Adapting Audiology Procedures During the Pandemic: Validity and Efficacy of Testing Outside a Sound Booth.

PURPOSE: This investigation aims to provide outcomes from a clinical perspective on the validity and efficacy of a wireless automated audiometer system that could be used in multiple settings when a sound booth is not accessible. Testing was conducted in a clinical setting under modified protocols meeting safety precautions during the COVID-19 pandemic. METHOD: Four doctoral students in audiology served as examiners. Participants were 69 adults between the ages of 20 and 69 years, with normal hearing (≤ 25 dB HL; n = 110 ears) or hearing loss (> 25 dB HL; n = 25 ears). Two versions of a pure-tone air-conduction threshold test following a modified Hughson-Westlake approach were performed and compared at 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz (a) in a sound-treated test booth using standard manual audiometry and (b) in a quiet, nonsound-treated clinical room (sound booth free) using automated KUDUwave audiometry. Participants were asked to complete a five-item feedback questionnaire, and examiners were interviewed to report on their experience. RESULTS: Clinical validity to within ±10 dB of standard audiometry was demonstrated for 94.5% of the total thresholds (n = 937) measured with the sound booth-free approach. Less accuracy (73.3%) was observed using a ±5 dB comparison. When comparing the mean thresholds, there were significant differences (p < .01) between the mean thresholds at most frequencies, with mean sound booth thresholds being higher than the sound booth-free mean thresholds. A strong threshold correlation (.91-.98) was found between the methods across frequencies. Participant and examiner feedback supported the efficacy of the sound booth-free technology. CONCLUSIONS: Findings support sound booth-free, automated software-controlled audiometry with active noise monitoring as a valid and efficient procedure for pure-tone hearing threshold assessment. This method offers an effective alternative when circumstances require more transportable hearing assessment technology or do not allow for standard manual audiometry in a sound booth.

The Accuracy of Smartphone Sound Level Meter Applications (SLMAs) in Measuring Sound Levels in Clinical Rooms.

BACKGROUND: The accuracy of smartphone sound level meter applications (SLMAs) has been investigated with varied results, based on differences in platform, device, app, available features, test stimuli, and methodology. PURPOSE: This article determines the accuracy of smartphone SLMAs with and without calibration of external and internal microphones for measuring sound levels in clinical rooms. RESEARCH DESIGN: Quasi-experimental research design comparing the accuracy of two smartphone SLMAs with and without calibration of external and internal microphones. DATA COLLECTION AND ANALYSIS: Two iOS-based smartphone SLMAs (NIOSH SLM and SPL Meter) on an iPhone 6S were used with and without calibrated external and internal microphones. Measures included: (1) white noise (WN) stimuli from 20 to 100 dB sound pressure level in a sound-treated test booth and (2) sound levels in quiet in four nonsound-treated clinical rooms and in simulated background sound conditions using music at 45, 55, and 80 dBA. Chi-square analysis was used to determine a significant difference (p ≤ 0.05) in sound measures between the SLMAs and a Type 1 SLM. RESULTS: Measures of WN signals and room sound level measures in quiet and simulated background sound conditions were significantly more accurate at levels ≥ 40 dBA using the SLMAs with calibrated external and internal microphones. However, SLMA measures with and without calibration of external and internal microphones overestimated sound levels < 40 dBA. CONCLUSION: The SLMAs studied with calibrated external or internal microphones are able to verify the room environment for audiologic screening at 1,000, 2,000, and 4,000 Hz at 20 dB hearing level (American Academy of Audiology and American Speech-Language-Hearing Association) using supra-aural earphones (American National Standards Institute S3.1-1999 [R2018]). However, the tested SLMAs overestimated low-level sound < 40 dBA, even when the external or internal microphones were calibrated. Clinicians are advised to calibrate the microphones prior to using measurement systems involving smartphones and SLMAs to measure room sound levels and to monitor background noise levels throughout the provision of clinical services.

The Accuracy of Smartphone Sound Level Meter Applications With and Without Calibration.

Purpose: The purpose of this study is to determine the accuracy of smartphone sound level meter applications (SLMAs) with calibration features across stimulus levels and for ambient room noise measures in the clinical setting. Method: The accuracy of 3 iOS-based smartphone SLMAs (SLMA1: Analyzer [Version 2.7.2, DSP Mobile], SLMA2: Sound Level Meter Pro [Version 2.2, Mint Muse LLC], and SLMA3: SPL Meter [Version 9.3, Andrew Smith, Studio Six Digital]), using a single smartphone device (iPhone 6S Model A1688, iOS 9.3.4, Apple), was evaluated with and without calibration using a 1000-Hz narrowband noise (NBN) and white noise (WN) stimuli over a range of sound levels (20-100 dB) and in ambient noise measures of 8 speech and hearing room environments. A simultaneous and corresponding SLMA and Type 1 sound level meter (SLM) measure per condition were documented with a photo image; each condition was replicated 5 times. Mean SLMA and SLM measures were compared. SLMA measures were considered accurate if within ± 2 dB of the SLM. Results: Measures of NBN and WN signals using these SLMAs were accurate at levels above 40-50 dB when calibrated. NBN and WN signals using some SLMAs were significantly (p < .05) more accurate with calibration at levels > 40 to 50 dB. SLMA measures with or without calibration adjustment were inaccurate and overestimated room ambient noise levels < 50 dB. Conclusions: These findings suggest that some SLMAs are accurate for measuring NBN and WN stimuli within the range of 50-100 dB in sound-treated environments when calibrated. However, outcomes indicated that some SLMAs, even with calibration, overestimated low ambient noise levels and may not accurately verify quiet room environments < 50 dB for clinical services. These results should not be generalized for all smartphone types, and continued research on SLMAs using next-generation smartphone devices is warranted.

Text messaging to promote responsible personal listening device use in young adults.

OBJECTIVES: The objective of this study is to examine efficacy of text message reminders and to educate and promote safe personal listening device (PLD) use in young adults. METHODS: Three hundred and eighty-seven urban college students from an urban university located in New York City, New York, participated in this pre- and postsurvey 6-month study (September 2016-March 2017). One hundred and ninety-eight students assigned to Group 1 (safe PLD use) received biweekly informative and humorous text reminders to encourage safe PLD use; 189 students assigned to Group 2 (controls) received monthly text messages related to the importance of their participation in the study with no mention of responsible PLD use. The Kruskal-Wallis test was used to analyze the pre- and postquestionnaire data; outcomes were considered significant at P < 0.05. RESULTS: Participants who received text message reminders reported significant (H[1] = 86.7, P < 0.001) change in increasing responsible PLD use; no significant change was reported by controls (H[1] = 0.002, P = 0.96). Females assigned to Group 1 reported modified PLD use more (H[1] = 6.7, P < 0.01) than males, suggesting a gender effect. Participants who received the bi-weekly text reminders rated them as helpful in promoting responsible PLD use; participants assigned to the control group who did not receive biweekly text reminders indicated the reminders could have been helpful in promoting safe PLD use. CONCLUSIONS: Text message reminders were reported and appear effective in motivating responsible PLD use in young adults.

Accuracy of Smartphone Self-Hearing Test Applications Across Frequencies and Earphone Styles in Adults.

PURPOSE: The purpose of this study is to evaluate smartphone-based self-hearing test applications (apps) for accuracy in threshold assessment and validity in screening for hearing loss across frequencies and earphone transducer styles. METHOD: Twenty-two adult participants (10 = normal hearing; 12 = sensorineural hearing loss; n = 44 ears) underwent conventional audiometry and performed 6 self-administered hearing tests using two iPhone-based apps (App 1 = uHear [Version 2.0.2, Unitron]; App 2 = uHearingTest [Version 1.0.3, WooFu Tech, LLC.]) each with 3 different transducers (earbud earphones, supra-aural headphones, circumaural headphones). Hearing sensitivity results using the smartphone apps across frequencies and transducers were compared with conventional audiometry. RESULTS: Differences in accuracy were revealed between the hearing test apps across frequencies and earphone styles. The uHear app using the iPhone standard EarPod earbud earphones was accurate to conventional thresholds (p > .002 with Bonferroni correction) at 1000, 2000, 4000, and 6000 Hz and found valid (81%-100% sensitivity, specificity, positive and negative predictive values) for screening mild or greater hearing loss (> 25 dB HL) at 500, 1000, 2000, 4000, and 6000 Hz. The uHearingTest app was accurate in threshold assessment and determined valid for screening mild or greater hearing loss (> 25 dB HL) using supra-aural headphones at 2000, 4000, and 8000 Hz. CONCLUSIONS: Self-hearing test apps can be accurate in hearing threshold assessment and screening for mild or greater hearing loss (> 25 dB HL) when using appropriate transducers. To ensure accuracy, manufacturers should specify earphone model instructions to users of smartphone-based self-hearing test apps.

Interprofessional Peer-Assisted Learning as a Model of Instruction in Doctor of Audiology Programs.

PURPOSE: This study reports on interprofessional peer-assisted learning (PAL) as a model of instruction in the preparation of doctoral audiology students. METHOD: Ten Doctor of Audiology (AuD) students provided training in audiologic screening for 53 graduate speech-language pathology students in 9 individual PAL sessions. Pre- and post-surveys assessed the peer teaching experience for AuD students in 5 areas of their confidence in audiologic screening: knowledge, skill, making a referral based on outcomes, teaching, and supervising. Pre- and post-learning outcomes in audiologic screening for the speech-language pathology student trainees determined the effectiveness of training by their AuD student peers. RESULTS: Survey outcomes revealed significant (p < .001) improvement in the overall confidence of AuD student peer instructors. Speech-language pathology students trained by their AuD peers exhibited significant (p = .003) improvements in their knowledge and skill and making outcome-based referrals in audiologic screening, supporting the effectiveness of the PAL paradigm. CONCLUSIONS: In addition to meeting required accreditation and professional certification competency standards, the PAL instructional model offers an innovative curricular approach in interprofessional education and in the teaching and supervisory preparation of students in doctoral audiology programs.

The Effectiveness of Parental Questionnaires in the Assessment of Speech-Language and Auditory Function in Children.

OBJECTIVE: This study investigates the use of a parental questionnaire to determine its effectiveness as a screening tool in identifying speech-language and/or auditory impairments in children. PATIENTS AND METHODS: Parents completed speech-language (n = 36) or audiology (n = 23) questionnaires prior to their child's speech-language and/or auditory evaluations. The speech-language and audiology evaluations were conducted by clinicians at three different universities not familiar with the administration and scoring of the parental questionnaires. A research assistant coded the results of the speech-language and audiology evaluations. Statistical analysis was used to determine if any aspects of the parents' evaluation of their child's speech, language, or hearing correlated with the speech-language pathologists'/audiologists' assessment. The results of the analyses would indicate whether parental reports are a reliable alternative to professionals' assessment. RESULTS: The speech-language questionnaires for children aged 2-5 years revealed the parents' perception of their children speaking 3-word sentences significantly (p < 0.05) corresponded to the children's comprehension and expression skills. The results from the auditory questionnaires revealed that reports of a child's ear pain were (p < 0.05) correlated with auditory dysfunction. CONCLUSIONS: These questionnaires can potentially be used in low-income countries where professional resources are scarce and there are barriers to identifying children with speech-language and/or auditory impairment.

Influence of Hearing Risk Information on the Motivation and Modification of Personal Listening Device Use.

PURPOSE: The purpose of this study was (a) to investigate the behaviors, knowledge, and motivators associated with personal listening device (PLD) use and (b) to determine the influence of different types of hearing health risk education information (text with or without visual images) on motivation to modify PLD listening use behaviors in young adults. METHOD: College-age students (N = 523) completed a paper-and-pencil survey tapping their behaviors, knowledge, and motivation regarding listening to music or media at high volume using PLDs. Participants rated their motivation to listen to PLDs at lower volume levels following each of three information sets: text only, behind-the-ear hearing aid image with text, and inner ear hair cell damage image with text. RESULTS: Acoustically pleasing and emotional motives were the most frequently cited (38%-45%) reasons for listening to music or media using a PLD at high volume levels. The behind-the-ear hearing aid image with text information was significantly (p < .0001) more motivating to participants than text alone or the inner ear hair cell damage image with text. CONCLUSIONS: Evocative imagery using hearing aids may be an effective approach in hearing protective health campaigns for motivating safer listening practices with PLDs in young adults.

Survey of Speech-Language Pathology Graduate Program Training in Outer and Middle Ear Screening.

PURPOSE: The purpose of this study was to determine the national training practices of speech-language pathology graduate programs in outer and middle ear screening. METHOD: Directors of all American Speech-Language-Hearing Association-accredited speech-language pathology graduate programs (N = 254; Council on Academic Accreditation in Audiology and Speech-Language Pathology, 2013) were surveyed on instructional formats in outer and middle ear screening. RESULTS: The graduate speech-language pathology program survey yielded 84 (33.1%) responses. Results indicated that some programs do not provide any training in the areas of conventional screening otoscopy using a handheld otoscope (15.5%; n = 13) or screening tympanometry (11.9%; n = 10), whereas close to one half (46.4%; n = 39) reported no training in screening video otoscopy. Outcomes revealed that approximately one third or more of speech-language pathology graduate programs do not provide experiential opportunities in screening handheld otoscopy (36.9%) or tympanometry (32.1%), and most (78.6%) do not provide experiential opportunities in video otoscopy. CONCLUSIONS: The implication from the graduate speech-language pathology program survey findings is that some speech-language pathologists will graduate from academic programs without the acquired knowledge or experiential learning required to establish skill in 1 or more areas of screening otoscopy and tympanometry. Graduate speech-language pathology programs should consider appropriate training opportunities for students to acquire and demonstrate skill in outer and middle ear screening.

The Efficacy of Routine Screening for High-Frequency Hearing Loss in Adults and Children.

PURPOSE: This study was conducted to investigate the efficacy of routine screening for high-frequency hearing loss (HFHL) including 3000, 6000, and 8000 Hz frequencies with conventional test frequencies (1000, 2000, and 4000 Hz) in adults and children in a university outreach program. METHOD: Screening outcomes were examined in 2 cohorts of adults (Cohort 1, N = 315, M = 66.2 years; Cohort 2, N = 67, M = 68.3 years) and children (Cohort 1, N = 177, M = 6.5 years; Cohort 2, N = 57, M = 6.9 years) with a high-frequency screen protocol (1000-8000 Hz at 25 dB HL for adults and 20 dB HL for children) using supra-aural headphones. A rescreen was conducted in Cohort 2 with a modified protocol using insert earphones and monitored ambient noise levels. RESULTS: Average total test time significantly increased (p < .0001) and nearly doubled with inclusion of 3000-, 6000-, and 8000-Hz frequencies, adding approximately 1 min. Rescreen referral rates decreased by approximately 2%-16% at 1000-8000 Hz (approximately 13%-16% at 6000 and 8000 Hz) using the modified protocol in adults and children, supporting false-positive responses using supra-aural headphones. CONCLUSION: Screening for HFHL should include insert earphones in order to prevent potential errors, particularly at 6000 and 8000 Hz.

Experiential instruction in graduate-level preparation of speech-language pathology students in outer and middle ear screening.

PURPOSE: This study presents a piloted training model of experiential instruction in outer and middle ear (OE-ME) screening for graduate speech-language pathology students with peer teaching by doctor of audiology (AuD) students. METHOD: Six individual experiential training sessions in screening otoscopy and tympanometry were conducted for 36 graduate-level speech-language pathology students led by a supervised AuD student. RESULTS: Postexperiential training, survey outcomes from 24 speech-language pathology students revealed a significant improvement (p = .01) in perceptions of attaining adequate knowledge and comfort in performing screening otoscopy (handheld and video otoscopy) and tympanometry. In a group of matched controls who did not receive experiential training in OE-ME screening (n = 24), ratings on the same learning outcomes survey in otoscopy and tympanometry were significantly poorer (p = .01) compared with students who did receive experiential training. CONCLUSION: A training model of experiential instruction for speech-language pathology students by AuD students improved learning outcomes, illustrating its promise in affecting clinical practices. The instructional model also meets the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA; American Speech-Language-Hearing Association, 2008) and American Speech-Language-Hearing Association (2014) Certificate of Clinical Competence (ASHA CCC) standards for speech-language pathology in OE-ME screening and CAA (2008) and ASHA (2012) CCC standards in the supervisory process for audiology.

Hearing screening in a well-infant nursery: profile of automated ABR-fail/OAE-pass.

OBJECTIVES: The goals were to examine the prevalence of a screening outcome pattern of auditory brainstem response fail/otoacoustic emission pass (ABR-F/OAE-P) in a cohort of infants in well-infant nurseries (WINs), to profile children at risk for auditory neuropathy spectrum disorder, and to compare inpatient costs for 2 screening protocols using automated auditory brainstem response (ABR) and otoacoustic emission (OAE) screening. METHODS: A total of 10.6% (n = 2167) of 20 529 infants admitted to WINs in 2006-2009 were screened for auditory neuropathy spectrum disorder risk by using an experimental protocol (automated ABR testing first, followed by OAE testing if the automated ABR test was not passed). A second WIN cohort (n = 281) was screened by using the standard WIN protocol for the facility (OAE testing first, followed by automated ABR testing if the OAE test was not passed). Comparisons were made regarding preparation and testing times and personnel costs. RESULTS: The ABR-F/OAE-P outcome was found for 0.92% of infants in WINs in inpatient testing and none in outpatient rescreening. The time for test preparation was 4 times longer and that for test administration was 2.6 times longer for the experimental protocol, compared with the standard protocol. Inpatient costs for the experimental protocol included 3 times greater personnel time costs. CONCLUSIONS: Less than 1% of infants in WINs had ABR-F/OAE-P screening outcomes as inpatients and none as outpatients. These results suggest that prevalence is low for infants cared for in WINs and use of OAE testing as a screening tool in WINs is not unreasonable.

High frequency hearing sensitivity in adolescent females of a lower socioeconomic status over a period of 24 years (1985-2008).

PURPOSE: To examine annually over a period of 24 years, the high frequency hearing sensitivity in different groups of urban female adolescents with a low socioeconomic status (SES) and residential foster care. METHODS: Hearing screening (15 decibel [dB] hearing level ranging from 1,000 to 8,000 Hertz [Hz]) and threshold (>15 dB hearing level) records were obtained from 8,710 female adolescents (mean age, 15.8 years [range, 12-20 years]), predominantly Hispanic and African American from households with a low SES. Data related to the use of personal listening devices (PLDs), daily hours of usage, occurrence of tinnitus, and hearing thresholds between 1,000 and 8,000 Hz over an 8-year period (2001-2008) were obtained from the adolescents. RESULTS: High frequency hearing loss (HFHL) doubled over the 24-year period from 10.1% in 1985 to 19.2% in 2008. In comparison with the general adolescent population, this group of female adolescents presented with a higher percentage of bilateral mild or greater degrees of HFHL at two or more frequencies including 3,000, 4,000, and 6,000 Hz. Use of PLDs increased four-fold, from 18.3% (n = 68) in 2001 to 76.4% (n = 227) in 2008. Of the total number reporting tinnitus (n = 286), 99.7% (n = 285) also reported regular PLD use. A significant relationship was found between PLD use and reported tinnitus and HFHL irrespective of time of use of PLD. CONCLUSIONS: Increased incidence of HFHL, reported tinnitus, PLD use, and hours of daily use in at-risk female adolescents of a low SES was found. A frequency interval of 3,000-6,000 Hz should be included in hearing screening protocols to identify potentially disabling hearing loss. Hearing conservation strategies need to be developed and/or modified that target and reach at-risk children and adolescents.

Quantitative and qualitative follow-up outcomes from a preschool audiologic screening program: perspectives over a decade.

PURPOSE: This investigation reports on quantitative and qualitative follow-up information obtained from a preschool audiologic screening program covering a 10-year period (1995 to 2004). METHOD: The audiologic screening consisted of a hearing (pure tone) and tympanometry screening. A total of 34,979 children, 3 to 5 years of age, were screened. RESULTS: Eighteen percent (6,337) of the children were referred for further hearing and/or medical ear evaluation. Of 1,421 follow-up responses received, 93% complied with the follow-up recommendations while 7% did not. Of 1,316 children in the follow-up group, outer and/or middle ear disorder in one or both ears was medically confirmed for 37%. Unilateral or bilateral hearing loss was diagnosed in 18% as conductive (12%), sensorineural (1%), mixed (0.4%), or unspecified (5%). Overall, hearing loss and/or otologic disorder was confirmed in 49% of the follow-up group, suggesting a prevalence of 1.8% in a preschool-age population. A small (n = 32) sample of unsolicited comments indicated that physicians most influenced noncompliance with hearing evaluation follow-up. CONCLUSIONS: The quantitative hearing and otologic follow-up outcome data affirm the importance of audiologic screening in the preschool population. Qualitative data suggest that some physicians may not be advocating appropriate screening follow-up services.