Automated Audiometry in Quiet and Simulated Exam Room Noise for Listeners with Normal Hearing and Impaired Hearing

Abstract

Background Up to 80% of audiograms could be automated which would allow more time for provision of specialty services. Ideally, automated audiometers would provide accurate results for listeners with impaired hearing as well as normal hearing. Additionally, accurate results should be provided both in controlled environments like a sound-attenuating room but also in test environments that may support greater application when sound-attenuating rooms are unavailable. Otokiosk is an iOS-based system that has been available for clinical use, but there are not yet any published validation studies using this product.

Purpose The purpose of this project was to complete a validation study on the OtoKiosk automated audiometry system in quiet and in low-level noise, for listeners with normal hearing and for listeners with impaired hearing.

Research Design Pure tone air conduction thresholds were obtained for each participant for three randomized conditions: standard audiometry, automated testing in quiet, and automated testing in noise. Noise, when present, was 35 dBA overall and was designed to emulate an empty medical exam room.

Study Sample Participants consisted of 11 adults with hearing loss and 15 adults with normal hearing recruited from the local area.

Data Collection and Analysis Thresholds were measured at 500, 1,000, 2,000, and 4,000 Hz using the Otokiosk system that incorporates a modified Hughson-Westlake method. Results were analyzed using descriptive statistics and also by a linear mixed-effects model to compare thresholds obtained in each condition.

Results Across condition and participant group 73.6% of thresholds measured with OtoKiosk were within ± 5 dB of the conventionally measured thresholds; 92.8% were within ± 10 dB. On average, differences between tests were small. Pairwise comparisons revealed thresholds were ∼3.5–4 dB better with conventional audiometry than with the mobile application in quiet and in noise. Noise did not affect thresholds measured with OtoKiosk.

Conclusions The OtoKiosk automated hearing test measured pure tone air conduction thresholds from 500 to 4,000 Hz at slightly higher thresholds than conventional audiometry, but less than the smallest typical 5 dB clinical step-size. Our results suggest OtoKiosk is a reasonable solution for sound booths and exam rooms with low-level background noise.

Keywords

audiology - audiometry - automated - diagnostics - hearing loss - noise

Note

Portions of this work were completed by Brianna N. Bean as a part of her capstone project at Vanderbilt University School of Medicine.

Disclaimer

Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.

Publication History

Received: 21 April 2020

Accepted: 16 January 2021

Article published online:
25 May 2021

• References

• 1 Deafness and Hearing Loss. World Health Organization; 2021
• 2 Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat 2021; 10: 1-161 . PMID: 24819891
• 3 Margolis RH, Morgan DE. Automated pure-tone audiometry: an analysis of capacity, need, and benefit. Am J Audiol 2008; 17 (02) 109-113
• 4 Baiduc RR, Poling GL, Hong O, Dhar S. Clinical measures of auditory function: the cochlea and beyond. Dis Mon 2013; 59 (04) 147-156
• 5 Shojaeemend H, Ayatollahi H. Automated audiometry: A review of the implementation and evaluation methods. Healthc Inform Res 2018; 24 (04) 263-275
• 6 Margolis RH, Glasberg BR, Creeke S, Moore BC. AMTAS: automated method for testing auditory sensitivity: validation studies. Int J Audiol 2010; 49 (03) 185-194
• 7 Swanepoel W, Biagio L. Validity of diagnostic computer-based air and forehead bone conduction audiometry. J Occup Environ Hyg 2011; 8 (04) 210-214
• 8 Storey KK, Muñoz K, Nelson L, Larsen J, White K. Ambient noise impact on accuracy of automated hearing assessment. Int J Audiol 2014; 53 (10) 730-736
• 9 Margolis RH, Killion MC, Bratt GW, Saly GL. Validation of the home hearing test. J Am Acad Audiol 2016; 27 (05) 416-420
• 10 Margolis RH, Moore BCJ. AMTAS(®): automated method for testing auditory sensitivity: III. sensorineural hearing loss and air-bone gaps. Int J Audiol 2011; 50 (07) 440-447
• 11 Margolis RH, Frisina R, Walton JP. AMTAS(®): automated method for testing auditory sensitivity: II. air conduction audiograms in children and adults. Int J Audiol 2011; 50 (07) 434-439
• 12 Saliba J, Al-Reefi M, Carriere JS, Verma N, Provencal C, Rappaport JM. Accuracy of mobile-based audiometry in the evaluation of hearing loss in quiet and noisy environments. Otolaryngol Head Neck Surg 2017; 156 (04) 706-711
• 13 Busch-Vishniac IJ, West JE, Barnhill C, Hunter T, Orellana D, Chivukula R. Noise levels in Johns Hopkins Hospital. J Acoust Soc Am 2005; 118 (06) 3629-3645
• 14 Swanepoel W, Matthysen C, Eikelboom RH, Clark JL, Hall III JW. Pure-tone audiometry outside a sound booth using earphone attentuation, integrated noise monitoring, and automation. Int J Audiol 2015; 54 (11) 777-785
• 15 American Speech-Language-Hearing Association. Guidelines for manual pure-tone threshold audiometry [Guidelines]. 2005 Available from www.asha.org/policy
• 16 Bates D, Maechler M, Bolker B, Walker S. Fitting linear mixed-effects models using {lme4}. J Stat Softw 2015; 67: 1-48
• 17 Matuschek H, Kliegl R, Vasishth S, Baayen H, Bates D. Balancing type I error and power in linear mixed models. J Mem Lang 2017; 94: 305-315
• 18 R Core Team. R: A language and environment for statistical computing. 2019. Vienna, Austria: R Foundation for Statistical Computing;
• 19 Russell L. Emmeans: Estimated marginal means, aka least-squares means. 2019 R package version 1.4. Https://cran.R-project.Org/package=emmeans