Abstract:
The global need for increased hearing health care currently far exceeds the capacity for delivering these services, especially in developing countries where the ratio of audiologists to the population is often less than one per every million. The imbalance is further compounded by the requirement for diagnostic assessments to be conducted in an audiometric (sound proof) booth, as a large proportion of the population has limited access to centres where these booths can be found. A tele-audiology approach utilising a portable diagnostic audiometer could provide the solution, enabling hearing assessments to be conducted remotely and without an audiometric booth. This would obviate the necessity for people from rural communities having to travel long distances, often with great difficulty and at great expense, to the nearest sound (audiometric) booth. An additional advantage would be that an audiologist could service a range of remote communities at the same time.
The purpose of this study was to determine the accuracy of pure tone air conduction (AC) thresholds obtained using a synchronous telehealth approach without a sound booth in a rural South African community.
Hearing thresholds in a sound booth and in a natural environment were obtained from an initial sample of 20 adults (range 19 to 63 years; mean age 50 ± 13 years; 55% female), recruited from a rural agricultural community. A subgroup of ten adults (20 ears) volunteered for the tele-audiology threshold testing. AC thresholds (250-8000 Hz) were determined and subsequently compared in these environments. Typical threshold variability was determined using test-retest correspondence as a reference for the threshold correspondence using a telehealth mode.
Test-retest threshold correspondence in the booth and natural environments were within ± 5 dB in 96.7% and 97.5% of comparisons respectively. No significant differences were noted when AC hearing thresholds determined in the telehealth configuration were compared to those recorded in the gold standard booth environment. Threshold correspondence between the telehealth environment on the one hand and booth and natural environments on the other hand were within ±5 dB in 82% and 85% of comparisons, respectively. The current study is the first of its kind to report synchronous telehealth hearing assessments conducted in a natural environment in a rural community. It demonstrates the validity of using synchronous tele-audiology for conducting hearing assessments in a remote rural agricultural community without a sound booth. It also highlights the potential for using non-clinical facilitators in remote locations, which could reduce the burden on the limited number of audiologists. These technologies make it possible for diagnostic hearing assessments to be included as part of a remote telemedicine kit and open up new possibilities in telehealth and tele-audiology support.
