Smartphone‐Based Applications to Detect Hearing Loss: A Review of Current Technology

Abstract

BACKGROUND/OBJECTIVES: Age-related hearing loss (ARHL) is a widely prevalent yet manageable condition that has been linked to neurocognitive and psychiatric comorbidities. Multiple barriers hinder older individuals from being diagnosed with ARHL through pure-tone audiometry. This is especially true during the COVID-19 pandemic, which has resulted in the closure of many outpatient audiology and otolaryngology offices. Smartphone-based hearing assessment apps may overcome these challenges by enabling patients to remotely self-administer their own hearing examination. The objective of this review is to provide an up-to-date overview of current mobile health applications (apps) that claim to assess hearing. DESIGN: Narrative review. MEASUREMENTS: The Apple App Store and Google Play Store were queried for apps that claim to assess hearing. Relevant apps were downloaded and used to conduct a mock hearing assessment. Names of included apps were searched on four literature databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL) to determine which apps had been validated against gold standard methods. RESULTS: App store searches identified 44 unique apps. Apps differed with respect to the type of test offered (e.g., hearing threshold test), cost, strategies to reduce ambient noise, test output (quantitative vs qualitative results), and options to export results. Validation studies were identified for seven apps. CONCLUSION: Given their low cost and relative accessibility, smartphone-based hearing apps may facilitate screening for ARHL, particularly in the setting of limitations on in-person medical care due to COVID-19. However, app features vary widely, few apps have been validated, and user-centered designs for older adults are largely lacking. Further research and validation efforts are necessary to determine whether smartphone-based hearing assessments are a feasible and accurate screening tool for ARHL.

Digital Technology for Remote Hearing Assessment—Current Status and Future Directions for Consumers

“…This test describes the hearing sensitivity in each ear, obtained by assessing the lowest threshold intensity (decibel hearing level) across frequencies ranging from 250 to 8000 Hz. Many hearing evaluation applications are publicly available online or can be downloaded on smartphones via app stores like Google Playstore or Apple iStore, yet few are clinically validated against gold-standard measures [23,24]. Some applications use a form of traditional pure-tone audiometry to measure hearing thresholds across a specific frequency range [24].…”

“…Many hearing evaluation applications are publicly available online or can be downloaded on smartphones via app stores like Google Playstore or Apple iStore, yet few are clinically validated against gold-standard measures [23,24]. Some applications use a form of traditional pure-tone audiometry to measure hearing thresholds across a specific frequency range [24]. However, as a sustainable solution, these tests pose a challenge due to varying test accuracy across devices [25].…”

“…Mobile applications that do not use tonal stimuli usually employ a speech-in-noise procedure to measure hearing at conversational loudness levels [24]. One measure commonly used is the digits-in-noise (DIN) test, which presents a series of three spoken digits (e.g., 3-5-8) in background masking noise [31].…”

“…Irace et al (2020) reviewed smartphone applications for hearing assessment in the elderly and found that many smartphone applications did not include simple interfaces and instructions to accommodate dexterity or mild cognitive impairment, hindering the use of touchscreens. In some instances, application instructions failed to indicate that the tests should be conducted using headphones [24]. Digital proficiency should, therefore, be a key factor considered when designing online applications to ensure usability for key demographics of people with hearing loss.…”

Pediatric Hearing Loss Management in the COVID‐19 Era: Possible Consequences and Resources for the Next Future

“…Even if online rehabilitation activities for young children require great involvement of the parents, more and more applications (apps) are available for self-administering hearing training via smartphone for collaborative patients and even children. 5 Also, clinical management of cochlear implants will benefit from new techniques for teleassistance. 6 New apps for cochlear implant recipients enable researchers to evaluate the data logging and to test the impedances of the implants and, in some cases, to perform audiometry via the smartphone, thus limiting the necessity of in-clinic evaluations.…”