Validity of Diagnostic Computer-Based Air and Forehead Bone Conduction Audiometry

Abstract

Computer-based audiometry allows for novel applications, including remote testing and automation, that may improve the accessibility and efficiency of hearing assessment in various clinical and occupational health settings. This study describes the validity of computer-based, diagnostic air and forehead bone conduction audiometry when compared wtih conventional industry standard audiometry in a sound booth environment. A sample of 30 subjects (19 to 77 years of age) was assessed with computer-based (KUDUwave 5000) and industry standard conventional audiometers (GSI 61) to compare air and bone conduction thresholds and test-retest reliability. Air conduction thresholds for the two audiometers corresponded within 5 dB or less in more than 90% of instances, with an average absolute difference of 3.5 dB (3.8 SD) and a 95% confidence interval of 2.6 to 4.5 dB. Bone conduction thresholds for the two audiometers corresponded within 10 dB or less in 92% of instances, with an average absolute difference of 4.9 dB (4.9 SD) and a 95% confidence interval of 3.6 to 6.1 dB. The average absolute test-retest threshold difference for bone conduction on the industry standard audiometer was 5.1 dB (5.3 SD) and for the computer-based audiometer 7.1 dB (6.4 SD). Computer-based audiometry provided air and bone conduction thresholds within the test-retest reliability limits of industry standard audiometry.

Validity of diagnostic pure-tone audiometry without a sound-treated environment in older adults

“…Air-conduction thresholds measured in the natural and standard audiometric booth corresponded within typical 5dB or less test-retest limits for thresholds measured in a sound booth (Stuart et al 1991;Smith-Olinde et al 2006;Margolis et al 2010;Swanepoel, Mngemane et al 2010;Swanepoel & Biagio, 2011). Average absolute air-conduction threshold differences for the current study (2.7 ± 3.1 dB) were within previously reported average test-retest absolute difference values (3.6 ± 3.9 dB and 3.5 ± 3.8 dB) for the same audiometer (Swanepoel, Mngemane et al 2010;Swanepoel & Biagio, 2011).…”

“…Placement of the insert earphones was deep with the foam tip inserted completely into the canal to improve the attenuation of ambient noise (Berger & Killion, 1989;Berger, 1983;Berger, Kieper & Gauger 2003) and to minimize the occlusion effect. Placing insert earphones down to the bony part of the ear canal reduces the occlusion effect allowing for bone-conduction evaluation with occluded ears (Dean & Martin, 2000;Stenfelt & Goode, 2005;Swanepoel & Biagio, 2011). Deep insertion required removal of cerumen by the audiologist in 24.5% of the subjects prior to their inclusion in this study.…”

“…The current study investigated the validity of hearing threshold estimation in a natural environment with a recently validated audiometer (Swanepoel & Biagio, 2011) utilizing insert earphones covered by circumaural earcups that incorporate external microphones monitoring environmental noise levels during testing.…”

Clinical validation of automated audiometry with continuous noise-monitoring in a clinically heterogeneous population outside a sound-treated environment

“…The mean ambient noise level when there was no outpatient clinic in progress was measured at 46 dBA. Placing insert earphones down to the bony part of the ear canal also reduces the occlusion effect allowing for bone-conduction evaluation with occluded ears using insert earphones (Slevin et al, 2000;Swanepoel & Biagio, 2011). However, not removing the insert earphone is a limitation to the technique as insertion down to the bony portion of the ear canal cannot be confirmed or guaranteed.…”

“…The ability to provide automated audiometric testing in the absence of a sound-treated environment has a great potential to increase service provision to low and middle-income countries, and rural and remote areas of high-income countries that do not have these facilities. At least two of the contemporary clinically available automation-capable audiometers use audiocups to provide attenuation from environmental sounds (Margolis et al, 2010;Swanepoel & Biagio, 2011), and studies have demonstrated their potential feasibility in environments that are not soundtreated Maclennan-Smith et al, 2013).…”