Validating Smartphone-Based and Web-Based Applications for Remote Hearing Assessment.

Abstract

Background: High prevalence of hearing loss and its physical, mental, and social impacts when unaddressedunderscore a need for early identification. However, in-person hearing assessment may beinaccessible in certain countries and areas. As such, numerous smartphone-based and web-basedapplications (apps) have been developed to perform remote hearing assessment, and yet many ofthem remain unvalidated.
Purpose: The purpose of this study was to evaluate the performance, ecological validity, and usabilityof two freely available smartphone-based hearing assessment apps-Hearing Test (Android) and MimiHearing Test (iOS)-alongside a web-based app, MDHearing Aid.
Research Design: This is a cross-sectional validation study.
Study Sample: This study included 60 adults with hearing thresholds no greater than 20 dB HL or anydegree of sensorineural hearing loss.
Data Collection and Analysis: Participants completed standard audiometric testing followed byassessments using three apps in a controlled laboratory setting. The assessments were repeated byparticipants at home the subsequent day. The mHealth App Usability Questionnaire (MAUQ) wasadministered to evaluate the apps' usability. Performance metrics included sensitivity, specificity, accuracy,and test-retest reliability. Intraclass correlation coefficient (ICC) estimates were calculated tomeasure the apps' accuracy, test-retest reliability, and ecological validity.
Results: All apps had moderate to good sensitivity (0.67-1.00) and specificity (0.72-0.99). The HearingTest app showed poor accuracy at lower frequencies (ICC: 0.24-0.53) and moderate to good accuracy above 1000 Hz (ICC: 0.74-0.83). The Mimi Hearing Test showed poor accuracy at lower frequencies(ICC: 0.27-0.50) and moderate to good accuracy above 2000 Hz (ICC: 0.68-0.85). The web-basedMDHearing Aid test showed moderate to good accuracy across frequencies (ICC: 0.64-0.85). All appshad moderate to excellent test-retest reliability (ICC: 0.66-0.99) and showed poor ecological validity below500 Hz (ICC: 0.20-0.51) and moderate to excellent ecological validity above 1000 Hz (ICC: 0.54-0.95).Usability was rated highly across all apps, with MAUQ scores ranging from 5.4 to 5.9 out of 7.
Conclusions: The examined apps exhibit varied accuracy levels and generally reasonable sensitivity,specificity, test-retest reliability, ecological validity, and usability. With additional validation, the HearingTest app may be useful for hearing screening and monitoring in adults. There is a necessity for furtherresearch to unlock the examined apps' full clinical potential.