title: Biological calibration for web-based hearing tests: evaluation of the methods.
abstract: BACKGROUND
  Online hearing tests conducted in home settings on a personal computer (PC) require prior calibration. Biological calibration consists of approximating the reference sound level via the hearing threshold of a person with normal hearing.
  
  
  OBJECTIVE
  The objective of this study was to identify the error of the proposed methods of biological calibration, their duration, and the subjective difficulty in conducting these tests via PC.
  
  
  METHODS
  Seven methods have been proposed for measuring the calibration coefficients. All measurements were performed in reference to the hearing threshold of a normal-hearing person. Three methods were proposed for determining the reference sound level on the basis of these calibration coefficients. Methods were compared for the estimated error, duration, and difficulty of the calibration. Web-based self-assessed measurements of the calibration coefficients were carried out in 3 series: (1) at a otolaryngology clinic, (2) at the participant's home, and (3) again at the clinic. Additionally, in series 1 and 3, pure-tone audiometry was conducted and series 3 was followed by an offline questionnaire concerning the difficulty of the calibration. Participants were recruited offline from coworkers of the Department and Clinic of Otolaryngology, Wroclaw Medical University, Poland.
  
  
  RESULTS
  All 25 participants, aged 22-35 years (median 27) completed all tests and filled in the questionnaire. The smallest standard deviation of the calibration coefficient in the test-retest measurement was obtained at the level of 3.87 dB (95% CI 3.52-4.29) for the modulated signal presented in accordance with the rules of Bekesy's audiometry. The method is characterized by moderate duration time and a relatively simple procedure. The simplest and shortest method was the method of self-adjustment of the sound volume to the barely audible level. In the test-retest measurement, the deviation of this method equaled 4.97 dB (95% CI 4.53-5.51). Among methods determining the reference sound level, the levels determined independently for each frequency revealed the smallest error. The estimated standard deviations of the difference in the hearing threshold between the examination conducted on a biologically calibrated PC and pure-tone audiometry varied from 7.27 dB (95% CI 6.71-7.93) to 10.38 dB (95% CI 9.11-12.03), depending on the calibration method.
  
  
  CONCLUSIONS
  In this study, an analysis of biological calibration was performed and the presented results included calibration error, calibration time, and calibration difficulty. These values determine potential applications of Web-based hearing tests conducted in home settings and are decisive factors when selecting the calibration method. If there are no substantial time limitations, it is advisable to use Bekesy method and determine the reference sound level independently at each frequency because this approach is characterized by the lowest error.
authors.affiliation: Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wrocław, Poland. marcin.masalski@pwr.wroc.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Masalski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grysiński
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kręcicki
mesh_terms: D000328:Adult; D002138:Calibration; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D020407:Internet; D011044:Poland; D055815:Young Adult
keywords: computer-assisted instruction; pure-tone audiometry; self-examination