AMTAS®: Automated method for testing auditory sensitivity: II. Air conduction audiograms in children and adults
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Objective: This study was designed to evaluate an automated pure-tone audiometric procedure (AMTAS®) for 4–8 year-old children, and a quality assessment method (QUALIND®) that predicts the accuracy of the test. Design: Children were tested with AMTAS and conventional manual air-conduction audiometry. A group of adults was tested for comparison. Study sample: Eighty-one 4–8 year-old children and 15 adults. Most had normal hearing. Results: For most subjects (93% of adults and 91% of children) differences between AMTAS and manual thresholds were similar to differences that occur when two experienced audiologists test the same subjects. QUALIND detected the inaccurate audiograms with a sensitivity of 71% and a specificity of 91%. When inaccurate audiograms identified by QUALIND are excluded, the accuracy of AMTAS is similar to the accuracy of manual audiometry. Conclusions: AMTAS produces accurate air-conduction audiograms in a high proportion of 4–8 year-old children and adults. QUALIND successfully identified most inaccurate AMTAS audiograms. The method can decrease the cost and increase efficiency and accessibility of hearing testing.SumarioObjetivo: Este estudio fue diseñado para evaluar un procedimiento automatizado de evaluación audiométrica de tonos puros (AMTAS®) para niños de 4-8 años y un método de evaluación de calidad (QUALIND™) que predice la exactitud de la prueba. Diseño: Los niños fueron evaluados con el AMTAS y con audiometría convencional manual de conducción aérea. Un grupo de adultos fue evaluado como comparación. Muestra de estudio: Ochenta y un niños de 4–8 años de edad y 15 adultos. La mayoría tenían audición normal. (“la mayoría”: COMO PUEDEN DECIR ESTO, ASI, EN UN ESTUDIO CIENTÍFICO?) Resultados: En la mayoría de los sujetos (93% de los adultos y 91% de los niños) la diferencia entre el AMTAS y los umbrales manuales fue similar a las diferencias que ocurren cuando dos audiólogos de experiencia evalúan al mismo sujeto. QUALIND detectó los audiogramas inexactos con una sensibilidad del 71% y una especificidad del 91%. Cuando se excluyen los audiogramas inexactos identificados por QUALIND, la exactitud de AMTAS es similar a la exactitud de la audiometría manual. Conclusiones: AMTAS produce audiogramas de conducción aérea exactos en una alta proporción de niños de 4–8 años de edad y en adultos. QUALIND identifica con éxito las mayor parte de los audiogramas inexactos obtenidos por AMTAS. El método puede disminuir el costo y aumentar la eficiencia y la accesibilidad para pruebas auditivas.Keywords:
Audiogram
Hearing test
Background. Developing countries have the world's highest prevalence of hearing loss, and hearing screening programmes are scarce. Mobile devices such as smartphones have potential for audiometric testing. Objectives. To evaluate the uHear app using an Apple iPhone as a possible hearing screening tool in the developing world, and to determine accuracy of certain hearing thresholds that could prove useful in early detection of hearing loss for high-risk populations in resource-poor communities. Methods. This was a quasi-experimental study design. Participants recruited from the Otolaryngology Clinic, Groote Schuur Hospital, Cape Town, South Africa, completed a uHear test in three settings – waiting room (WR), quiet room (QR) and soundproof room (SR). Thresholds were compared with formal audiograms. Results. Twenty-five patients were tested (50 ears). The uHear test detected moderate or worse hearing loss (pure-tone average (PTA) >40 dB) accurately with a sensitivity of 100% in all three environments. Specificity was 88% (SR), 73% (QR) and 68% (WR). It was highly accurate in detecting high-frequency hearing loss (2 000, 4 000, 6 000 Hz) in the QR and SR with 'good' and 'very good' Kappa values, showing statistical significance ( p <0.05). It was moderately accurate in low-frequency hearing loss (250, 500, 1 000 Hz) in the SR, and poor in the QR and WR. Conclusion. Using the iPhone, uHear is a feasible screening test to rule out significant hearing loss (PTA >40 dB). It is highly sensitive for detecting threshold changes at high frequencies, making it reasonably well suited to detect presbycusis and ototoxic hearing loss from HIV, tuberculosis therapy and chemotherapy. Portability and ease of use make it appropriate to use in developing world communities that lack screening programmes.
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Objectives: To assess the effectiveness of hearing application as an initial hearing assessment in adult, to analyse and compare between the Uhear hearing application and conventional audiometer of its usage and to make recommendation about the use the hearing application as the screening tools for the underprivileged.
Methodology: We recruited 140 patients at Hospital Ampang. Patients with otorrhea and cognitive impairment were excluded. All patients completed Uhear test in clinic and underwent standard audiogram.
Results: The mean PTA (Pure tone average) of all ears measured by the standard audiogram was 32 dB. The PTA of all ears measured by Uhear was 15 dB less compared to the standard audiogram (p40 dB HL) documented on the audiogram, 34 had a PTA≤40 dB by Uhear testing. This translates to sensitivity of 54%. Of the 206 ears without moderate or worse hearing loss documented on the audiogram, one had moderate or worse hearing loss by Uhear testing. This translates to a specificity of 99%. Conclusion: Uhear hearing application is a conceivable screening test to rule out significant hearing loss. In Kappa analysis, it is in the fair range in almost all frequencies. Portability and ease of use make it appropriate to use for hearing screening for the underprivileged.
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Mobile hearing applications (apps) are available for hearing testing, personal sound amplification, as well as hearing aid modulation. Hearing testing apps are gaining popularity, especially in resource-limited settings. The reliability of mobile hearing testing apps, however, is not well characterized.A case study of a single patient with a complaint of sudden hearing loss presenting to a tertiary-care hospital.Comparison of a mobile hearing testing app results with standard audiogram.A commercially available mobile hearing testing app was used after hours to determine if a patient's hearing complaints were consistent with sudden sensorineural hearing loss. The hearing app produced a rudimentary audiogram that was consistent with unilateral SSNHL. Given contraindications to oral treatment, preparations for possible intratympanic dexamethasone after a full audiometric evaluation were completed. Confirmatory audiogram the following day demonstrated normal hearing without evidence of hearing loss. Steroid treatment was aborted and appropriate counseling provided.While mobile hearing testing apps offer improved access to hearing screening in resource-limited settings, caution must be exercised when interpreting data and making clinical decisions based upon results. The role of professional audiologists remains critical. Further testing and validation of specific apps is required.
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We report two cases of pseudohypacusis with organic hearing loss in which useful diagnostic information could be obtained from otoacoustic emission (OAE) testing.Case 1 was a 12-year-old female who had complained of fluctuating hearing loss for a few years. Although her initial pure-tone audiogram indicated moderate hearing loss in both ears, speech audiometry strongly suggested that the hearing of her left ear was considerably better than anticipated based on the pure-tone testing. Since the wave V thresholds of auditory brainstem response (ABR) were 70 and 20dBnHL in the right and left ear, respectively, it was suspected that she had moderate hearing loss in the right ear and normal hearing sensitivity in the left ear. However, OAE testing subsequently performed revealed moderate to severe hearing loss in all frequency regions except between 1.5 and 5kHz in her left ear, and this finding was also confirmed by follow-up pure-tone audiometry.Case 2 was a 54-year-old male whose complaints were left-sided hearing loss and tinnitus developing after a traffic accident. His initial pure-tone audiogram showed moderate to severe hearing loss in the left ear. However, his speech discrimination score for the left ear suggested much better hearing than expected from the pure-tone testing results, and mild hearing loss in the left ear was suspected based on ABR examined later. OAE testing was subsequently performed and revealed moderate to severe hearing loss in the frequency region above 3kHz in the left ear, a finding subsequently confirmed by pure-tone audiometry.The diagnosis of pseudohypacusis is sometimes difficult in patients with organic hearing loss, as in the two cases presented here. In such cases, frequency-specific information about cochlear function provided by OAE might be helpful for assessment of true hearing loss. From this perspective, OAE testing is considered useful as a diagnostic tool for pseudohypacusis.
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Purpose: This 3rd of 4 articles on a study of the efficacy of the 2-stage otoacoustic emission/automated auditory brainstem response (OAE/A-ABR) newborn hearing screening protocol describes (a) the behavioral audiometric protocol used to validate hearing status at 8–12 months of age, (b) the hearing status of the sample, and (c) the success of the visual reinforcement audiometry (VRA) protocol across 7 sites. Method: A total of 973 infants who failed OAE but passed A-ABR, in one or both ears, during newborn screening were tested with a VRA protocol, supplemented by tympanometry and OAE screening at age 8–12 months. Results: VRA audiograms (1.0, 2.0, and 4.0 kHz) were obtained for 1,184 (82.7%) of the 1,432 study ears. Hearing loss was ruled out in another 100 ears by VRA in combination with OAE, for a total of 88.7% of the study sample. Permanent hearing loss was identified in 30 ears of 21 infants. Sites differed in their success with the VRA protocol. Conclusions: Continued monitoring of hearing beyond the newborn period is an important component of early detection of hearing loss. Using a structured protocol, VRA is an appropriate test method for most, but not all, infants. A battery of test procedures is often needed to adequately delineate hearing loss in infants. Examiner experience appears to be a factor in successful VRA.
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Hearing loss (HL) is the most common chronic disease and has been linked to negative health outcomes. Hearing aids (HAs) are regarded as the gold standard for HL management, however, the adoption rate of HAs is relatively low for various reasons. With this background, hearing devices, such as personal sound amplification products (PSAPs) received significant attention as an alternative to conventional HAs. This study aimed to evaluate the clinical efficacy of PSAPs in patients with mild to moderately severe HL.Nineteen patients with mild hearing loss (MHL), 23 with moderate hearing loss (MDHL), and 15 with moderately severe hearing loss (MSHL) participated in the study. Electroacoustic analysis, simulated real-ear measurements (REMs), and three clinical evaluations were implemented.All devices satisfied the electroacoustic tolerances. All devices provided sufficient gain for MHL and MDHL audiograms. However, in MSHL audiogram, the gains of PSAPs were insufficient, especially for high frequencies. In terms of clinical evaluations, sound-field audiometry showed significant improvements between aided and unaided thresholds in all groups for all devices (P < 0.001). Significant improvements of word recognition scores were only shown for HAs between aided and unaided conditions. The Korean version of the Hearing In Noise Test did not show any consistent findings for all devices and groups.Certain PSAPs are beneficial for improving hearing and speech perception in patients with HL. Well-chosen PSAPs could be an alternative hearing rehabilitation option for these patients.
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Introduction. The problem of hearing loss and deafness, due to the general prevalence of hearing loss in different age groups, is significant not only for medicine, but also for the social sphere of society. Nowadays, just as 40 years ago, preventive medical examinations and initial examinations by an otorhinolaryngologist use methods of testing hearing by means of whispered speech, which has its own characteristics for everyone. This leads to diagnostic errors and does not allow to detect hearing loss in its early stages. Purpose of the study —development of a whispered-speech apparatus for early express diagnosis of hearing loss, and study of the effectiveness of the developed apparatus. Materials and methods. The Department of Hygiene at the Izhevsk State Medical Academy, as part of the program "Umnic-2018" a whispered hearing analyzer — a device for early express diagnosis of hearing loss was developed. The device was tested on the basis of otorhinolaryngologist offices in Izhevsk and Tchaikovsky. The study group included 53 patients aged 19 to 76. As part of the testing of the device, the subjects underwent whispered speech hearing tests using acumetric Voyacek word tables; express diagnostics of the hearing level with the whispered hearing analyzer and tonal threshold audiometry using the ITERA II diagnostic audiometer (Otometrics, Denmark). Results. As a result of the testing of the developed device, we found that the use of the whispered hearing analyzer allows you to reduce the time of examination and increase its diagnostic efficiency compared to conventional methods of hearing level examination at medical check-ups. Discussion. The Whispering Hearing Analyzer is designed to quickly and accurately detect hearing loss during medical examinations. The results obtained with this instrument can only tell you that you have a hearing loss, but it is not possible to make a diagnosis. Conclusion. The problem of disabling hearing loss can be solved through preventive measures, one of which is the developed device for early express diagnosis of hearing loss. The use of this device eliminates the occurrence of diagnostic errors associated with the researcher's speech characteristics, thereby making it possible to detect hearing loss at an early stage.
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