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Blankenship CM, Hickson LM, Quigley T, Larsen E, Lin L, Hunter LL. Extended High-Frequency Audiometry using the Wireless Automated Hearing Test System Compared to Manual Audiometry in Children and Adolescents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.22.23290339. [PMID: 37292836 PMCID: PMC10246139 DOI: 10.1101/2023.05.22.23290339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectives Reliable wireless automated audiometry that includes extended high frequencies (EHF) outside a sound booth would increase access to monitoring programs for individuals at risk for hearing loss, particularly those at risk for ototoxicity. The purpose of the study was to compare thresholds obtained with 1) standard manual audiometry to automated thresholds measured with the Wireless Automated Hearing Test System (WAHTS) inside a sound booth, and 2) automated audiometry in the sound booth to automated audiometry outside the sound booth in an office environment. Design Cross-sectional, repeated measures study. Twenty-eight typically developing children and adolescents (mean = 14.6 yrs; range = 10 to 18 yrs). Audiometric thresholds were measured from 0.25 to 16 kHz with manual audiometry in the sound booth, automated audiometry in the sound booth, and automated audiometry in a typical office environment in counterbalanced order. Ambient noise levels were measured inside the sound booth and the office environment were compared to thresholds at each test frequency. Results Automated thresholds were overall about 5 dB better compared to manual thresholds, with greater differences in the extended high frequency range (EHF;10-16 kHz). The majority of automated thresholds measured in a quiet office were within ± 10 dB of automated thresholds measured in a sound booth (84%), while only 56% of automated thresholds in the sound booth were within ± 10 dB of manual thresholds. No relationship was found between automated thresholds measured in the office environment and the average or maximum ambient noise level. Conclusions These results indicate that self-administered, automated audiometry results in slightly better thresholds overall than manually administered audiometry in children, consistent with previous studies in adults. Ambient noise levels in a typical office environment did not have an adverse effect on audiometric thresholds measured using noise attenuation headphones. Thresholds measured using an automated tablet with noise attenuating headphones could improve access to hearing assessment for children with a variety of risk factors. Additional studies of extended high frequency automated audiometry in a wider age range are needed to establish normative thresholds.
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Bessen SY, Magro IL, Alvarez KM, Cowan DR, Peñalba D, Fellows A, Gonzalez-Quiroz M, Rieke C, Buckey JC, Niemczak C, Saunders JE. Test-Retest repeatability of automated threshold audiometry in Nicaraguan schoolchildren. Int J Audiol 2023; 62:209-216. [PMID: 35130458 DOI: 10.1080/14992027.2022.2032416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Automated threshold audiometry (ATA) could increase access to paediatric hearing assessment in low- and middle-income countries, but few studies have evaluated test-retest repeatability of ATA in children. This study aims to analyse test-retest repeatability of ATA and to identify factors that affect the reliability of this method. DESIGN ATA was performed twice in a cohort of Nicaraguan schoolchildren. During testing, the proportion of responses occurring in the absence of a stimulus was measured by calculating a stimulus response false positive rate (SRFP). Absolute test-retest repeatability was determined between the two trials, as well as the impact of age, gender, ambient noise, head circumference, and SRFP on these results. STUDY SAMPLE 807 children were randomly selected from 35 schools in northern Nicaragua. RESULTS Across all frequencies, the absolute value of the difference between measurements was 5.5 ± 7.8 dB. 89.6% of test-retest differences were within 10 dB. Intra-class correlation coefficients between the two measurements showed that lower SRFP was associated with improved repeatability. No effect of age, gender, or ambient noise was found. CONCLUSIONS ATA produced moderate test-retest repeatability in Nicaraguan schoolchildren. Participant testing behaviours, such as delayed or otherwise inappropriate response patterns, significantly impacts the repeatability of these measurements.
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Affiliation(s)
- Sarah Y Bessen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Isabelle L Magro
- Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Devin R Cowan
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Donoso Peñalba
- National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua
| | | | - Marvin Gonzalez-Quiroz
- Research Center on Health, Work, and Environment at the National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua.,Centre for Nephrology, University College London, London, UK
| | | | - Jay C Buckey
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Kulinski D, Dirks C, Carr W, Sheffield B, Kamimori G, Brungart DS. Field assessment of acute auditory responses to environmental exposures in close quarters tactics training. Int J Audiol 2023; 62:138-150. [PMID: 35073491 DOI: 10.1080/14992027.2022.2028023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate auditory performance of military instructors as part of a training course involving noise and blast exposure. Boothless audiometry was used to estimate the test-retest reliability of the auditory measures under realistic field conditions and to determine risk of acute auditory injury during standard training practices. DESIGN AND STUDY SAMPLE Thirteen U.S. Marine instructors participated in study activities. An audiologic testing suite embedded in a noise-attenuating headset was used to test various tone detection tasks on subjects after exposure. Acoustic exposures were captured with sound level meters. RESULTS Boothless audiometry provide highly repeatable results for various tests of auditory performance in the field environment. In this test population, changes in auditory performance pre- and post-noise exposure were minimal for most measures. The notable exception was binaural (NoSπ) tone detection, which showed significant degradations both as a function of pre- and post-noise exposure on the same day and as a result of cumulative noise exposure over the period of the study. CONCLUSIONS Study outcomes are consistent with prior laboratory and epidemiological work and suggest a link between the binaural processes required for NoSπ detection and the hearing-related issues reported by blast-exposed service members.
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Affiliation(s)
- Devon Kulinski
- Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Coral Dirks
- Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Walter Carr
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Benjamin Sheffield
- Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Army Hering Program, Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gary Kamimori
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Douglas S Brungart
- Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Saunders JE, Bessen S, Magro I, Cowan D, Gonzalez Quiroz M, Mojica-Alvarez K, Penalba D, Reike C, Neimczak C, Fellows A, Buckey J. School Hearing Screening With a Portable, Tablet-Based, Noise-Attenuating Audiometric Headset in Rural Nicaragua. Otol Neurotol 2022; 43:1196-1204. [PMID: 36351228 DOI: 10.1097/mao.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the utility and effectiveness of a noise-attenuating, tablet-based mobile health system combined with asynchronous telehealth evaluations for screening rural Nicaraguan schoolchildren for hearing loss. STUDY DESIGN Prospective population-based survey. SETTING Rural Nicaraguan communities. PATIENTS There were 3,398 school children 7 to 9 years of age. INTERVENTIONS Diagnostic automated and manual audiometry, detailed asynchronous telehealth evaluations. MAIN OUTCOME MEASURES Referral rates, ambient noise levels, and audiometric results as well as hearing loss prevalence, types, and risk factors. RESULTS Despite high ambient noise levels during screening (46.7 dBA), no effect of noise on referral rates on automated audiometry or confirmatory manual audiometry in those who failed automated testing was seen. The overall audiometric referral rate was 2.6%. Idiopathic sensorineural hearing loss (SNHL) and cerumen impaction were the most common types of hearing loss in this population with an estimated prevalence of hearing loss (all types) of 18.3 per 1,000 children. SNHL was associated with both drug exposure during pregnancy (p = 0.04) and pesticide exposure in the home (p = 0.03). CONCLUSION Hearing screening using a tablet-based, noise-attenuating wireless headset audiometer is feasible and effective in rural low-resource environments with moderately elevated ambient noise levels. The referral rate with noise-attenuating headsets was much lower than that previous reports on this population. In addition, manual audiometry resulted in much lower referral rates than automated audiometry. The confirmed hearing loss rate in this study is comparable to reports from other low-income countries that use some form of noise attenuation during screening. Pesticide exposure and drug exposure during pregnancy are potential causes of SNHL in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth
| | - Sarah Bessen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Isabelle Magro
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Devin Cowan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | | | - Donoso Penalba
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Chris Neimczak
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abigail Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Jay Buckey
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Liu H, Du B, Liu B, Fu X, Wang Y. Clinical comparison of two automated audiometry procedures. Front Neurosci 2022; 16:1011016. [PMID: 36303947 PMCID: PMC9595274 DOI: 10.3389/fnins.2022.1011016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Automated pure-tone audiometry has been shown to provide similar hearing threshold estimates to conventional audiometry, but lower correlations were reported at high and low frequencies in audiometric tests than those of manual tests, while the correlations were better in the middle frequencies. In this paper, we used the same equipment and different test procedures for automated testing, and compared the results with manual test results. Design One hundred subjects aged 18–36 years were randomly divided into two groups to perform air-conduction pure-tone audiometry (0.25, 0.5, 1, 2, 4, 8 kHz) using the ascending and shortened ascending protocols built-in to the automated audiometer, respectively. Recorded testing time, the total number of responses and the subject’s preference tests were compared with those of manual tests. Results Significant difference was found at 250 Hz regarding the distribution of the absolute difference between the two automated and the manual thresholds. The testing time spend in the ascending method (9.8 ± 1.4 min, mean ± SD) was significantly longer than in the shorted ascending method (5.8 ± 0.9 min). The total numbers of responses of the ascending method (90.5 ± 10.8 times) and shorted ascending method (62.0 ± 11.4 times) were significantly different. Finally, no significant difference was found in preferences between automated and manual procedures. Conclusion The shorted ascending method can save lots of testing time. The difference between the two automated thresholds at 250 Hz is caused by the different test procedures, and the difference at 8,000 Hz between the automated test and the manual test can be due to the transducer types and allowable differences in calibration.
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Affiliation(s)
- Hui Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Beijing, China
| | - Bingqing Du
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Beijing, China
| | - Bo Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Beijing, China
| | - Xinxing Fu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Beijing, China
- Medical School, The University of Western Australia, Crawley, WA, Australia
- Ear Science Institute Australia, Subiaco, WA, Australia
- *Correspondence: Xinxing Fu,
| | - Yao Wang
- School of Life Sciences, Tiangong University, Tianjin, China
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Yao Wang,
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Saunders JE, Bessen S, Magro I, Cowan D, Quiroz MG, Mojica-Alvarez K, Penalba D, Reike C, Niemczak CE, Fellows A, Buckey JC. Community health workers and mHealth systems for hearing screening in rural Nicaraguan schoolchildren. J Glob Health 2022; 12:04060. [PMID: 35938885 PMCID: PMC9359107 DOI: 10.7189/jogh.12.04060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders. Methods A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed. Results Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone. Conclusions Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sarah Bessen
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Isabelle Magro
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Devin Cowan
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Marvin Gonzalez Quiroz
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua.,Centre for Nephrology, University College London, London, UK
| | | | - Donoso Penalba
- Department of Public Health at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Christopher E Niemczak
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Abigail Fellows
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Alhussaini K, Saleh S, Aleid A, Alkhalaf S, Badghaish R, Altinawi A, Alwasel A. Software Application toward Accessible Hearing Care Assessment: Gap in Noise Test. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1112598. [PMID: 35529544 PMCID: PMC9076313 DOI: 10.1155/2022/1112598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Currently, several methods are being applied to assess auditory temporal resolution in a controlled clinical environment via the measurements of gap detection thresholds (GDTs). However, these methods face two issues: the relatively long time required to perform the gap detection test in such settings and the potential of inaccessibility to such facilities. This article proposes a fast, affordable, and reliable application-based method for the determination of GDT either inside or outside the soundproof booth. The proposed test and the acoustic stimuli were both developed using the MATLAB® programming platform. GDT is determined when the subject is able to distinguish the shortest silent gap inserted randomly in one of two segments of white noise. GDTs were obtained from 42 normal-hearing subjects inside and outside the soundproof booth. The results of this study indicated that average GDTs measured inside the booth (5.12 ± 1.02 ms) and outside (4.78 ± 1.16 ms) were not significantly different. The measured GDTs were also comparable to that reported in the literature. In addition, the GDT screening time of the proposed method was approximately 5 minutes, a screening time that is much less than that reported by the literature. Data show that the proposed application was fast and reliable to screen GDT compared to the standard method currently used in clinical settings.
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Affiliation(s)
- Khalid Alhussaini
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, 10219 Riyadh, Saudi Arabia
| | - Shaza Saleh
- King Abdullah Ear Specialist Center, King Abdulaziz University, King Saud University, 10219 Riyadh, Saudi Arabia
- Ear Institute, University College London, London, UK
| | - Adham Aleid
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, 10219 Riyadh, Saudi Arabia
| | - Saad Alkhalaf
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, 10219 Riyadh, Saudi Arabia
| | - Reem Badghaish
- King Abdullah Ear Specialist Center, King Abdulaziz University, King Saud University, 10219 Riyadh, Saudi Arabia
| | - Amir Altinawi
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, 10219 Riyadh, Saudi Arabia
| | - Abdullatif Alwasel
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, 10219 Riyadh, Saudi Arabia
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Wasmann JW, Pragt L, Eikelboom R, Swanepoel DW. Digital approaches to automated and machine learning assessments of hearing: a scoping review (Preprint). J Med Internet Res 2021; 24:e32581. [PMID: 34919056 PMCID: PMC8851345 DOI: 10.2196/32581] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 01/24/2023] Open
Abstract
Background Hearing loss affects 1 in 5 people worldwide and is estimated to affect 1 in 4 by 2050. Treatment relies on the accurate diagnosis of hearing loss; however, this first step is out of reach for >80% of those affected. Increasingly automated approaches are being developed for self-administered digital hearing assessments without the direct involvement of professionals. Objective This study aims to provide an overview of digital approaches in automated and machine learning assessments of hearing using pure-tone audiometry and to focus on the aspects related to accuracy, reliability, and time efficiency. This review is an extension of a 2013 systematic review. Methods A search across the electronic databases of PubMed, IEEE, and Web of Science was conducted to identify relevant reports from the peer-reviewed literature. Key information about each report’s scope and details was collected to assess the commonalities among the approaches. Results A total of 56 reports from 2012 to June 2021 were included. From this selection, 27 unique automated approaches were identified. Machine learning approaches require fewer trials than conventional threshold-seeking approaches, and personal digital devices make assessments more affordable and accessible. Validity can be enhanced using digital technologies for quality surveillance, including noise monitoring and detecting inconclusive results. Conclusions In the past 10 years, an increasing number of automated approaches have reported similar accuracy, reliability, and time efficiency as manual hearing assessments. New developments, including machine learning approaches, offer features, versatility, and cost-effectiveness beyond manual audiometry. Used within identified limitations, automated assessments using digital devices can support task-shifting, self-care, telehealth, and clinical care pathways.
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Affiliation(s)
- Jan-Willem Wasmann
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Leontien Pragt
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Robert Eikelboom
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, Medical School, The University of Western Australia, Perth, Australia
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - De Wet Swanepoel
- Ear Science Institute Australia, Subiaco, Australia
- Ear Sciences Centre, Medical School, The University of Western Australia, Perth, Australia
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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