title: Self-administered hearing loss screening using an interactive, tablet play audiometer with ear bud headphones.
abstract: OBJECTIVE
  The timely diagnosis and treatment of acquired hearing loss in the pediatric population has significant implications for a child's development. Audiological assessment in children, however, carries both technological and logistical challenges. Typically, specialized methods (such as play audiometry) are required to maintain the child's attention and can be resource intensive. These challenges were previously addressed by a novel, calibrated, interactive play audiometer for Apple(®) iOS(®) called "ShoeBOX Audiometry". This device has potential applications for deployment in environments where traditional clinical audiometry is either unavailable or impractical. The objective of this study was to assess the screening capability of the tablet audiometer in an uncontrolled environment using consumer ear-bud headphones.
  
  
  METHODS
  Consecutive patients presenting to the Audiology Clinic at the Children's Hospital of Eastern Ontario (ages 4 and older) were recruited. Participants' hearing was evaluted using the tablet audiometer calibrated to Apple(®) In-Ear headphones. The warble tone thresholds obtained were compared to gold standard measurements taken with a traditional clinical audiometer inside a soundbooth.
  
  
  RESULTS
  80 patients were enrolled. The majority of participants were capable of completing an audiologic assessment using the tablet computer. Due to ambient noise levels outside a soundbooth, thresholds obtained at 500Hz were not consistent with traditional audiometry. Excluding 500Hz threholds, the tablet audiometer demonstrated strong negative predictive value (89.7%) as well as strong sensitivity (91.2%) for hearing loss.
  
  
  CONCLUSIONS
  Thresholds obtained in an uncontrolled setting are not reflective of diagnostic thresholds due to the uncalibrated nature of the headphones and variability of the setting without a booth. Nevertheless, the tablet audiometer proved to be both a valid and sensitive instrument for unsupervised screening of warble-tone thresholds in children.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Yeung
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Sophie
authors.initials: S
authors.lastname: Heley
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Yves
authors.initials: Y
authors.lastname: Beauregard
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Sandra
authors.initials: S
authors.lastname: Champagne
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1. Electronic address: mbromwich@cheo.on.ca.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Bromwich
mesh_terms: D000293:Adolescent; D001301:Audiometry, Pure-Tone / Q000295:instrumentation* / Q000379:methods; D001309:Auditory Threshold; D002648:Child; D002675:Child, Preschool; D034201:Computers, Handheld; D059026:Diagnostic Self Evaluation; D034381:Hearing Loss / Q000175:diagnosis*; D006801:Humans; D009622:Noise; D011237:Predictive Value of Tests; D012984:Software
keywords: Hearing loss; Interactive audiometry; Screening