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Mobile audiometry for hearing threshold assessment: A systematic review and meta‐analysis

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  • Babatunde Oremule
  • Jonathan Abbas
  • Gabrielle Saunders
  • Karolina Kluk
  • Rachel Isba
  • Sebastian Bate
  • Iain Bruce
<mark>Journal publication date</mark>1/01/2024
<mark>Journal</mark>Clinical Otolaryngology
Issue number1
Number of pages13
Pages (from-to)74-86
Publication StatusPublished
Early online date12/10/23
<mark>Original language</mark>English


Technological advancements in mobile audiometry (MA) have enabled hearing assessment using tablets and smartphones. This systematic review (PROSPERO ID: CRD42021274761) aimed to identify MA options available to health providers, assess their accuracy in measuring hearing thresholds, and explore factors that might influence their accuracy. A systematic search of online databases including PubMed, Embase, Cochrane, Evidence Search and Dynamed was conducted on 13th December 2021, and repeated on 30th October 2022, using appropriate Medical Subject Headings (MeSH) terms. Eligible studies reported the use of MA to determine hearing thresholds and compared results to conventional pure-tone audiometry (CA). Studies investigating MA for hearing screening (i.e. reporting just pass/fail) were ineligible for inclusion. Two authors independently reviewed studies, extracted data, and assessed methodological quality and risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Adults and children, with and without diagnosis of hearing impairment. A meta-analysis was performed to obtain the mean difference between thresholds measured using MA and CA in dB HL. Searches returned 858 articles. After systematic review, 17 articles including 1032 participants were analysed. The most used software application was Shoebox (6/17) followed by Hearing Test (3/17), then HearTest (2/17). Tablet computers were used in ten studies, smartphones in six, and a computer in one. The mean difference between MA and CA thresholds was 1.36 dB (95% CI, 0.07-2.66, p = 0.04). Significant differences between mobile audiometry (MA) and conventional audiometry (CA) thresholds were observed in thresholds measured at 500Hz, in children, when MA was conducted in a sound booth, and when MA was self-administered. However, these differences did not exceed the clinically significant threshold of 10 decibels (dB). Included studies exhibited high levels of heterogeneity, high risk of bias and low concerns about applicability. MA compares favourably to CA in measuring hearing thresholds and has role in providing access to hearing assessment in situations where CA is not available or feasible. Future studies should prioritize the integration of pure-tone threshold assessment with additional tests, such as Speech Recognition and Digits-in-Noise, for a more rounded evaluation of hearing ability, assesses acceptability and feasibility, and the cost-effectiveness of MA in non-specialist settings. [Abstract copyright: © 2023 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.]