Test-Retest repeatability of automated threshold audiometry in Nicaraguan schoolchildren

Bessen, Sarah Y.; Magro, Isabelle; Alvarez, Karen Mojica; Cowan, Devin R; Peñalba, Donoso; Fellows, Abigail; González-Quiroz, Marvin; Rieke, Catherine C.; Buckey, Jay C.; Niemczak, Christopher E.; Saunders, James E.

doi:10.1080/14992027.2022.2032416

Cited by 2 publications

(5 citation statements)

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“…We have now demonstrated that CHWs can perform manual audiometry effectively with high validity (98.5%) with shorter testing times than automated audiometry (4.28 minutes vs 5.80 minutes). Occasional invalid responses seen in the convergence pattern analysis for manual audiometry may be due to transient noise effects or erratic testing behaviour, as we have described in a previous report on automated audiometry in this population [ 34 ]. Importantly, both the automated and manual audiometry protocols in this study employed threshold audiometry to measure audiometric thresholds, not merely a response to suprathreshold stimuli.…”

Section: Discussionmentioning

confidence: 88%

“…However, there are concerns regarding the accuracy and reliability of automated audiometry in young children [ 20 ]. Our previous experience with Nicaraguan children demonstrates a higher specificity when automated audiometry was coupled with manual audiometry [ 34 ]. We have now demonstrated that CHWs can perform manual audiometry effectively with high validity (98.5%) with shorter testing times than automated audiometry (4.28 minutes vs 5.80 minutes).…”

Section: Discussionmentioning

confidence: 99%

“…Automated WAHTS testing consisted of modified Hughson-Westlake audiometry to determine audiometric thresholds (rather than the presentation of suprathreshold stimuli) for 1, 2, and 4 kHz. The details of the test parameters are described elsewhere [ 34 ]. If the CHW noticed that the child was having difficulty with automated audiometry (eg, inattentiveness or pressing the button at regular or erratic intervals), they could identify the child as having “difficulty with testing”, abort the automated test, and refer for manual audiometry [ 33 ].…”

Section: Methodsmentioning

confidence: 99%

“…The Committee for the Protection of Human Subjects at Dartmouth College, the Ministry of Education of the Department of Jinotega, and the Institutional Review Board of the National Autonomous University of Nicaragua, Leon and the Nicaraguan Ministry of Health approved the project. The rationale and description of the study design have been presented elsewhere [ 34 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…The focus of this report is to: 1) evaluate the effectiveness of minimally trained CHW to detect hearing loss reliably and perform the necessary asynchronous telehealth examinations (including otoscopy and tympanometry), and 2) examine the capacity of the mHealth system to improve compliance with recommended referrals (ie, audiology and otolaryngology). Other aspects of this work including automated audiometry reliability, specific audiometry results, and clinical findings are presented elsewhere [ 34 , 35 ].…”

mentioning

confidence: 99%

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Community health workers and mHealth systems for hearing screening in rural Nicaraguan schoolchildren

et al. 2022

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Background We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders. Methods A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed. Results Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone. Conclusions Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%