title: Accuracy of Remote Hearing Assessment in a Rural Community.
abstract: BACKGROUND
  This study determined the accuracy of pure tone air conduction (AC) thresholds obtained using a synchronous telemedicine approach without a sound booth in a rural South African community. The global need for increased hearing healthcare currently far exceeds the capacity for delivering these services, especially in developing countries. A tele-audiology approach using a portable diagnostic audiometer could provide the solution, enabling hearing assessments to be conducted remotely and without a sound booth.
  
  
  METHODS
  Hearing thresholds in a sound booth and natural environment were obtained from an initial sample of 20 adults (age range, 19-63 years; mean age, 50±13 years; 55% female), recruited from a rural agricultural community. A subgroup of 10 adults (20 ears) volunteered for the telemedicine threshold testing. AC thresholds (250-8,000 Hz) were determined and subsequently compared in these environments. Typical threshold variability was determined using test-retest correspondence as a reference for the threshold correspondence using a telemedicine mode.
  
  
  RESULTS
  Test-retest threshold correspondence in the booth and natural environments was within±5 dB in 96.7% and 97.5% of comparisons, respectively. No significant differences were obtained in AC hearing thresholds determined in the telemedicine configuration compared with those recorded in the gold standard booth environment. Threshold correspondence between the telemedicine compared with booth and natural environments were within±5 dB in 82% and 85% of comparisons, respectively.
  
  
  CONCLUSIONS
  The current study demonstrates the validity of using synchronous telemedicine for conducting hearing assessments in a remote rural agricultural community without a sound booth.
authors.affiliation: 1 Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, Gauteng, South Africa .
authors.forename: Ansophi
authors.initials: A
authors.lastname: Visagie
authors.affiliation: 1 Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, Gauteng, South Africa .|2 Ear Sciences Centre, School of Surgery, The University of Western Australia , Nedlands, Australia .|3 Ear Science Institute Australia , Subiaco, Australia .
authors.forename: De Wet
authors.initials: de W
authors.lastname: Swanepoel
authors.affiliation: 1 Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, Gauteng, South Africa .|2 Ear Sciences Centre, School of Surgery, The University of Western Australia , Nedlands, Australia .|3 Ear Science Institute Australia , Subiaco, Australia .
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eikelboom
mesh_terms: D000328:Adult; D001299:Audiometry / Q000379:methods; D005260:Female; D006320:Hearing Tests / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D055815:Young Adult
keywords: audiology; e-health; extreme environment; technology; telemedicine