Tablet-Based Hearing Screening in an Urban Community Healthcare Setting

Introduction: Urban communities face multiple obstacles in implementing effective hearing loss (HL) screening programs. This study evaluates the effectiveness of a tablet-based fixed-dB screening (TBFDS) in an urban community by comparing it to booth audiometry.

Methods: In this prospective cross-sectional study, patients were recruited from the busy podiatry outpatient clinic of a Northeastern United States tertiary hospital between March 2020 and January 2024. Demographics and comorbidities were collected. Each patient completed the Hearing Handicap Inventory for the Elderly (HHIE-S) where a score of 25 or more indicated HL. The free EarTest mobile application was used to screen patients using 35 dB pure tones at 500, 1000, 2000, 4000, and 8000 Hz. A minimum of 4/5 frequencies missed was the threshold for HL. Patients were tested with headphones on a tablet in a quiet clinic room. All patients were followed up with pure tone audiometry (PTA) performed by an audiologist. A pure tone threshold average of 35 dB or greater indicated hearing loss on PTA. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios (LRs) were used to determine the effectiveness of TBFDS.

Results: In total, 20 patients and 40 ears were enrolled. The mean age was 56.9 years old (SD: 10). Of the total, 55% of patients were female, 50% were Black, 30% were White, and 20% were other. Also, 5% of patients lived in a group home, 1/12 with type II diabetes, 2/11 with hypertension, 1/9 with a history of vertigo, 1/2 with autoimmune disease, and 0/1 with cancer history had demonstrated HL on TBFDS, confirmed by audiometry. Comorbidities were not significantly associated with hearing loss. With EarTest alone, the sensitivity was 66.7%, the specificity was 78.4%, and the accuracy was 77.5%. The positive LR was 3.08 and the negative LR was 0.43. When EarTest was combined with the HHIE-S, the sensitivity was 100%, the specificity was 70.3%, and the accuracy was 72.%, with positive and negative LRs of 3.36 and 0, respectively.

Conclusions: TBFDS offers an accurate, timely, and inexpensive way to screen a population with varying comorbidities in an urban community setting.