Globally applicable solution to hearing loss screening: a diagnostic accuracy study of tablet-based audiometry.

Abstract

Hearing loss (HL) affects 20% of the world's population, with shortages of audiologists and audiometric sound booths unable to meet demand for hearing care services. We aimed to assess the accuracy of tablet-based audiometry (TA) to screen for HL at standard (0.25-8 kHz) and extended high frequencies (>8 kHz). Diagnostic accuracy study. Two secondary care audiology and ear, nose and throat outpatient clinics in the UK between April 2022 and September 2023. Adults aged≥16 years undergoing sound booth audiometry (SBA). TA, hearing-related questionnaires and patient usability questionnaires. Sensitivity, specificity and accuracy of TA compared with SBA for detecting HL. Patient usability assessment of TA and SBA. 129 patients were enrolled with 127 patients (254 ears) included in the final analysis. Median age was 43 years (IQR 33-56), 55% (70/127) were women. 76% (96/127) and 68% (86/127) of patients had HL defined by British Society of Audiology (BSA) and American Speech-Language-Hearing Association (ASHA) criteria. Age was significantly associated with HL (p<0.0001); however, hearing-related questionnaire scores were not significantly different between those with or without HL. There was no significant difference in detecting HL between TA and SBA using either BSA or ASHA criteria at each frequency. Overall, 92% (1612/1751) of TA results were within 10 dB agreement with SBA results. Sensitivity and specificity of TA for detecting HL were 77-100% and >85%, respectively, between 0.25 and 12.5 kHz. In terms of patient usability, TA showed significantly higher scores in attractiveness (p<0.0001), novelty (p<0.0001), efficiency (p=0.0003), stimulation (p=0.003) and perspicuity (p=0.02). TA demonstrated good sensitivity with high specificity for detecting HL at frequencies 0.25-12.5 kHz and would be an acceptable accurate alternative to SBA. This would increase the accessibility of HL screening and has the potential to be used as a diagnostic test in those without tinnitus where resources are limited. NCT05847556.