title: Pure-tone audiometry outside a sound booth using earphone attentuation, integrated noise monitoring, and automation.
abstract: OBJECTIVE
  Accessibility of audiometry is hindered by the cost of sound booths and shortage of hearing health personnel. This study investigated the validity of an automated mobile diagnostic audiometer with increased attenuation and real-time noise monitoring for clinical testing outside a sound booth.
  
  
  METHODS
  Attenuation characteristics and reference ambient noise levels for the computer-based audiometer (KUDUwave) was evaluated alongside the validity of environmental noise monitoring. Clinical validity was determined by comparing air- and bone-conduction thresholds obtained inside and outside the sound booth (23 subjects).
  
  
  METHODS
  Twenty-three normal-hearing subjects (age range, 20-75 years; average age 35.5) and a sub group of 11 subjects to establish test-retest reliability.
  
  
  RESULTS
  Improved passive attenuation and valid environmental noise monitoring was demonstrated. Clinically, air-conduction thresholds inside and outside the sound booth, corresponded within 5 dB or less > 90% of instances (mean absolute difference 3.3 ± 3.2 SD). Bone conduction thresholds corresponded within 5 dB or less in 80% of comparisons between test environments, with a mean absolute difference of 4.6 dB (3.7 SD). Threshold differences were not statistically significant. Mean absolute test-retest differences outside the sound booth was similar to those in the booth.
  
  
  CONCLUSIONS
  Diagnostic pure-tone audiometry outside a sound booth, using automated testing, improved passive attenuation, and real-time environmental noise monitoring demonstrated reliable hearing assessments.
authors.affiliation: a * Department of Speech-Language Pathology and Audiology , University of Pretoria , South Africa.|b Ear Sciences Centre, School of Surgery, The University of Western Australia , Nedlands, Perth , Australia.|c Ear Science Institute Australia , Subiaco , Australia.|d Callier Center for Communication Disorders, University of Texas at Dallas , USA.
authors.forename: De Wet
authors.initials: de W
authors.lastname: Swanepoel
authors.affiliation: a * Department of Speech-Language Pathology and Audiology , University of Pretoria , South Africa.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Matthysen
authors.affiliation: a * Department of Speech-Language Pathology and Audiology , University of Pretoria , South Africa.|b Ear Sciences Centre, School of Surgery, The University of Western Australia , Nedlands, Perth , Australia.|c Ear Science Institute Australia , Subiaco , Australia.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eikelboom
authors.affiliation: d Callier Center for Communication Disorders, University of Texas at Dallas , USA.
authors.forename: Jackie L
authors.initials: JL
authors.lastname: Clark
authors.affiliation: a * Department of Speech-Language Pathology and Audiology , University of Pretoria , South Africa.|e George S. Osborne College of Audiology, Salus University , Elkins Park , USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Hall
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone / Q000379:methods*; D001331:Automation; D064368:Healthy Volunteers; D006801:Humans; D008875:Middle Aged; D009622:Noise; D055815:Young Adult
keywords: Audiometry; attenuation; automated audiometry; diagnostic hearing assessment; maximum permissible ambient noise levels; noise monitoring; occupational hearing assessment