Description of a new low-cost and open-source audiometer and its validation with normal-hearing listeners: The Aupiometer.

Hearing loss is a major public health problem. In 2050, it could affect 2.5 billion people. It has therefore become necessary to prevent and diagnose them as early and as widely as possible. However, the costs of clinical equipment dedicated to the functional exploration of hearing remain high and hamper their distribution, while the technologies used are relatively basic. For example, the gold-standard pure-tone audiometry (PTA) essentially consists of emitting pure sounds. In addition, clinical audiometers are generally limited to PTA or few audiological tests, while hearing loss induce multiple functional deficits. Here, we present the Aupiometer, a low-cost audiometer implemented on a modular open-source system based on Raspberry Pi, and which integrates the entire technical framework necessary to carry out audiological measurements. Several hearing tests are already implemented (e.g. PTA, speech audiometry, questionnaires), while the clinical validity of the Aupiometer was verified on a panel of participants (N = 16) for an automated test of standard and extended high-frequency PTA, from 0.125 to 16 kHz, in comparison with a clinical audiometer. For this comparison between the two devices and over this wide frequency range, the difference is evaluated as less than ±10 dB for a 90% confidence interval, of the same order of magnitude as on test-retest differences on a single device. The interest of this device also extends to academic research as it should encourage the prototyping of innovative hearing tests by the community, in order to better understand the diversity of hearing problems in the population.

A Multicenter Validity Study of Four Smartphone Hearing Test Apps in Optimized and Home Environments.

OBJECTIVE: Pure tone audiometry (PTA) is the gold standard for hearing assessment. However, it requires access to specialized equipment. Smartphone audiometry applications (apps) have been developed to perform automated threshold audiometry and could allow patients to perform self-administered screening or monitoring. This study aimed to assess the validity and feasibility of patients using apps to self-assess hearing thresholds at home, with comparison to PTA. METHODS: A multi-center, prospective randomized study was conducted amongst patients undergoing PTA in clinics. Participants were randomly allocated to one of four publicly-available apps designed to measure pure tone thresholds. Participants used an app once in optimal sound-treated conditions and a further three times at home. Ear-specific frequency-specific thresholds and pure tone average were compared using Pearson correlation coefficient. The percentage of app hearing tests with results within ±10 dB of PTA was calculated. Patient acceptability was assessed via an online survey. RESULTS: One hundred thirty-nine participants submitted data. The results of two at-home automated smartphone apps correlated strongly/very strongly with PTA average and their frequency-specific median was within ±10 dB accuracy. Smartphone audiometry performed in sound-treated and home conditions were very strongly correlated. The apps were rated as easy/very easy to use by 90% of participants and 90% would be happy/very happy to use an app to monitor their hearing. CONCLUSION: Judicious use of self-performed smartphone audiometry was both valid and feasible for two of four apps. It could provide frequency-specific threshold estimates at home, potentially allowing assessments of patients remotely or monitoring of fluctuating hearing loss. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:2864-2870, 2024.

The Emerging Future of Mobile Audiometry: A Prospective Validation Study of the Mimi Hearing Test Application.

OBJECTIVE: The objective of this study is to assess the accuracy of the Mimi Hearing Test (MHT) mobile application in the detection of air conduction (AC) thresholds and in screening for moderate hearing loss. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary care center. PATIENTS: Participants with or without a varying degree of hearing loss, aged 18 years and over, without cognitive impairment and without active otorrhea or earwax impaction at the time of the hearing assessment were included. INTERVENTION: Subjects with a ranging severity of hearing loss underwent a conventional in-booth audiogram as well as mobile-based screening with MHT in a quiet room (45.5 dB background noise) on the same day. Both regular over-the-ear and noise-canceling headphones were tested with MHT. MAIN OUTCOME MEASURES: Comparisons of AC thresholds between conventional audiometry and mobile-based audiometry at discrete frequencies and with pure-tone averages (PTA) were performed. RESULTS: A total of 75 adults (mean age: 56.2 yr, 54.7% male) were recruited and 63 used for analysis. Of the thresholds measured with MHT using regular headphones, 44.0% were within 10 dB of the conventional audiogram, compared to 39.3% using noise-canceling headphones. MHT demonstrated best accuracy at high frequencies (4-8 kHz). When screening for moderate hearing loss (PTA >40 dB HL), MHT demonstrated a sensitivity and specificity of 100.0% and 80.2%, respectively. CONCLUSIONS: MHT is reliable for identifying moderate hearing loss but lacks precision in detecting thresholds at low frequencies. Noise canceling headphones seem to improve its precision at 4,000 Hz only.

Positioning of earphones and variations in auditory thresholds, / O posicionamento dos fones de ouvido e as variações dos limiares auditivos

ABSTRACT INTRODUCTION: One of the problems observed in pure-tone audiometry tonal has been the variation in test results of a same individual, particularly at frequencies of 4 kHz, 6 kHz and/or 8 kHz. Improper placement of headphones is one of the factors that can cause alterations in results. OBJECTIVE: To compare differences in auditory thresholds using earphones positioned by the examiner and by the worker. METHODS: Clinical and experimental study conducted in 2009, with 324 workers aged between 19 and 61 years, with a mean of 33.29 years and mean exposure time of 7.67 years. All subjects were familiar with audiometry procedures. Auditory thresholds were obtained at frequencies of 0.25-8 kHz, with earphones positioned by the examiners, and at frequencies of 4, 6 and 8 kHz, with earphones placed by workers in a comfortable position, following the examiner's instructions. The thresholds obtained in these two situations were compared. RESULTS: The three frequencies exhibited better responses with earphones placed by the workers themselves (p < 0.001). At a frequency of 8 kHz a greater difference was found (p < 0.001), with a mean of 13.89 dB and standard deviation of 6.07 dB. CONCLUSION: Earphone placement by the workers themselves under supervision of the examiner results in improved mean auditory thresholds at frequencies of 4, 6 and 8 kHz, the last one significantly higher than the other two.

RESUMO INTRODUÇÃO: Um dos problemas observados na audiometria tonal é a variação nos resultados de testes de um mesmo indivíduo, sobretudo nas frequências de 4, 6 e/ou 8 kHz. A colocação indevida dos fones é um dos fatores que podem causar alterações nos resultados. OBJETIVO: Comparar as diferenças nos limiares auditivos com os fones posicionados pelo examinador e pelo paciente. MÉTODO: Estudo clínico e experimental realizado, em 2009, com 324 trabalhadores, com idade entre 19 e 61 anos, média de 29,33 anos e tempo médio de exposição ao ruído de 7,67 anos; todos familiarizados com os procedimentos da audiometria. Os limiares auditivos foram obtidos nas frequências de 0,25 a 8 kHz, com os fones colocados pelos examinadores; e nas frequências de 4, 6 e 8 kHz com os fones colocados pelos trabalhadores em posição de conforto, sob orientação do examinador. Os limiares obtidos nas duas situações foram comparados. RESULTADOS: As três frequências apresentaram melhores respostas com os fones colocados pelos próprios indivíduos (p < 0,001). Na frequência de 8 kHz foi encontrada a maior diferença (p < 0,001), com média de 13,89 dB e desvio padrão de 6,07 dB. CONCLUSÃO: A colocação dos fones de ouvido pelos próprios trabalhadores, sob supervisão dos examinadores, resulta na melhora dos limiares auditivos médios nas frequências de 4, 6 e 8 kHz, sendo esta última significativamente maior que as demais.

Influência do tipo de transdutor na deficiência auditiva de grau profundo / Influence of the type of transducer in profound hearing loss

TEMA: indivíduos com deficiência auditiva de grau profundo podem apresentar respostas por vibração com os fones supra-aurais devido a grande área do crânio exposta à vibração nestes transdutores. OBJETIVO: verificar a influência do tipo de transdutor na obtenção dos limiares auditivos por via aérea em indivíduos com deficiência auditiva neurossensorial de grau profundo. MÉTODO: 50 indivíduos, com idades variando de 16 a 55 anos, foram submetidos a anamnese, meatoscopia, e posteriormente, a audiometria tonal liminar e limiar de detecção de voz (LDV). As audiometrias tonal e vocal foram realizadas tanto com fones supra-aurais TDH-39 quanto com os fones de inserção ER-3A. RESULTADOS: nas audiometrias tonal e vocal, notamos que, com o fone de inserção, foram obtidos limiares auditivos mais elevados do que os obtidos com o fone supra-aural, com significância estatística nas freqüências de 250Hz e 1000Hz. Ao observarmos a diferença entre os resultados obtidos com o transdutor TDH-39 e o ER-3A em cada orelha separadamente, notamos que a diferença foi maior na orelha direita com significância estatística somente na freqüência de 250 Hz. Em relação ao sexo, notamos que as diferenças entre os transdutores foram maiores no sexo masculino com significância estatística na freqüência de 250 Hz. No entanto, no LDV, a diferença maior foi encontrada no sexo feminino. CONCLUSÃO: deficientes auditivos neurossensorias de grau profundo bilateral apresentam limiares de audibilidade mais elevados (piores) com os fones de inserção do que com os fones supra-aurais nas freqüências baixas, evidenciando a existência das respostas por vibração com os fones supra-aurais.

BACKGROUND: individuals with profound hearing loss may present vibrotactile responses when tested with supra-aural earphones due to the large skull area exposed to vibration in these transducers. AIM: to verify the influence of the type of transducer when assessing air conducted pure tone thresholds in individuals with profound sensorineural hearing loss. METHOD: 50 individuals, ranging in age from 16 to 55 years, were submitted to a clinical history questionnaire, meatoscopy, and pure tone and speech audiometry, using both TDH-39 supra-aural earphones and ER-3A insert earphones. RESULTS: in both pure tone and speech testing, thresholds were higher when obtained using insert earphones, with statistical significant differences for 250Hz and 1000Hz. Considering right and left ear testing with the different transducers, this difference was greater for the right ear, with statistical significant differences only for 250 Hz. Regarding gender, it was observed that the difference between the transducers was greater in males, with statistical significant differences for 250 Hz. However, in the SDT (Speech Detection Threshold), the greatest difference was found in females. CONCLUSION: people with bilateral sensorineural profound hearing loss presented higher (worse) thresholds with insert earphones (ER-3A) than with supra aural earphones (TDH-39) for low frequencies (250Hz and 1000Hz), confirming the existence of vibrotactile responses with supra aural earphones.

Audiometría de estado / Estable steady state audiometry

El uso de pruebas electrofisiológicas ha sido una útil herramienta en la evaluación auditiva de pacientes con hipoacusia no susceptibles de evaluación con pruebas audiológicas conductuales. La Audiometría de Estado Estable (AEE) es una prueba desarrollada recientemente que mediante la estimulación con tonos modulados en frecuencia y amplitud evoca una respuesta detectada en el electroencefalograma mediante técnicas de procesamiento computacional. Esta técnica permite una estimación frecuencia específica del audiograma lo que es de especial utilidad en pacientes candidatos al uso de implantes cocleares. Los métodos actuales muestran una buena correlación con el audiograma conductual en pacientes con hipoacusia severa, pero con mayor diferencia de umbral en pacientes con audición normal. La AEE se ha constituido como una útil herramienta para complementar la batería de pruebas audiológicas usadas actualmente, sin embargo aún es necesario establecer nuevos protocolos que permitan mejorar la exactitud del examen.

The use of electrophysiological tests has been a useful tool in the auditory evaluation ofhypoacusia patients non-susceptible to evaluation with behavioral audiological tests. Steady state audiometry (SSA) is a recently developed test that, by means of stimulation with amplitude and frequency modulated tones, evokes an electroencephalogram response detected by computer processing techniques. This technique allows for a frequency-specific evaluation of the audiogram, which is especially useful in patients that are being considered for cochlear implant. Current methods show a good correlation with the behavioral audiogram in patients with severe hypoacusia, but with a higher threshold difference in patients with normal audition. SSA constitutes a useful tool to complement the audiological test batteries currently used. However, new protocols with improved test accuracy are still needed.

Influência do posicionamento do fone na audiometria de alta freqüência / Phone positioning influence in high-frequency audiometry

Pesquisas apontam que a audiometria tonal de altas freqüências é um instrumento de diagnóstico precoce de alterações auditivas provenientes de agentes etiológicos. OBJETIVO: Verificar possíveis diferenças na avaliação audiométrica de altas freqüências de indivíduos com audição normal em função da pessoa que posiciona o fone de ouvido. CASUíSTICA E MÉTODO: Estudo clínico e experimental na qual participaram 55 graduandos de uma Universidade do interior paulista, com audição normal. Para cada participante, foram realizadas duas testagens: na primeira o avaliador posicionou o fone no participante e na segunda, o próprio participante o fez. Utilizou-se um audiômetro AC40 calibrado para emitir tom puro nas freqüências de 10, 12.5 e 16 khz. RESULTADOS: A análise estatística por meio do coeficiente kappa (k) verificou a concordância entre as duas formas de posicionamento do fone, tendo como critério o valor de kappa>"0,70. Os resultados obtidos para ambas as orelhas ficaram abaixo desse valor, com média de k=0,50. DISCUSSÃO: Os resultados indicaram existência de risco de comprometimento da fidedignidade da avaliação em função da pessoa que ajusta o fone ao ouvido do examinado. CONCLUSÃO: Ao realizar audiometria deve-se levar em consideração a interferência dessa variável, para obtenção de resultados fidedignos.

Research considers high frequency tonal audiometry as a tool for the early diagnosis of auditory alterations derived from etiological agents. AIM: to investigate possible differences in high frequency audiometry of individuals with normal hearing, based on the person who places the earphone. PATIENTS AND METHOD: clinical and experimental study with 55 undergraduate students from a country side branch of the São Paulo State University, with normal hearing, underwent two tests each; for the first, the evaluator positioned the earphone on the participant; for the second one, the participant did it by him/herself. An AC40 audiometer calibrated to emit pure tone was used in the frequencies of 10, 12.5, and 16 kHz. RESULTS: The kappa(k) coefficient statistical analysis was used to verify the agreement between the two ways of earphone positioning of earphone, bearing a ≥0.70 kappa value as a criterion. Results attained for both ears were below this criterion, with k average of 0.50. DISCUSSION: results indicate a risk of compromising the exam reliability when the patient him/herself adjusts phone to his/her own ear. CONCLUSION: when performing audiometric assessment, this variable must be considered in order to attain reliable results.