Automated smartphone-based threshold audiometry has the potential to provide affordable audiometric services in underserved contexts where adequate resources and infrastructure are lacking. This study investigated the validity of the threshold version (hearTest) of the hearScreen™ smartphone-based application using inexpensive smartphones (Android OS) and calibrated supra-aural headphones. A repeated-measures, within-subject, study design was employed, comparing automated smartphone audiometry air conduction thresholds (0.5 to 8 kHz) to conventional audiometry thresholds. A total of 95 participants, with varying degrees of hearing sensitivity, were included in the study. 30 participants were adults, with known bilateral hearing losses of varying degrees (mean age of 59 years, 21.8 SD; 56.7% female). 65 participants were adolescents (mean age of 16.5 years, 1.2 SD; 70.8% female), of which 61 had normal hearing and 4 had mild hearing losses. Within the adult sample, 70.6% of thresholds obtained through smartphone and conventional audiometry corresponded within 5 dB. There was no significant difference between smartphone (6.75 min average, 1.5 SD) and conventional audiometry test duration (6.65 min average, 2.5 SD). Within the adolescent sample, 84.7% of audiometry thresholds obtained at 0.5, 2 and 4 kHz corresponded within 5 dB. At 1 kHz 79.3% of the thresholds differed by 10 dB or less. There was a significant difference (p&#060.01) between smartphone (7.09 min, 1.2 SD) and conventional audiometry test duration (3.23 min, 0.6 SD). The hearTest application using calibrated supra-aural headphones provided valid air conduction hearing thresholds. Therefore, it is evident that using inexpensive smartphones with calibrated headphones provides a cost-effective way to provide access to threshold air conduction audiometry. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / M Communication Pathology / Unrestricted

The need for hearing health care services across the world far outweighs the capacity to deliver these services with the present shortage of hearing health care personnel. Automated test procedures coupled with telemedicine may assist in extending services. Automated threshold audiometry has existed for many decades; however, there has been a lack of systematic evidence supporting its clinical use. The aim of this study was to systematically review the current body of peer-reviewed publications on the validity (test-retest reliability and accuracy) of automated threshold audiometry. A meta-analysis was thereafter conducted to combine and quantify the results of individual reports so that an overall assessment of validity based on existing evidence could be made for automated threshold audiometry. A systematic literature review and meta-analysis was conducted using peerreviewed publications. A multifaceted approach, covering several databases and employing different search strategies, was utilized to ensure comprehensive coverage and crosschecking of search findings. Publications were obtained using the following three databases: Medline, SCOPUS and PubMed, and by inspecting the reference list of relevant reports. Reports were selected based according to inclusion and an exclusion criterion, thereafter data extraction was conducted. Subsequently, the meta-analysis combined and quantified data to determine the validity of automated threshold audiometry. In total, 29 articles met the inclusion criteria. The outcomes from these studies indicated that two types of automated threshold testing procedures have been utilized, the ‘method of limits’ and ‘method of adjustments’. Reported findings suggest accurate and reliable thresholds when utilizing automated audiometry. Most of the reports included data on adult populations using air conduction testing, limited data on children, bone conduction testing and the effects of hearing status on automated threshold testing were however reported. The meta-analysis revealed that test-retest reliability for automated threshold audiometry was within typical testretest reliability for manual audiometry. Furthermore, the meta-analysis showed comparable overall average differences between manual and automated air conduction audiometry (0.4 dB, 6.1 SD) compared to test-retest differences for manual (1.3 dB, 6.1 SD) and automated (0.3 dB, 6.9 SD) air conduction audiometry. Overall, no significant differences (p>0.01; Summarized Data ANOVA) were obtained in any of the comparisons between test-retest reliability (manual and automated) and accuracy. Current evidence demonstrates that automated threshold audiometry can produce an accurate measure of hearing threshold. The differences between automated and manual audiometry fall within typical test-retest and inter-tester variability. Despite its long history however, validation is still limited for (i) automated bone conduction audiometry; (ii) automated audiometry in children and difficult-to-test populations and; (iii) automated audiometry with different types and degrees of hearing loss. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / unrestricted