Download PDF
J Am Acad Audiol 2019; 30(03): 217-226
DOI: 10.3766/jaaa.17111
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Extended High-Frequency Smartphone Audiometry: Validity and Reliability

Martelle Bornman
*   Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
,
De Wet Swanepoel
*   Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
†   Ear Science Institute Australia, Subiaco, Australia
‡   Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
,
Leigh Biagio De Jager
*   Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
,
Robert H. Eikelboom
*   Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
†   Ear Science Institute Australia, Subiaco, Australia
‡   Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
26 May 2020 (online)

   Permissions and Reprints

Abstract

Background:

Extended high-frequency (EHF) audiometry (8–16 kHz) has an important role in audiological assessments such as ototoxicity monitoring, and for speech recognition and localization. Accurate and reliable EHF testing with smartphone technologies has the potential to provide more affordable and accessible hearing-care services, especially in underserved contexts.

Purpose:

To determine the accuracy and test–retest reliability of EHF audiometry with a smartphone application, using calibrated headphones.

Research Design:

Air-conduction thresholds (8–16 kHz) and test–retest reproducibility, recorded with conventional audiometry (CA) and smartphone audiometry (SA), using audiometric (Sennheiser HDA 300 circumaural) and nonstandard audiometric (Sennheiser HD202 II supra-aural) headphones, were compared in a repeated-measures design.

Study Sample:

A total of 61 participants (122 ears) were included in the study. Of these, 24 were adults attending a tuberculosis clinic (mean age = 36.8, standard deviation [SD] = 14.2 yr; 48% female) and 37 were adolescents and young adults recruited from a prospective students program (mean age = 17.6, SD = 3.2 yr; 76% female). Of these, 22.3% (n = 326) of EHF thresholds were ≥25 dB HL.

Data Analysis:

Threshold comparisons were made between CA and SA, with audiometric headphones and nonstandard audiometric headphones. A paired samples t-test was used for comparison of threshold correspondence between conventional and smartphone thresholds, and test–retest reproducibility of smartphone thresholds.

Results:

Conventional thresholds corresponded with smartphone thresholds at the lowest intensity (10 dB HL), using audiometric and nonstandard audiometric headphones in 59.4% and 57.6% of cases, respectively. Conventional thresholds (exceeding 10 dB HL) corresponded within 10 dB or less, with smartphone thresholds in 82.9% of cases using audiometric headphones and 84.1% of cases using nonstandard audiometric headphones. There was no significant difference between CA and SA, using audiometric headphones across all frequencies (p > 0.05). Test–retest comparison also showed no significant differences between conditions (p > 0.05). Smartphone test–retest thresholds corresponded within 10 dB or less in 86.7% and 93.4% of cases using audiometric and nonstandard audiometric headphones, respectively.

Conclusions:

EHF smartphone testing with calibrated headphones can provide an accurate and reliable option for affordable mobile audiometry. The validity of EHF smartphone testing outside a sound booth as a cost-effective and readily available option to detect high-frequency hearing loss in community-based settings should be established.

Key Words

aging - automated audiometry - diagnostic audiometry - extended high frequencies - mHealth - noise-induced hearing loss - ototoxicity - smartphone

The University of Pretoria has assigned the IP of the hearTest smartphone application for commercialization by the hearX group (Pretoria, South Africa). The second author has declared an involvement with the hearX group (equity, consulting, potential royalties).


 

  • REFERENCES

  • Arslan E, Orzan E, Santarelli R. 1999; Global problem of drug-induced hearing loss. Ann N Y Acad Sci 884 (01) 1-14
    CrossrefPubMedGoogle Scholar
  • Balatsouras DG, Homsioglou E, Danielidis V. 2005; Extended high-frequency audiometry in patients with acoustic trauma. Clin Otolaryngol 30 (03) 249-254
    CrossrefPubMedGoogle Scholar
  • Basner M, Babisch W, Davis A, Brink M, Clark C, Janssen S, Stansfeld S. 2014; Auditory and non-auditory effects of noise on health. Lancet 383 (9925) 1325-1332
    CrossrefPubMedGoogle Scholar
  • Carhart R, Jerger JF. 1959; Preferred method for clinical determination of pure-tone thresholds. J Speech Hear Disord 24 (04) 330-345
    CrossrefGoogle Scholar
  • Clark JL, Swanepoel W. 2014; Technology for hearing loss—as We Know it, and as We Dream it. Disabil Rehabil Assist Technol 9 (05) 408-413
    CrossrefPubMedGoogle Scholar
  • Davis A, McMahon CM, Pichora-Fuller KM, Russ S, Lin F, Olusanya BO, Chadha S, Tremblay KL. 2016; Aging and hearing health: the life-course approach. Gerontologist 56 (Suppl 2) S256-S267
    CrossrefPubMedGoogle Scholar
  • Dieroff HG. 1982; Behaviour of high-frequency hearing in noise. Audiology 21 (01) 83-92
    CrossrefPubMedGoogle Scholar
  • Dille MF, Jacobs PG, Gordon SY, Helt WJ, McMillan GP. 2013; OtoID: new extended frequency, portable audiometer for ototoxicity monitoring. J Rehabil Res Dev 50 (07) 997-1006
    CrossrefPubMedGoogle Scholar
  • Durrant JD, Campbell K, Fausti S, Guthrie O, Jacobson G, Lonsbury-Martin BL, Poling G. 2009. American Academy of Audiology Position Statement and Clinical Practice Guidelines: Ototoxicity Monitoring. Washington DC: ASHA;
    Google Scholar
  • Eikelboom RH, Swanepoel W, Motakef S, Upson GS. 2013; Clinical validation of the AMTAS automated audiometer. Int J Audiol 52 (05) 342-349
    CrossrefPubMedGoogle Scholar
  • Fausti SA, Frey RH, Erickson DA, Rappaport BZ, Cleary EJ, Brummett RE. 1979; A system for evaluating auditory function from 8000–20 000 Hz. J Acoust Soc Am 66 (06) 1713-1718
    CrossrefPubMedGoogle Scholar
  • Frank T. 1990; High-frequency hearing thresholds in young adults using a commercially available audiometer. Ear Hear 11 (06) 450-454
    CrossrefPubMedGoogle Scholar
  • Frank T. 2001; High-frequency (8 to 16 kHz) reference thresholds and intrasubject threshold variability relative to ototoxicity criteria using a Sennheiser HDA 200 earphone. Ear Hear 22 (02) 161-168
    CrossrefPubMedGoogle Scholar
  • Frank T, Dreisbach LE. 1991; Repeatability of high-frequency thresholds. Ear Hear 12 (04) 294-295
    CrossrefPubMedGoogle Scholar
  • Fuente A, Hickson L. 2011; Noise-induced hearing loss in Asia. Int J Audiol 50 (Suppl 1) S3-S10
    CrossrefPubMedGoogle Scholar
  • Gordon JS, Phillips DS, Helt WJ, Konrad-Martin D, Fausti SA. 2005; Evaluation of insert earphones for high-frequency bedside ototoxicity monitoring. J Rehabil Res Dev 42 (03) 353-361
    PubMedGoogle Scholar
  • Hallmo P, Borchgrevink HM, Mair IW. 1995; Extended high-frequency thresholds in noise-induced hearing loss. Scand Audiol 24 (01) 47-52
    PubMedGoogle Scholar
  • Harris T, Peer S, Fagan JJ. 2012; Audiological monitoring for ototoxic tuberculosis, human immunodeficiency virus and cancer therapies in a developing world setting. J Laryngol Otol 126 (06) 548-551
    CrossrefPubMedGoogle Scholar
  • International Organization for Standardization 389-9 (ISO). (2009) Acoustics—Reference Zero for the Calibration of Audiometric Equipment—Part 9: Preferred Test Conditions for the Determination of Reference Hearing Threshold Levels. Geneva, Switzerland: ISO.
  • Jacobs PG, Silaski G, Wilmington D, Gordon S, Helt W, McMillan G, Fausti SA, Dille M. 2012; Development and evaluation of a portable audiometer for high-frequency screening of hearing loss from ototoxicity in homes/clinics. IEEE Trans Biomed Eng 59 (11) 3097-3103
    CrossrefPubMedGoogle Scholar
  • John AB, Kreisman BM. 2017; Equivalence and test-retest reproducibility of conventional and extended-high-frequency audiometric thresholds obtained using pure-tone and narrow-band-noise stimuli. Int J Audiol 56 (09) 635-642
    CrossrefPubMedGoogle Scholar
  • Langer T, am Zehnhoff-Dinnesen A, Radtke S, Meitert J, Zolk O. 2013; Understanding platinum-induced ototoxicity. Trends Pharmacol Sci 34 (08) 458-469
    CrossrefPubMedGoogle Scholar
  • Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF. 2016; Toward a differential diagnosis of hidden hearing loss in humans. PLoS One 11 (09) e0162726
    CrossrefPubMedGoogle Scholar
  • Louw C, Swanepoel W, Eikelboom RH, Myburgh HC. 2017; Smartphone-based hearing screening at primary health care clinics. Ear Hear 38 (02) e93-e100
    CrossrefPubMedGoogle Scholar
  • Leedy PD, Ormrod JE. 2013. Practical Research: Planning and Design. 10th ed. Upper Saddle River, NJ: Pearson Education Inc;
    Google Scholar
  • Maccà I, Scapellato ML, Carrieri M, Maso S, Trevisan A, Bartolucci GB. 2015; High-frequency hearing thresholds: effects of age, occupational ultrasound and noise exposure. Int Arch Occup Environ Health 88 (02) 197-211
    CrossrefPubMedGoogle Scholar
  • Mahomed F, Swanepoel W, Eikelboom RH, Soer M. 2013; Validity of automated threshold audiometry: a systematic review and meta-analysis. Ear Hear 34 (06) 745-752
    CrossrefPubMedGoogle Scholar
  • Mahomed-Asmail F, Swanepoel W, Eikelboom RH. 2016; Diagnostic hearing assessment in schools: validity and time-efficiency of automated audiometry. J Am Acad Audiol 27 (01) 42-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • Mehrparvar AH, Mirmohammadi SJ, Davari MH, Mostaghaci M, Mollasadeghi A, Bahaloo M, Hashemi SH. 2014; Conventional audiometry, extended high-frequency audiometry, and DPOAE for early diagnosis of NIHL. Iran Red Crescent Med J 16 (01) e9628
    PubMedGoogle Scholar
  • Mehrparvar AH, Mirmohammadi SJ, Ghoreyshi A, Mollasadeghi A, Loukzadeh Z. 2011; High-frequency audiometry: a means for early diagnosis of noise-induced hearing loss. Noise Health 13 (55) 402-406
    CrossrefPubMedGoogle Scholar
  • Mulwafu W, Ensink R, Kuper H, Fagan J. 2017; Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015. Glob Health Action 10 (01) 1289736
    CrossrefPubMedGoogle Scholar
  • Nelson DI, Nelson RY, Concha-Barrientos M, Fingerhut M. 2005; The global burden of occupational noise-induced hearing loss. Am J Ind Med 48 (06) 446-458
    CrossrefPubMedGoogle Scholar
  • Olusanya BO, Neumann KJ, Saunders JE. 2014; The global burden of disabling hearing impairment: a call to action. Bull World Health Organ 92 (05) 367-373
    CrossrefPubMedGoogle Scholar
  • Osterhammel D, Osterhammel P. 1979; High-frequency audiometry. Age and sex variations. Scand Audiol 8 (02) 73-81
    CrossrefPubMedGoogle Scholar
  • Palmer KT, Griffin MJ, Syddall HE, Davis A, Pannett B, Coggon D. 2002; Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain. Occup Environ Med 59 (09) 634-639
    CrossrefPubMedGoogle Scholar
  • Rodríguez Valiente A, Trinidad A, García Berrocal JR, Górriz C, Ramírez Camacho R. 2014; Extended high-frequency (9–20 kHz) audiometry reference thresholds in 645 healthy subjects. Int J Audiol 53 (08) 531-545
    CrossrefPubMedGoogle Scholar
  • Sandström J, Swanepoel W, Carel Myburgh H, Laurent C. 2016; Smartphone threshold audiometry in underserved primary health-care contexts. Int J Audiol 55 (04) 232-238
    CrossrefPubMedGoogle Scholar
  • Schmuziger N, Patscheke J, Probst R. 2007; An assessment of threshold shifts in nonprofessional pop/rock musicians using conventional and extended high-frequency audiometry. Ear Hear 28 (05) 643-648
    CrossrefPubMedGoogle Scholar
  • Schmuziger N, Probst R, Smurzynski J. 2004; Test-retest reliability of pure-tone thresholds from 0.5 to 16 kHz using Sennheiser HDA 200 and Etymotic Research ER-2 earphones. Ear Hear 25 (02) 127-132
    CrossrefPubMedGoogle Scholar
  • Seddon JA, Godfrey-Faussett P, Jacobs K, Ebrahim A, Hesseling AC, Schaaf HS. 2012; Hearing loss in patients on treatment for drug-resistant tuberculosis. Eur Respir J 40 (05) 1277-1286
    CrossrefPubMedGoogle Scholar
  • Serra MR, Biassoni EC, Richter U, Minoldo G, Franco G, Abraham S, Carignani JA, Joekes S, Yacci MR. 2005; Recreational noise exposure and its effects on the hearing of adolescents. Part I: an interdisciplinary long-term study. Int J Audiol 44 (02) 65-73
    CrossrefPubMedGoogle Scholar
  • Somma G, Pietroiusti A, Magrini A, Coppeta L, Ancona C, Gardi S, Messina M, Bergamaschi A. 2008; Extended high-frequency audiometry and noise induced hearing loss in cement workers. Am J Ind Med 51 (06) 452-462
    CrossrefPubMedGoogle Scholar
  • Swanepoel W, Biagio L. 2011; Validity of diagnostic computer-based air and forehead bone conduction audiometry. J Occup Environ Hyg 8 (04) 210-214
    CrossrefPubMedGoogle Scholar
  • Swanepoel DW, Clark JL, Koekemoer D. et al. 2010; Telehealth in audiology—the need and potential to reach underserved communities. J Telemed Telecare 16 (05) 245-252
    Google Scholar
  • Swanepoel W, Hall 3rd JW. 2010; A systematic review of telehealth applications in audiology. Telemed J E Health 16 (02) 181-200
    CrossrefPubMedGoogle Scholar
  • Swanepoel W, Koekemoer D, Clark J. 2010; Intercontinental hearing assessment—a study in tele-audiology. J Telemed Telecare 16 (05) 248-252
    CrossrefPubMedGoogle Scholar
  • Swanepoel W, Myburgh HC, Howe DM, Mahomed F, Eikelboom RH. 2014; Smartphone hearing screening with integrated quality control and data management. Int J Audiol 53 (12) 841-849
    CrossrefPubMedGoogle Scholar
  • Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD, Finucane M. Global Burden of Disease Hearing Loss Expert Group. 2011; Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries Eur J Public Health 23 (01) 146-152
    PubMedGoogle Scholar
  • Valente M, Valente M, Goebel J. 1992; High-frequency thresholds: circumaural earphone versus insert earphone. J Am Acad Audiol 3 (06) 410-418
    PubMedGoogle Scholar
  • Van der Aerschot M, Swanepoel W, Mahomed-Asmail F, Myburgh HC, Eikelboom RH. 2016; Affordable headphones for accessible screening audiometry: an evaluation of the Sennheiser HD202 II supra-aural headphone. Int J Audiol 55 (11) 616-622
    CrossrefPubMedGoogle Scholar
  • van Tonder J, Swanepoel W, Mahomed-Asmail F, Myburgh H, Eikelboom RH. 2017; Automated smartphone threshold audiometry: validity and time efficiency. J Am Acad Audiol 28 (03) 200-208
    Article in Thieme ConnectPubMedGoogle Scholar
  • Vitela AD, Monson BB, Lotto AJ. 2014; Phoneme categorization relying solelry on high-frequency energy. J Acoust Soc Am 137 (01) EL65-EL70
    Google Scholar
  • Vlaming MSMG, MacKinnon RC, Jansen M, Moore DR. 2014; Automated screening for high-frequency hearing loss. Ear Hear 35 (06) 667-679
    CrossrefPubMedGoogle Scholar
  • Vos T, Allen C, Arora M. et al. 2016; Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388 (10053) 1545-1602
    CrossrefPubMedGoogle Scholar
  • Vos T, Barber RM, Bell B. et al. 2015; Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386 (9995) 743-800
    CrossrefPubMedGoogle Scholar
  • Vos T, Flaxman AD, Naghavi M. et al. 2012; Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380 (9859) 2163-2196
    CrossrefPubMedGoogle Scholar
  • Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. 2017; Global hearing health care: new findings and perspectives. Lancet S0140-6736(17)31073-5
    Google Scholar
  • World Health Organization (WHO) 2013. Multi-country Assessment of National Capacity to Provide Hearing Care. Geneva, Switzerland: WHO;
    Google Scholar
  • World Health Organization (WHO) 2015 a Global Tuberculosis Report 2015. http://www.who.int/tb/publications/global_report/en/ . Accessed February 17, 2016
    PubMedGoogle Scholar
  • World Health Organization (WHO) 2015 b Hearing Loss Due to Recreational Exposure to Loud Sounds: A Review. http://apps.who.int/iris/bitstream/10665/154589/1/9789241508513_eng.pdf . Accessed February 17, 2016
    PubMedGoogle Scholar
  • Yousuf Hussein S, Wet Swanepoel D, Biagio de Jager L, Myburgh HC, Eikelboom RH, Hugo J. 2016; Smartphone hearing screening in mHealth assisted community-based primary care. J Telemed Telecare 22 (07) 405-412
    CrossrefPubMedGoogle Scholar