The evolution of e-Health and telemedicine has shifted focus from patients coming to the hearing clinic for hearing health evaluation towards the possibility of evaluating the hearing status remotely at home. But is an online hearing test accurate?
Why are online hearing tests becoming so popular?
Sound systems of modern home electronic equipment, such as a personal computer (PC), tablet, or smartphone, offer opportunities to conduct hearing examinations at low cost and on a large scale. With the rise of the digital age, there has been a dramatic change in the accessibility of everything from groceries to healthcare. Online tests offer a more appealing and convenient option to the conventional means of accessing a desired item or service. The population of people who are computer literate is aging and their hearing sensitivity is declining. Therefore, the number of people interested in online hearing tests is increasing. Additionally, research shows that the use of the Internet is higher in the hearing-impaired population in comparison to similar age groups in the general population.
Types of online hearing assessment tests
The use of the internet as a testing platform allows several different types of hearing assessment tests such as speech in noise tests (SIN) and variants of SIN tests, questionnaires, temporal gap detection, sound localization (minimum audible angle), and spectral (un)masking tests. In addition, the use of the internet allows audiovisual presentations, visual interaction, and cues in the tests for a more user-friendly and ecological approach. Several new and novel approaches for hearing assessments using the internet are constantly surfacing, however, the validated tests are based on questionnaires or SIN tests. Furthermore, the internet provides a platform that is more broadly and remotely accessible to populations who may have restricted access to ear and hearing care.
What do the online hearing test results tell us?
An important consideration is the target disorder of the hearing screening test. According to the International Classification of Functionality (ICF), disability, and health model by the WHO (2001) for hearing, the screening should be for hearing disability. However, not all technologies target the disability but rather hearing impairment.
The results obtained from the hearing screening test indicate whether the user requires more comprehensive testing. Advancements in modern technology have taken online hearing testing to a further level where diagnostic hearing assessments can be made to recommend and pre-program hearing aids for the user. In this article, we will take a look at the types of online hearing tests that are administered and how accuracy is achieved.
Calibrated vs non-calibrated tests
The online tests can be grouped according to calibrated and non-calibrated tests. Calibrated tests offer you an indication of your absolute hearing thresholds. This means that the test administered will measure the readings of the test according to a standardized reading. For example, the readings of the test can be measured against the output of the most commonly used headphones or speakers. If not, additional tools can be supplied or procedures implemented to ensure calibration of the test to ensure that the same readings are obtained. This is how accuracy is achieved with calibrated tests by ensuring that the results obtained are measured against standardized readings.
Pure tone audiometry
An example of a calibrated test is a pure tone test, in which tones are presented at different frequencies at different intensities (loud and soft) and the lowest heard tone is recorded as a hearing threshold. The pure tones are measured as a standardized reading by the output of the headphones or speakers used.
Non-calibrated tests are those running without a precise reference level. During these tests, you will often be asked to turn the level of your computer up until you comfortably hear the sounds used for the test. SIN tests are usually an example of non-calibrated tests.
Speech in noise (SIN)
Difficulty in understanding speech in noisy situations is often one of the first signs of noise-induced hearing loss (NIHL). This specific hearing disability can be tested more accurately by means of a speech-in-noise test than by traditional pure-tone audiometry. SIN tests were developed to create more real-world listening scenarios and evaluate a person’s aided performance against a normal performance-intensity function. Digits in noise (DIN) tests are commonly used, which are a SIN test that uses digit triplets in steady-state speech noise. The test measures primarily the auditory and speech recognition abilities in noise. SIN tests help you decipher and quantify how much distortional loss there might be. Accuracy in SIN tests is achieved by comparing the signal to noise ratio (SNR). The SIN test involves the evaluation of speech intelligibility in relation to SNR; therefore, the knowledge of the absolute sound level is not required. The sensitivity of the SIN test can be improved after applying low-band noise. As studies show that background noise and a patient’s perception of background annoyance and tolerance can affect hearing aid use, we can use speech-in-noise tests as a positive counseling tool to help patients evaluate their expectations and reach their listening potential.
Many online hearing tests are paired with a number of questions. These questions consist of personal questions and then advance to further questions about lifestyle habits that may influence hearing loss. The questionnaires may vary, but it is recommended to use a questionnaire that has been standardized and validated. Studies have shown that a self-reported questionnaire-based approach may be used for the assessment of hearing loss and has been proposed as a valid screening method. The accuracy of self-reported hearing loss questionnaires is based on the measure against the standardization of these questionnaires.
What about hearing healthcare professionals?
A comprehensive audiological test battery will include a combination of the above-mentioned tests amongst other evaluations, to provide the hearing health care professional with a comprehensive overview of the patients’ diagnosis. There are several hearing tests implemented on the internet; however, only a few are verified in terms of sensitivity and specificity. Most online hearing tests are accurate enough to give you an overview of your current hearing state. They cannot offer you a medical diagnosis or identify the root cause or type of hearing. For further information, a consultation with your hearing healthcare professionals is recommended. Online tests can be used to monitor your hearing and possibly detect deterioration in your hearing abilities. An annual hearing assessment is recommended to ensure healthy hearing.