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

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It is estimated that 10% of the global population is impaired to a significant degree by a decrease in hearing sensitivity. With the greatest proportion of these persons residing in developing countries where communities are grossly underserved, it is incumbent on hearing healthcare professionals to seek means of offering equitable hearing health care services to these communities. The delivery of conventional diagnostic hearing services to these population groups is challenged by limitations in human resources, financial constraints and by the dearth of audiometric testing facilities that are compliant with permissible ambient noise levels for reliable testing. Valid diagnostic hearing assessment without an audiometric test booth will allow greater mobility of services and could extend hearing healthcare service delivery in underserved areas. The purpose of this study was to investigate the validity of diagnostic pure tone audiometry in a natural environment, outside a sound treated room, using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. A within-subject repeated measures research design was employed to assess elderly adults with diagnostic air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure tone audiometry. The study was of a quantitative nature and the required data was collected by testing subjects initially in a natural environment and subsequently in a sound booth environment to compare the threshold measurements. One experienced audiologist used audiometric KUDUwave test equipment to evaluate subjects in both environments. A total of 147 adults with an average age of 76 (± 5.7) years were tested. Ears had pure tone averages (500, 1000, 2000 and 4000 Hz) of ≥ 25 dB in 59%, >40 dB in 23% and ˃ 55 dB in 6% of cases. Analysis of collected data showed air conduction thresholds (n = 2259) corresponding within 0 to 5 dB in 95% of all comparisons between testing in the natural and sound booth environments. Bone conduction thresholds (n = 1669) corresponded within 0 to 5 dB in 86% of comparisons and within 10 dB or less in 97% of cases. Average threshold differences (–0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Recorded thresholds showed no statistically significant differences with a paired samples t-test (p ˃ 0.01) except at 8000 Hz in the left ear. Overall the correlation between the air-conduction thresholds recorded in the sound booth environment and the natural environment was very high (˃ 0.92) across all frequencies while for bone conduction threshold correlation for the two environments fell between 0.63 and 0.97. This study demonstrates that valid diagnostic pure tone audiometry in an elderly population can be performed in a natural environment using an audiometer employing insert earphones covered by circumaural earcups with real-time monitoring of ambient noise levels. Mobile diagnostic audiometry performed outside of an audiometric sound booth may extend current hearing healthcare services to remote underserved communities where booths are scarce or inaccessible. In combination with Telehealth applications this technology could offer a powerful and viable alternate diagnostic service to persons unable to attend conventional testing facilities for whatever reasons. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / 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

Made available in DSpace on 2016-04-27T18:12:12Z (GMT). No. of bitstreams: 1 Denise Torreao Correa da Silva.pdf: 13435475 bytes, checksum: 0ee13ef29957b217cb6d5b50c30944cf (MD5) Previous issue date: 2016-02-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / To estimate the measurement uncertainty of the pure-tone audiometry by air-conduction, in the frequencies from 250 Hz to 8000 Hz, and bone-conduction, at frequencies of 500 Hz to 4000 Hz. Method: This is an observational, descriptive and cross sectional study. Accuracy measurement tests under repeatability conditions were conducted (same measurement procedure, operator, measuring system, operating conditions and site, in a short time interval). Each of the nine participants took part in two trials with five repetitions each through air and bone conduction, in the right and left ear. In Trial 1 the interval between each repetition was five minutes. In Trial 2 the interval between repetitions was sixty minutes. To calculate the combined uncertainty the type A uncertainty, derived from repeatability, and Type B uncertainty derived from the audiometer calibration certificate, the audiometer resolution, and the conditions of the test environment were considered. Results: There was no statistically significant difference intra-individuals in different time intervals (p> 0,05), in both air and bone conduction. The median of type A uncertainty ranged from 0 dB to 2,7 dB in the right ear, and 0 dB to 3,5 dB in the left ear for air conduction. In bone conduction the median of type A uncertainty ranged from 2.2 dB to 2.7 dB in both ears. Type B uncertainties, for air and bone conduction, derived from the contribution of the equipment used for the test (0,4 dB), of the equipment resolution (1,4 dB), and the test environment (5,0 dB). Considering the median of type A uncertainty derived from accuracy measurement, and type B uncertainties mentioned above, the estimated of measurement uncertainty of pure tone audiometry, air and bone conduction, in this study, for the confidence level of 95% (k=1.96) and 95.45% (k=2.0) were 10 dB or 11 dB, for the frequencies tested, in both Trials 1 and Trial 2, in both ears. Conclusions: This study demonstrates the feasibility of accuracy measurement tests under repeatability conditions, as proposed in this work. In this study the contribution of type B uncertainties, derived from the audiometer calibration certificate, potentiometer and test environment, this latter being more prevalent, was higher than that of type A uncertainty derived from repeatability, indicating the need to keep control of these variables. The expression of measurement uncertainty can increase even more the sensitivity and specificity of audiometry, respectively increasing the rate of true positives and true negatives, since it is considered the gold standard. In this study the expanded uncertainty, for the confidence level of 95% and 95,45% ranged between 10 and 11 dB, in air and bone conduction. The reliability of the pure-tone audiometry test depends on the expression of its uncertainty; only so results obtained with the same subject in different places and times can be compared. Therefore the expression of uncertainty should be taken into consideration when delivering results and in preparing reports, for subsidizing decisions on hearing aids prescription, selection and adaptation procedures, as well as assessment of social security benefit payments, labor actions and health surveillance actions / Estimar a Incerteza de Medição no exame de audiometria tonal por via aérea, nas frequências de 250 Hz a 8 000 Hz, e por via óssea, nas frequências de 500 Hz a 4 000 Hz. Método: Nesta pesquisa, de natureza observacional, descritiva e transversal, foram realizados ensaios de precisão de medição sob condições de repetibilidade (mesmo procedimento de medição, operador, sistema de medição, condições de operação e mesmo local, em curto intervalo de tempo). Cada um dos nove participantes realizou dois ensaios, com cinco repetições de audiometria cada, por vias aérea e óssea, orelhas direita e esquerda. No Ensaio 1 o intervalo entre cada repetição foi de cinco minutos. No Ensaio 2 o intervalo entre as repetições foi de sessenta minutos. Para cálculo da incerteza padrão combinada considerou-se a incerteza do tipo A, derivada da repetibilidade, e as incertezas do tipo B, derivadas do certificado de calibração do audiômetro, da resolução do audiômetro, e das condições do ambiente de teste. Resultados: Para as vias aérea e óssea não houve diferença estatisticamente significante intraindivíduos nos diferentes intervalos de tempo (p > 0,05). A mediana da incerteza do tipo A variou de 0 dB a 2,7 dB, na orelha direita, e de 0 dB a 3,5 dB na orelha esquerda, para a via aérea. Na via óssea a mediana da incerteza do tipo A variou de 2,2 dB a 2,7 dB, em ambas as orelhas. As incertezas do tipo B, tanto para via aérea quanto para a via óssea, foram derivadas da contribuição do equipamento utilizado para o exame (0,4 dB), da resolução do equipamento (1,4 dB), e do ambiente de teste (5,0 dB). Levando-se em consideração a mediana das incertezas do tipo A e as incertezas do tipo B citadas acima, a estimativa da incerteza de medição da audiometria tonal por vias aérea e óssea, neste estudo, para os níveis da confiança de 95% (k=1,96) e 95,45% (k=2,0), foi de 10 dB ou 11 dB, nas frequências testadas, tanto no Ensaio 1 quanto no Ensaio 2, em ambas as orelhas. Conclusões: Este estudo demonstra a viabilidade de ensaios de precisão de medição sob condições de repetibilidade, conforme proposto neste trabalho. Neste estudo a contribuição das incertezas do tipo B, derivadas do certificado de calibração do audiômetro, do potenciômetro e do ambiente de teste, preponderando esta última, foi maior do que a incerteza do tipo A, derivada da repetibilidade, indicando a necessidade de manter-se controle sobre estas variáveis. A expressão da incerteza de medição da audiometria pode elevar, ainda mais, a sensibilidade, e a especificidade da audiometria, respectivamente aumentando a taxa de verdadeiros positivos e de verdadeiros negativos, uma vez que é considerada padrão ouro. Neste estudo a incerteza de medição expandida, para os níveis da confiança de 95% e 95,45% variou entre 10 dB e 11 dB, tanto para via aérea quanto para via óssea. A confiabilidade do exame de Audiometria Tonal, ou Audiometria de Tons Puros depende da expressão de sua incerteza; somente assim resultados obtidos com o mesmo sujeito, em locais e épocas diferentes, podem ser comparados. Portanto a expressão da incerteza deve ser levada em consideração quando da entrega de resultados e confecção de relatórios, seja para decisão sobre procedimentos de indicação, seleção e adaptação de aparelhos de amplificação sonora individual, assim como para avaliação de concessão de benefícios previdenciários, ações trabalhistas e ações de vigilância em saúde

The presented master’s thesis deals with the acoustics, specifically with the selected characteristics of the sound. It focuses on the anatomy of the auditory system and its function. The work describes the testing approaches for an evaluation of the auditory organ function and introduces modern methods used for the hearing tests, especially pure tone audiometry. A part of the thesis is dedicated to a concept of an audiometer for pure tone audiometry, which is presented in a detailed block diagram along with a description of its working components. Included chapters describe the partial circuits of the audiometer supplemented by the calcuations of its individual elements. The concluding part of the thesis deals with the evaluation of the device’s functionality.