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.