title: Automated Smartphone Threshold Audiometry: Validity and Time Efficiency.
abstract: BACKGROUND
  Smartphone-based threshold audiometry with automated testing has the potential to provide affordable access to audiometry in underserved contexts.
  
  
  OBJECTIVE
  To validate the threshold version (hearTest) of the validated hearScreen™ smartphone-based application using inexpensive smartphones (Android operating system) and calibrated supra-aural headphones.
  
  
  METHODS
  A repeated measures within-participant study design was employed to compare air-conduction thresholds (0.5-8 kHz) obtained through automated smartphone audiometry to thresholds obtained through conventional audiometry.
  
  
  METHODS
  A total of 95 participants were included in the study. Of these, 30 were adults, who had known bilateral hearing losses of varying degrees (mean age = 59 yr, standard deviation [SD] = 21.8; 56.7% female), and 65 were adolescents (mean age = 16.5 yr, SD = 1.2; 70.8% female), of which 61 had normal hearing and the remaining 4 had mild hearing losses.
  
  
  METHODS
  Threshold comparisons were made between the two test procedures. The Wilcoxon signed-ranked test was used for comparison of threshold correspondence between manual and smartphone thresholds and the paired samples t test was used to compare test time.
  
  
  RESULTS
  Within the adult sample, 94.4% of thresholds obtained through smartphone and conventional audiometry corresponded within 10 dB or less. There was no significant difference between smartphone (6.75-min average, SD = 1.5) and conventional audiometry test duration (6.65-min average, SD = 2.5). Within the adolescent sample, 84.7% of thresholds obtained at 0.5, 2, and 4 kHz with hearTest and conventional audiometry corresponded within ≤5 dB. At 1 kHz, 79.3% of the thresholds differed by ≤10 dB. There was a significant difference (p < 0.01) between smartphone (7.09 min, SD = 1.2) and conventional audiometry test duration (3.23 min, SD = 0.6).
  
  
  CONCLUSIONS
  The hearTest application with calibrated supra-aural headphones provides a cost-effective option to determine valid air-conduction hearing thresholds.
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
authors.forename: Jessica
authors.initials: J
authors.lastname: van Tonder
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.|Ear Science Institute Australia, Subiaco, Australia.|Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
authors.forename: De Wet
authors.initials: W
authors.lastname: Swanepoel
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
authors.forename: Faheema
authors.initials: F
authors.lastname: Mahomed-Asmail
authors.affiliation: Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
authors.forename: Hermanus
authors.initials: H
authors.lastname: Myburgh
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.|Ear Science Institute Australia, Subiaco, Australia.|Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eikelboom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry / Q000379:methods*; D001309:Auditory Threshold / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006312:Hearing Loss, Bilateral / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011930:Reaction Time; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D000068997:Smartphone / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult