Neonatal hearing screening using a smartphone-based otoacoustic emission device: A comparative study.

OBJECTIVE: Increasing options are becoming available for clinicians and healthcare professionals who use smartphone-based applications (apps) to identify hearing loss. The use of smartphone-based apps for newborn hearing screening (NHS) has been proposed as an alternative screening method in NHS programs. This study aims to compare the screening outcomes of a smartphone-based otoacoustic emission (OAE) screening device to a commercially available OAE screening device. METHODS: NHS was conducted in the post-natal maternity ward and neonatal intensive care unit (NICU) of two tertiary public healthcare hospitals over a period of 8 months. Within participant DPOAE and TEOAE screening outcomes of a smartphone-based OAE device (hearOAE) were compared to that of the Otodynamics ILO V6. RESULTS: A total of 176 infants (n = 352 ears; 48.9 % female) underwent NHS (DPOAE n = 176; TEOAE n = 176). The mean age at was 4.5 days (SD 11.3). Signal-to-noise ratio (SNR) were higher with the hearOAE with TEOAE NHS, and equivalent or higher SNR at four out of six frequencies with DPOAEs. Mean and total noise levels were significantly lower for the hearOAE compared to the Otodynamics with DPOAEs noise levels of five out of six frequencies being equivalent to, or lower than the Otodynamics (p < 0.001). Lower noise levels are likely to be advantageous in less-than-ideal test conditions. Inter-device DPOAE comparison indicated no statistically significant difference in the refer rate between the devices (p = 0.238). DPOAE pass rates between devices differed in 6 ears (p > 0.05), and in 20 ears for TEOAEs, with the hearOAE demonstrating a higher TEOAE pass rate (p = 0.009). The hearOAE did, however, demonstrate lower noise levels at three out five frequencies, which may have impacted the pass rate. No statistically significant correlation was found between the independent variables and the screening outcome (pass/refer) for TEOAEs using either device (p = 0.105 to 0.810). A high concordance of NHS outcomes within-participants of 89.7 % and 85.0 % for DPOAE and TEOAE respectively, was measured. CONCLUSIONS: The mHealth based OAE device demonstrated good agreement in NHS outcomes compared to a commercially available device. This verifies the performance of the novel smartphone based OAE device, and may facilitate increased accessibility of decentralised NHS service in resource constrained populations.

Chirp-Evoked VEMPs: A Test-Retest Reliability Study.

OBJECTIVES: To determine the test-retest reliability of cervical and ocular vestibular-evoked myogenic potentials (c&oVEMP) evoked by 500 Hz narrowband (NB) CE-Chirp and broadband (BB) CE-Chirp stimuli. DESIGN: Twenty healthy participants (10 female) were tested twice on the same day to determine the within-session reliability and 1 week later to determine the between-session reliability. The latency, amplitude, and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air-conducted (AC) 500 Hz NB CE-Chirp and BB CE-Chirp were recorded bilaterally. RESULTS: A moderate to good between-session reliability with intraclass correlation coefficient (ICC) values ranging from 0.52 to 0.82 was observed for cVEMP latency, amplitude, and asymmetry ratio evoked by 500 Hz NB CE-Chirp, as well as for the BB CE-Chirp cVEMP amplitude (ICC of 0.70 and 0.84). In contrast, an overall poor reliability ICC values between 0.30 and 0.42 for cVEMP latency and asymmetry ratio were observed for BB CE-Chirp. For the oVEMP, overall poor between-session reliability for all response parameters evoked by the 500 Hz NB CE-Chirp and the BB CE-Chirp was observed. CONCLUSIONS: The 500 Hz NB CE-Chirp was more reliable than the BB CE-Chirp in terms of cVEMP latency, amplitude, and asymmetry ratio. Further investigation using the standard electrode montage is necessary to assess the test-retest reliability of the chirp-evoked oVEMP.

Cervical and ocular vestibular evoked myogenic potential: A comparison of narrowband chirp, broadband chirp, tone burst and click stimulation.

OBJECTIVES: To compare the response rate and response parameters of cervical and ocular vestibular evoked myogenic potentials (c&oVEMP) elicited by narrowband (NB) and broadband (BB) CE-Chirp, with the more classical tone burst (TB) and click VEMPs. DESIGN: The response rate, latency, amplitude and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air conducted (AC) 500 Hz NB CE-chirp, BB CE-chirp, 500 Hz TB and click stimuli were recorded bilaterally. STUDY SAMPLE: 20 male and 38 female participants (19-39 years). RESULTS: For the cVEMP, the highest response rate was found for NB chirp (100%), followed by TB (91%), BB chirp (87%) and finally click (85%). A similar order was seen for oVEMP with percentages of 100%; 57%, 57%, and 43%. The 500 Hz NB CE-Chirp elicited significantly shorter cVEMP P1 and N1 latencies and significantly larger c&oVEMP amplitudes compared to all other stimuli. BB CE-Chirp elicited significantly shorter c&oVEMP P1 and N1 latencies with smaller amplitudes compared to TB. Asymmetry ratios were not statistically significant for all comparisons. CONCLUSION: The 500 Hz NB CE-chirp provides the highest response rates, shorter latencies and larger amplitudes, and therefore seem a promising stimulus for reliably measuring c&oVEMPs in clinical practice.

Extended High-Frequency Audiometry for Ototoxicity Monitoring: A Longitudinal Evaluation of Drug-Resistant Tuberculosis Treatment.

PURPOSE: The aim of this study was to describe extended high-frequency (EHF) pure-tone audiometry monitoring of ototoxicity in a longitudinal treatment program for drug-resistant tuberculosis (DRTB). METHOD: This was a retrospective record review of longitudinal conventional (0.25-8 kHz) and EHF (9-16 kHz) audiometry for ototoxicity monitoring of DRTB patients undergoing treatment at community-based clinics between 2013 and 2017. Data from 69 patients with an average age of 37.9 years (SD = 11.2, range: 16.0-63.8 years) were included. Patients were assessed by primary health care audiologists (87%) or community health workers (13%) using portable audiological equipment. The average length of time between initial and exit assessments was 84.6 days (SD = 74.2, range: 2-335 days). RESULTS: EHF ototoxicity of a mild or greater degree of hearing loss (> 25 dB HL in one or both ears across frequencies) was evident in 85.5% of patients' posttreatment, compared with 47.8% of patients across conventional frequencies. EHF audiometry demonstrated an ototoxic shift (American Speech-Language-Hearing Association criteria) in 56.5% of cases compared with 31.9% when only conventional audiometry was considered. Mean hearing deterioration for patients was significant across EHFs (9-16 kHz) bilaterally (p < .05). Absent EHF thresholds at the initial assessment, owing to maximum output limits, was a limitation that occurred most frequently at 16 kHz (17.4%, 24/138). CONCLUSIONS: EHF audiometry is most sensitive for the early detection of ototoxicity and should be included in monitoring programs. Clinical ototoxicity monitoring protocols should consider shortened assessment approaches that target frequencies most sensitive to ototoxicity, including EHFs. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21651242.

A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape.

BACKGROUND:  South Africa has a high burden of drug-resistant tuberculosis (DRTB) and until recently, ototoxic aminoglycosides were predominant in treatment regimens. Community-based ototoxicity monitoring programmes (OMPs) have been implemented for early detection of hearing loss and increased patient access. OBJECTIVES:  A longitudinal study was conducted to describe the service delivery characteristics of a community-based OMP for DRTB patients facilitated by CHWs as well as observed ototoxic hearing loss in this population. METHOD:  A descriptive retrospective record review of longitudinal ototoxicity monitoring of 194 DRTB patients undergoing treatment at community-based clinics in the city of Cape Town between 2013 and 2017. RESULTS:  Follow-up rates between consecutive monitoring assessments reached as high as 80.6% for patients assessed by CHWs. Few patients (14.2% - 32.6%) were assessed with the regularity (≥ 6 assessments) and frequency required for effective ototoxicity monitoring, with assessments conducted, on average, every 53.4-64.3 days. Following DRTB treatment, 51.5% of patients presented with a significant ototoxic shift meeting one or more of the American Speech-Language-Hearing Association (ASHA) criteria. Deterioration in hearing thresholds was bilateral and most pronounced at high frequencies (4 kHz - 8 kHz). The presence of pre-existing hearing loss, human immunodeficiency virus co-infection and a history of noise exposure were significant predictors of ototoxicity in patients. CONCLUSION:  DRTB treatment with kanamycin resulted in significant deterioration of hearing longitudinally, predominantly at high frequencies. With ongoing training and supportive supervision, CHWs can facilitate community-based ototoxicity monitoring of DRTB patients. Current protocols and guidelines may require reassessment for appropriate community-based ototoxicity monitoring.

Wideband acoustic immittance in superior semicircular canal dehiscence.

OBJECTIVE: The apparent effect of superior semicircular canal dehiscence (SSCD) on middle ear- and cochlear impedance has led researchers to investigate the use of wideband acoustic immittance as a screening tool when SSCD is suspected. The purpose of the study was to describe the absorbance characteristics and tympanometric values of ears with confirmed SSCD measured at tympanometric peak pressure (TPP) and at ambient pressure. METHODS: Wideband Acoustic Immittance was performed at ambient pressure and at TPP on ten participants (12 ears) with confirmed SSCD, as well as on an age- and gender matched control group (12 ears). Inferential statistics were used to determine whether statistical differences existed for the absorbance values at each of the averaged frequencies, the resonance frequency (RF) and tympanometric data between the SSCD and control groups. RESULTS: The mean absorbance of the SSCD group reached a maximum at 890.9 Hz and a minimum at 6349.6 Hz. When testing absorbance at TPP, a statistically significant increase/peak in the absorbance values of the SSCD group (compared to those of the control group) was found from 630 to 890.9 Hz and a decrease from 4489.8 to 6349.6 Hz. Similar patterns were observed for absorbance at ambient pressure. A lower mean RF for ears with SSCD as well as an increased mean admittance magnitude (AM) value at RF was found compared to those of the control group. CONCLUSION: The use of SSCD as a screening tool when SSCD is suspected was strengthened by results similar to those of previous studies. As a result of the significant difference in RF of SSCD ears compared to the RF of the control group, the potential value of measuring the RF of the middle ear to differentiate between mass-and stiffness dominated pathologies, was also illustrated.

Community-Based Ototoxicity Monitoring for Drug-Resistant Tuberculosis in South Africa: An Evaluation Study.

In response to the drug-resistant tuberculosis (DRTB) ototoxicity burden in South Africa, ototoxicity monitoring has been decentralised, with community health workers (CHWs) acting as facilitators. This study describes a community-based ototoxicity monitoring programme (OMP) for patients with DRTB. Findings are compared to the recommended guidelines for ototoxicity monitoring, the OMP protocol and published studies. This was a retrospective study of longitudinal ototoxicity monitoring of 831 patients with DRTB, using data collected at community-based clinics in the City of Cape Town between 2013 and 2017. Approximately half (46.8%) of the patients had an initial assessment conducted in accordance with the OMP protocol recommendations, and follow-up rates (79.5%) were higher than those of a similar DRTB programme. However, patients in this study were not monitored within the timeframes or with the regularity recommended by the guidelines or the OMP protocol. Extended high-frequency pure-tone audiometry (27.5%) was underutilised by testers and data recording was inconsistent (e.g., 37.7% of patient gender was not recorded by testers). Community-based OMP using CHWs to facilitate monitoring showed improvement over previous hospital-based reports, with more accessible services and higher follow-up rates. However, to improve OMP outcomes, OMP managers should reassess current protocols and data recording practices.

Auditory Brainstem Response Test at Different Stimulus Rates in Normal-Hearing Adults Living With HIV.

Purpose The study investigated whether the auditory brainstem response (ABR) at a baseline and at higher repetition rates can detect if neurodegeneration has occurred in adults living with HIV who present with normal behavioral pure-tone thresholds. Method An exploratory research design was used. Forty adults with HIV (80 ears, 57.5% female; M age = 26.3 years, SD = 3.68) and 20 adults without HIV participated. Phase 1 compared ABR absolute and interwave latencies at a baseline rate. Phase 2 examined the effect of HIV status and category of immunodeficiency on ABR absolute Wave V latency and Wave V latency shift at increased stimulus rates. Analysis included a two-way analysis of variance of the interaction between stimulus rate and HIV status and between CD4+ category and rate, and multiple regression analysis. Results In adults living with HIV, the baseline ABR yielded prolonged Wave III and V absolute latencies and interpeak prolongations in 22.5%. Interaural Wave V latency differences were present in 15% of participants. An additional 15% of ears presented with abnormal Wave V at increased rates. No significant interaction between HIV status and rate in either ear or between CD4+ category and rate was found in either ear (p > .05). Although rate and gender contributed significantly to the prediction of Wave V latency of the rate study (left and right, p < .001), HIV status did not (left and right, p > .05). Conclusions Although the interaction of HIV status and CD4+ with rate was not significant, more ears were identified with abnormal results at increased stimulus rates than with the baseline ABR alone. The ABR at increased rates may therefore be a valuable addition for the identification of individuals living with HIV with auditory neural deficiencies.

Diagnostic accuracy of CE Chirp.

OBJECTIVE: There has been an increase in the use of the CE-Chirp stimulus in automated auditory brainstem response (AABR) equipment for neonatal hearing screening. The purpose of this study is to evaluate the diagnostic accuracy of the LS CE-Chirp-evoked auditory brainstem response (ABR) compared to the click-evoked ABR for the identification of different degrees and configurations of sensorineural (SNHL) hearing loss. METHOD: 49 ears with mild to moderate SNHL were assessed: 16 ears with rising SNHL and 33 ears with sloping high frequency SNHL. Behavioural pure tone thresholds were obtained at 125-8000 Hz and ABR thresholds were measured using the click and LS CE-Chirp stimuli respectively. Click- and LS CE-Chirp-evoked thresholds were compared with each other and with behavioural pure tone average at 500, 1000, 2000 Hz (PTA), high frequency average at 2000, 4000, 8000 Hz (HFA) and low frequency average at 250, 500, 1000 Hz (LFA). Diagnostic accuracy of the two ABR stimuli was also compared by using ROC curves. RESULTS: Differences between click- and LS CE Chirp-evoked ABR, and behavioural thresholds were not statistically significant (p > 0.05). The highest significant correlations for ABR using clicks to behavioural thresholds was found at 2000 and 4000 Hz, whereas, the highest correlation for LS CE-Chirp ABRs to behavioural thresholds was found at 1000, 2000 and 4000 Hz (r > 0.7, p < 0.001). A very strong, positive correlation was found between both click (r = 0.805, p < 0.001) and LS CE-Chirp (r = 0.825, p < 0.001) and the behavioural PTA. LS CE-Chirp ABR thresholds were closer to mid and low frequency thresholds than the click ABR while the click-evoked thresholds were in closer proximity to HFA. Sensitivity and specificity and false negative rates were identical. Diagnostic accuracy of the LS CE-Chirp ABR was equal to or better than click for low (area under the curve (AUC) = 0.83), mid (AUC = 0.89) and high frequency hearing losses (AUC = 0.73). However, scatterplots indicated more frequent underestimation of behavioural pure tone thresholds at mid and high frequencies with the LS CE-Chirp than for the click ABR. CONCLUSION: The diagnostic accuracy of the LS CE Chirp-evoked ABR is equivalent or better than the click-evoked ABR. The importance of ongoing surveillance and consideration of ABR screening protocols is consequently emphasized.

Short-Term Test-Retest Reliability of Electrically Evoked Cortical Auditory Potentials in Adult Cochlear Implant Recipients.

Background: Late latency auditory evoked potentials (LLAEPs) provide objective evidence of an individual's central auditory processing abilities. Electrically evoked cortical auditory evoked potentials (eCAEPs) are a type of LLAEP that provides an objective measure of aided speech perception and auditory processing abilities in cochlear implant (CI) recipients. Aim: To determine the short-term test-retest reliability of eCAEPs in adult CI recipients. Design: An explorative, within-subject repeated measures research design was employed. Study Sample: The study sample included 12 post-lingually deafened, unilaterally implanted adult CI recipients with at least 9 months of CI experience. Method: eCAEPs representing basal, medial and apical cochlear regions were recorded in the implanted ears of each participant. Measurements were repeated 7 days after the initial assessment. Results: No significant differences between either median latencies or amplitudes at test and retest sessions (p > 0.05) were found when results for apical, medial and basal electrodes were averaged together. Mean intraclass correlation coefficient (ICC) scores averaged across basal, medial and apical cochlear stimulus regions indicated that both consistency and agreement were statistically significant and ranged from moderate to good (ICC = 0.58-0.86, p < 0.05). ICC confidence intervals did demonstrate considerable individual variability in both latency and amplitudes. Conclusion: eCAEP latencies and amplitudes demonstrated moderate to good short-term test-retest reliability. However, confidence intervals indicated individual variability in measurement consistency which is likely linked to attention and listening effort required from the CI recipients.

P300 Event-Related Potentials in Normal-Hearing Adults With Type 2 Diabetes Mellitus.

Background P300 event-related potentials can be used to measure auditory processing speed, working memory, and attention. Purpose The purpose of the study was to compare P300 event-related potentials in normal-hearing adults with those of adults with Type II diabetes mellitus. Research Design A two-group (with diabetes and controls) comparative study (age- and sex-matched) with a nonprobability sampling method was used. Study Sample Sixty-four adult participants (32 with diabetes, 32 without diabetes) between the ages of 23 and 60 years participated. Data Collection and Analysis Pure-tone audiometry was performed to ensure participants had pure-tone averages of ≤ 25 dB HL. Folstein Mini-Mental State Examinations were conducted, which ensured absence of cognitive impairment. Blood glucose levels were measured immediately prior to P300 testing, after which amplitude and latency results were captured. Descriptive analysis was used to calculate mean, standard deviation, median, and 25th and 75th percentiles. To study differences between adults with and without diabetes as well as the effect of glucose, linear mixed-model regression analyses were performed when left and right ears were combined, and simple linear regression analyses were performed when left and right ears were analyzed separately. Results For P300 latency results, a significant statistical difference (p < .001) was observed between participants with and without diabetes (352.46 ms, SD = 36.36; 314.09 ms, SD = 32.08), respectively. A significant statistical difference (p < .001) in amplitude was observed between participants with and without diabetes, respectively (12.10 µV, SD = 3.70; 15.08 µV, SD = 2.82). Glucose was a key moderator of only amplitude after adjusting for diabetes status. Glucose had no effect on amplitude and latency for adults without Type II diabetes mellitus (DM). Conclusions Type II DM decreases amplitude and increases latency; in addition, adults with Type II DM, attention, and working memory, as denoted by P300 amplitude, may deteriorate with increased glucose levels on the day of testing.

The correlation between hair and eye colour and contralateral suppression of otoacoustic emissions.

Genetics and environmental factors frequently influence individual's susceptibility to hearing loss. It is postulated that melanin in the inner ear is related to individual's susceptibility to noise induced hearing loss (NIHL). General pigmentation in turn, suspected to be related to the amount of pigmentation in the inner ear. The amount of melanin in the inner ear is said to modulate the endocochlear potential and provide an otoprotective effect. AIM: The study aimed to determine the relationship between the contralateral suppression of otoacoustic emissions (CSOAE) in individuals with brown eyes and hair, and blue eyes and blond hair, and temporary emission shift (TES) after short-term noise exposure. SETTING AND DESIGN: The research was conducted using a quantitative research design with a quasi-experimental repeated within the subject design to compare the CSOAE in subjects with different hair and eyes colour with TES after short-term noise exposure. Quantitative research was used to determine the relationship between the measurable variables to predict occurrence. MATERIAL AND METHOD: The hearing sensitivity of young adults was determined by using pure tone audiometry followed by CSOAE's and distortion product otoacoustic emissions (DPOAE) before listening to music for one hour individually. Pure tone audiometry and DPOAE's were repeated after music exposure to determine the amount of TES and temporary threshold shift (TTS). STATISTICAL ANALYSIS USED: One-way ANOVA was used during the analysis of the data obtained during this research study, in addition to, two-tailed Wilcoxon Sign Rank test and Friedman's test. In all analyses, a 95% level of significance (P<0.05) was used. RESULTS: No statistically significant difference between efferent suppression was measured by CSOAE's between the participant groups. A larger TTS at 4000 Hz and TES at 2000 Hz was evident in the blue eyes and blond hair group after short-term music exposure. Conclusion: CSOAE's were unable to predict which group of individuals were more susceptible to NIHL after short-term noise exposure.

Community-based hearing screening for young children using an mHealth service-delivery model.

BACKGROUND: Hearing loss is one of the most common developmental disorders identifiable at birth with its prevalence increasing throughout school years. However, early detection programs are mostly unavailable in low- and middle-income countries (LMICs) where more than 80% of children with hearing loss reside. OBJECTIVE: This study investigated the feasibility of a smartphone-based hearing screening program for preschool children operated by community healthcare workers (CHWs) in community-based early childhood development (ECD) centers. METHOD: Five CHWs were trained to map ECD centers and conduct smartphone-based hearing screenings within a poor community in South Africa over a 12-month period. The hearScreenTM smartphone application employed automated test protocols operating on low-cost smartphones. A cloud-based data management and referral function allowed for remote monitoring for surveillance and follow up. RESULTS: 6424 children (3-6 years) were screened for hearing loss with an overall referral rate of 24.9%. Only 39.4% of these children attended their follow-up appointment at a local clinic, of whom 40.5% referred on their second screening. Logistic regression analysis indicated that age, gender and environmental noise levels (1 kHz) had a significant effect on referral rates (p < 0.05). The quality index reflecting test operator test quality increased during the first few months of testing. CONCLUSION: Smartphone-based hearing screening can be used by CHWs to detect unidentified children affected by hearing loss within ECD centers. Active noise monitoring, quality indices of test operators and cloud-based data management and referral features of the hearScreenTM application allows for the asynchronous management of hearing screenings and follow-ups.

Knowledge and attitudes of early childhood development practitioners towards hearing health in poor communities.

OBJECTIVE: Within the educational sector of low-and middle-income countries (LMICs), formal and informal early childhood development (ECD) centers are often the first point of contact for majority of children. Since early hearing detection services are mostly absent in LMICs, these ECD centers may serve as the first point of access to screenings for these children. ECD practitioner awareness regarding hearing and hearing loss is essential for the successful implementation of hearing screening programs. This study thus investigated the current knowledge and attitudes of ECD practitioners towards childhood hearing loss in a community representative of typical LMIC contexts. METHOD: Purposive sampling was used to identify ECD centers and participants across a community. Thereafter, a cross-sectional quantitative survey (23 items) was adminstered amongst 82 ECD practitioners. RESULTS: More than 80% of ECD practitioners correctly identified genetics and ear infections as etiological factors of hearing loss. Gaps in knowledge regarding identification techniques for children 3-6 years of age and the impact of hearing loss in the classroom were evident. ECD personnel's duration of experience had a significant effect on overall knowledge and attitude (p < .05; F (1,53) = 8.68). ECD personnel displayed a positive attitude towards children receiving a hearing test (88.3%) and almost all participants indicated the need for more information regarding hearing loss (93.5%). CONCLUSIONS: This study demonstrated a general readiness amongst ECD practitioners for the implementation of ECD hearing screening programs in LMICs, however additional information and guidelines are needed to improve practitioner knowledge and attitudes.

Diagnostic accuracy of a general practitioner with video-otoscopy collected by a health care facilitator compared to traditional otoscopy.

OBJECTIVE: Video-otoscopy is rapidly developing as a new method to diagnose common ear disease and can be performed by trained health care facilitators as well as by clinicians. This study aimed to compare remote asynchronous assessments of video-otoscopy with otoscopy performed by a general practitioner. METHOD: Children, aged 2-16 years, attending a health center in Johannesburg, South Africa, were examined. An otologist performed otomicroscopy and a general practitioner performed otoscopy. Video-otoscopy was performed by a health care facilitator and video sequences were stored on a server for assessment by the same general practitioner 4 and 8 weeks later. At all examinations, a diagnosis was set and the tympanic membrane appearance was graded using the OMgrade-scale. The otologist's otomicroscopic diagnosis was set as reference standard to compare the accuracy of the two otoscopic methods. RESULTS: Diagnostic agreement between otologist's otomicroscopic examination and the general practitioner's otoscopic examination was substantial (kappa 0.66). Agreement between onsite otomicroscopy and the general practitioners asynchronous video assessments were also substantial (kappa 0.70 and 0.80). CONCLUSION: Video-otoscopy performed by a health care facilitator and assessed asynchronously by a general practitioner had similar or better accuracy compared to face-to-face otoscopy performed by a general practitioner.

Smartphone hearing screening in mHealth assisted community-based primary care.

INTRODUCTION: Access to ear and hearing health is a challenge in developing countries, where the burden of disabling hearing loss is greatest. This study investigated community-based identification of hearing loss using smartphone hearing screening (hearScreen™) operated by community health workers (CHWs) in terms of clinical efficacy and the reported experiences of CHWs. METHOD: The study comprised two phases. During phase one, 24 CHWs performed community-based hearing screening as part of their regular home visits over 12 weeks in an underserved community, using automated test protocols employed by the hearScreen™ smartphone application, operating on low-cost smartphones with calibrated headphones. During phase two, CHWs completed a questionnaire regarding their perceptions and experiences of the community-based screening programme. RESULTS: Data analysis was conducted on the results of 108 children (2-15 years) and 598 adults (16-85 years). Referral rates for children and adults were 12% and 6.5% respectively. Noise exceeding permissible levels had a significant effect on screen results at 25 dB at 1 kHz (p<0.05). Age significantly affected adult referral rates (p < 0.05), demonstrating a lower rate (4.3%) in younger as opposed to older adults (13.2%). CHWs were positive regarding the hearScreen™ solution in terms of usability, need for services, value to community members and time efficiency. CONCLUSION: Smartphone-based hearing screening allows CHWs to bring hearing health care to underserved communities at a primary care level. Active noise monitoring and data management features allow for quality control and remote monitoring for surveillance and follow-up.