 2: does cognitive function at the time of HA fitting predict future persistent HA use? This case-control study performed at two referral centres reported data obtained over a 4.5-year period. We recruited a group of patients with cognitive decline, aged 65 or older with or without hearing loss. The intervention consisted of the use of HAs. The primary outcome measures were adherence to continuous HA use and cognitive function measured using the Japanese version of the Mini-Mental State Examination Test and the Reading Cognitive Test Kyoto. Eighteen HA users and 18 controls were included in the first analysis. HA use was associated with a deceleration of cognitive decline 12 months later. In the second analysis, 11 participants with good adherence to HA use were compared with 12 participants who showed poor adherence to HA use. Among the variables employed in this study, cognitive function measured using the Reading Cognitive Test Kyoto was significantly lower in participants with poor adherence to HA. HA use in cognitively impaired individuals with hearing loss can slow age-related cognitive decline. Cognitively impaired people with hearing loss who fail to commit to HA use tend to have lower cognitive measurement scores before HA fitting. HA use is generally more challenging as people age and their cognitive abilities decline. Therefore, it is desirable that HAs be used when hearing loss and dementia are in their early stages.

Current Rehabilitative Concepts in Ear Nose and Throat Department, University of Medical Sciences Teaching Hospital (UNIMEDTH): Challenges Encountered

Introduction: Unaddressed communication disorders are multidimensional, affecting individuals physiologically, psychologically and emotionally. The quality of life of these individuals can be improved with rehabilitative measures, justifying this study. The study therefore aims to assess the impact of rehabilitation on these patients, determine the challenges and proffer possible solutions. Methods: Eighteen months prospective study on audiological and speech disorders among ENT patients in the University of Medical Sciences Teaching Hospital, Ondo State, from April 2021 to September 2022 was carried out. History was taken, general examination and full E.N.T. examinations were done. Those with audiological disorders from canal blockage due to foreign bodies, debris and impacted wax had ear syringing. Others with persistent audiological condition were further evaluated and treated accordingly, with Hearing Aids trial and fitting inclusive. Patients with speech disorder had speech therapy after baseline audiological screening. Data were represented in tables and figures. P value &lt; 0.05 was statistically significant. Results: 930 patients presented at the ENT clinic. 537 (57.74%) females and 393 (42.26%) males. Of this, 405 (43.55%) patients had audiological conditions while 23 (2.47%) had speech disorders. Impacted wax, tinnitus, hearing loss, foreign body in the ear and delayed speech development were commonest. 297 had syringing while 105 patients were further evaluated. 369 of 405 patients were successfully rehabilitated. 3 stroke patients had good speech recovery. Predominant challenges encountered were unavailability of instruments and uncooperativeness of elderly patients. Weekly savings and incorporation of dedicated relatives for home therapy ensures solutions respectively. Conclusion: Rehabilitation in E.N.T., though gradually progressive, is beneficial. The guiding concept is patience.

Classification, registration and segmentation of ear canal impressions using convolutional neural networks

Today, fitting bespoke hearing aids involves injecting silicone into patients’ ears to produce ear canal molds. These are subsequently 3D scanned to create digital ear canal impressions. However, before digital impressions can be used they require a substantial amount of effort in manual 3D editing. In this article, we present computational methods to pre-process ear canal impressions. The aim is to create automation tools to assist the hearing aid design, manufacturing and fitting processes as well as normalizing anatomical data to assist the study of the outer ear canal’s morphology. The methods include classifying the handedness of the impression into left and right ear types, orienting the geometries onto the same coordinate system sense, and removing extraneous artifacts introduced by the silicone mold. We investigate the use of convolutional neural networks for performing these semantic tasks and evaluate their accuracy using a dataset of 3000 ear canal impressions. The neural networks proved highly effective at performing these tasks with 95.8% adjusted accuracy in classification, 92.3% within 20° angular error in registration and 93.4% intersection over union in segmentation.

Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study

Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.

Pediatric Hearing Aid Daily Wear Time Is Significantly Impacted by Clinician-Family Language Discordance.

The purpose of this study was to evaluate the potential contribution of limited English proficiency on daily hearing aid wear time for children with hearing loss. A retrospective chart review was completed to evaluate hearing aid wear time based on data logging information available at the time of a follow-up visit following an initial hearing aid fitting. Children were included in the study if they had permanent bilateral hearing loss and were less than 60 months of age at the time of their first follow-up visit. Wear time was compared between children who attended an interpreter-mediated appointment and those who did not have an interpreter present. The presence of an interpreter at the appointment was the study indicator that the family had limited English proficiency. Children from families with limited English proficiency exhibited significantly shorter daily wear time (M = 1.3 hr) than their peers whose families were English-proficient speakers, thus, having a shared language with their audiologists (M = 5.2 hr). Results of this study suggest that family-clinician language discordance might put children at greater risk of shorter hearing aid wear time than children whose caregivers share a common language with their child's audiologist. There can be many linguistic, cultural, and educational factors that contribute to hearing aid wear time in children whose families have limited English proficiency as well as different approaches to improving that wear time. Efforts should ensure that hearing and hearing aid-related information is accessible to all families, especially those with clinician-family language discordance. Such efforts can include, among others, training that improves clinicians' cultural and linguistic responsiveness to the diverse families they serve.

Amplifying Access: Progress After 1 Year of Over-the-Counter Hearing Aids

Purpose: A number of barriers exist that limit access to hearing aids and services, including high cost, limited number of providers, and patients' perceived lack of need. The traditional model of hearing aid service delivery requires patients to undergo a hearing test, receive a medical evaluation or waiver, and receive a hearing aid fitting from qualified providers, such as a licensed audiologist. In an effort to improve access and affordability, the U.S. Food and Drug Administration recently established a new category of over-the-counter (OTC) hearing aids for adults with perceived mild–moderate hearing loss that can be purchased without the involvement of a professional. The purpose of this Viewpoint article is to reflect on the progress that has been accomplished in the inaugural year of OTC hearing aids. Conclusions: In the last year, hearing aids have become more readily available to consumers online and in stores. A number of companies have entered the OTC hearing aid market, leading to innovative designs and a variety of options for consumers. The regulations governing OTC hearing aids have also spurred increased attention on hearing care and created new opportunities for interprofessional collaboration. In addition, research has illustrated the real-world effectiveness of OTC hearing aids. Still, in some respects, the first year of OTC hearing aids has not met expectations. Evidence points to low adoption as well as misconceptions, including regarding the distinction between OTC and prescription hearing aids. Audiologists can play an important role in addressing misconceptions by increasing their own knowledge of the devices and talking about them with patients and in outreach activities. There are a number of outstanding needs, including to investigate U.S. consumers' satisfaction when using these devices long term and to evaluate the impact of OTC hearing aids in countries outside of the United States.

Availability of resources for paediatric hearing care in a South African province.

Unavailability of healthcare resources can lead to poor patient outcomes. The latter is true for infants with hearing loss and require early hearing detection and intervention (EHDI). To determine the availability and distribution of resources for EHDI in state hospitals in the Eastern Cape (EC) province, South Africa. Sixteen state hospitals (nine district, four regional and three tertiary hospitals). Descriptive cross-sectional survey completed between July 2022 and October 2022. Thirteen hospitals had audiologists (n= 4) or speech therapists and audiologists (n= 9). Specific to equipment, 10 hospitals had a screening otoacoustic emissions or automated auditory brainstem response, 8 hospitals had diagnostic middle ear analysers and only 3 hospitals had diagnostic auditory brainstem response and/or auditory steady state response. Twelve hospitals did not have visual response audiometry (VRA) and 94% had no hearing aid verification systems. Budget allocations were uneven, with only 10 hospitals, i.e., 4 districts, all regional and 2 tertiary hospitals being allocated varying amounts. Subsequently, only 50% provided newborn hearing screening, 56% provided diagnostic evaluations and 14 hospitals fitted hearing aids. Results revealed a limited and uneven distribution of resources, which negatively impacted the provision of EHDI. Even distribution of healthcare resources and further research aimed at strengthening hearing health services is recommended as these could potentially improve equitable access to EHDI and the overall quality of healthcare provided.Contribution:This study highlights the need for even distribution of resources and strengthening of health systems, especially in the dawn of the National Health Insurance.

Smartphone-Facilitated In-Situ Hearing Aid Audiometry for Community-Based Hearing Testing.

Hearing loss prevalence is increasing, with an estimated 2.5 billion people affected globally by 2050. Scalable service delivery models using innovative technologies and task-shifting are World Health Organization priorities to improve access to hearing care, particularly in low- and middle-income countries. Smartphone-facilitated audiometry in the community using hearing aids covered by noise-attenuating ear cups ("in-situ") could support more accessible hearing care when provided by less trained individuals such as community health workers (CHWs). This study aimed to determine the validity of this method for potential hearing aid fitting. Study objectives included determining the maximum permissible ambient noise level (MPANL), inter-device reliability, clinical threshold accuracy, reliability, and performance in real-world settings. Experiment 1: 15 normal-hearing adult participants were evaluated to determine MPANLs for circumaural Peltor 3M earcups covering Lexie Lumen hearing aids with smartphone-facilitated in-situ audiometry. MPANLs were calculated by measuring the difference in attenuation between thresholds obtained with standard headphones and in-situ hearing aids. Experiment 2: Pure-tone frequency and intensity output of 14 same-model Lexie Lumen hearing aids were measured to determine inter-device reliability. Pure-tone stimuli were measured and analyzed to determine sound pressure levels in decibels and pure-tone frequency when connected to a test box 2cc coupler. Experiment 3: 85 adult participants were tested in a sound booth to determine the accuracy of automated in-situ pure-tone audiometry (PTA) compared to clinical PTA (500, 1000, 2000, 3000, 4000, 6000 Hz) facilitated by an audiologist. The first 39 participants were tested twice to determine test-retest reliability. Experiment 4: In a community setting, 144 adult participants were tested with automated in-situ audiometry facilitated by CHWs using a smartphone app. These participants were subsequently tested with automated mobile PTA (500, 1000, 2000, 4000 Hz). An additional 44 participants were tested twice to determine test-retest reliability. Experiment 1: MPANLs of the Peltor 3M earcup-covered hearing aids were higher than standard headphones across all frequencies, ranging from 24 to 47.3 dB SPL. Experiment 2: Inter-device performance reliability was high, with all inter-device differences across all intensities and frequencies less than 3 dB. Frequency output was consistent and differed less than 0.7% between devices. Experiments 3 and 4: 85.2% and 83.3% of automated in-situ audiometry thresholds were within 10 dB of thresholds obtained in the sound booth and in a community setting, respectively. Acceptable test-retest intraclass correlation coefficient (ICC) was evident across all thresholds obtained in a sound booth (ICC = 0.85 to 0.93) and in a community setting (ICC = 0.83 to 0.97). Smartphone-facilitated in-situ audiometry allows for reliable and valid community-based testing. A simple smartphone user interface and automated in-situ audiometry allow CHWs with minimal training to facilitate the testing. With the additional capability to program hearing aids via the smartphone after the initial test, this approach would have the potential to support widespread access to personalized hearing aid fittings facilitated by CHWs in low- and middle-income countries. This approach also supports self-fitting options based on in-situ thresholds, enabling testing and fitting via over the counter hearing aids.