Clinical utility of mobile and automated hearing health technology in an infectious disease clinic setting

Abstract

Decentralised detection and monitoring of hearing loss can be supported by new mHealth technologies using automated testing, which can be facilitated by minimally trained persons. These technologies may prove particularly useful in an infectious disease (ID) clinic setting where patients are at high risk for hearing loss. The current study aimed to evaluate the clinical utility of mobile and automated audiometry hearing health technology in an ID clinic setting. The current study was exploratory as it aimed to determine whether smartphone automated audiometry and South African English Digits-In-Noise (SA Eng DIN) smartphone applications could be utilised in an infectious disease clinic setting to monitor an HIV-related hearing loss in a feasible and time efficient way. Smartphone automated audiometry (hearTest™) and speech-in-noise testing (SA English Digits-In-Noise (DIN) test) were compared with manual audiometry at 2, 4, and 8 kHz. Smartphone automated audiometry and the DIN test were repeated to determine the test re-test reliability. Two hundred subjects (73% female and 27% male) were enrolled. Fifty participants were re-tested with the smartphone applications. Participants’ ages ranged from 18 to 55 years with a mean age of 44.4 (8.7 SD). Threshold comparisons were made between smartphone audiometry testing and manual audiometry. Smartphone automated audiometry, manual audiometry, and test re-test measures were compared to determine the statistical significance of any differences observed using the Wilcoxon signed-ranked test. Spearman rank correlation test was used to determine the relationship between the smartphone applications and manual audiometry, as well as for test re-test measurements. For all participants, 88.2% of thresholds corresponded within 10 dB or less between smartphone audiometry and manual audiometry. There was a significant difference (p>0.05) between smartphone and manual audiometry for the right ear at 4 and 8 kHz and the left ear at 2 and 4 kHz respectively. No significant difference was noted (p>0.05) between test and re-test measures of smartphone technology except at 4kHz in the right ear in smartphone automated audiometry. The absolute average difference between the initial and re-test of DIN testing was 1.2 dB (1.5 SD). No significant difference was noted in the test re-test measures of the DIN test (p < vii 0.05). A correlation coefficient of 0.56 was present in the DIN test re-test measures when the Spearman rank correlation test was administered. Smartphone audiometry with calibrated headphones provides reliable results and can be used as a baseline and monitoring tool at ID clinics.