Smartphone-based National Hearing Test Launched in South Africa

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... In developing nations like Africa, where the burden of disabling hearing loss is the highest, access to ear and hearing protection was a problem [14]. This study examined using mobile hearing screening (hearWHO) to detect hearing damage in people using headphones. ...
... Audiometric screening should be performed on handheld devices such as mobiles and tablets facilitating early detection of hearing loss. On World Hearing Day in March 2016, the hearZA app, South Africa's national hearing test, was unveiled [14]. In underserved areas, using the hearing application test at small health settings and primary health centers can reduce the demand for audiological services. ...
... Besides hearing screening, the DIN test app also serves as a public awareness tool for hearing loss. It can monitor oneself or someone else's hearing status using personalized profiles and can connect people to a hearing health care provider using location-based referral systems (De Sousa et al., 2018;Swanepoel, 2017). The app includes a decision support tool, developed in collaboration with the Ida Institute (Denmark), encouraging listeners to take the next step to manage their hearing loss (De Sousa et al., 2018;Swanepoel, 2017). ...
... It can monitor oneself or someone else's hearing status using personalized profiles and can connect people to a hearing health care provider using location-based referral systems (De Sousa et al., 2018;Swanepoel, 2017). The app includes a decision support tool, developed in collaboration with the Ida Institute (Denmark), encouraging listeners to take the next step to manage their hearing loss (De Sousa et al., 2018;Swanepoel, 2017). In this way, smart device-based screening methods are offering new possibilities not only for detection but also for supporting listeners by aiding their decision making and linking them with professionals (Swanepoel et al., 2019). ...
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Purpose This study investigated user characteristics, help-seeking behavior, and follow-up actions of people who failed an app-based digits-in-noise hearing screening test, considering their stage of change. Method Test and user characteristics of 3,092 listeners who failed the test were retrospectively analyzed. A posttest survey determining follow-up (verb) actions was sent to listeners who failed the test ( n = 1,007), of which 59 responded. Results The majority of listeners were in the precontemplation stage (75.5%). Age and stage of change were significant ( p < .05) predictors of the digits-in-noise speech recognition threshold (DIN SRT). Listeners in the precontemplation stage were significantly younger than in other stages ( p < .05). Posttest survey response rate was low (5.9%). Of those, most (82.4%) did not think they had a hearing loss. Only 13.6% followed up with an audiologist. Conclusion Older people presented with poorer DIN SRTs and were typically in a more advanced stage of change. The majority of those who did not follow up after failing the screening test did not believe they had a hearing loss. A combination of factors, including poor DIN SRT, older age, and a more advanced stage of change inclined participants to follow up with audiological care.
... The hearZA campaign and platform are utilized for several different purposes, of which hearing screening is only one. These purposes include serving as a (a) strategic public awareness tool for hearing health, (b) screening tool for hearing loss, (c) personal hearing profile for tracking hearing health, (d) decision support tool encouraging action on hearing loss developed in collaboration with the Ida Institute, and (e) location-based referral system to connect persons to their closest hearing health providers in partnership with national audiologic societies (Swanepoel, 2017). ...
... This means it is reaching an important target audience, those who think they have hearing loss. Conversely, it also reaches a high proportion of persons not yet presenting with a clear hearing problem but, having taken the test, are aware of their hearing status and can then track it through the app's personal profile (Swanepoel, 2017). Users are also reminded annually (via in-app notifications) to conduct follow-up tests allowing for longitudinal tracking and the possibility of early detection of hearing problems. ...
Purpose: The smartphone digits-in-noise hearing test, called hearZA, was made available as a self-test in South Africa in March 2016. This study determined characteristics and test performance of the listeners who took the test. Method: A retrospective analysis of 24,072 persons who completed a test between March 2016 and August 2017 was conducted. User characteristics, including age, English-speaking competence, and self-reported hearing difficulty, were analyzed. Regression analyses were conducted to determine predictors of the speech reception threshold. Results: Overall referral rate of the hearZA test was 22.4%, and 37% of these reported a known hearing difficulty. Age distributions showed that 33.2% of listeners were ages 30 years and younger, 40.5% were between ages 31 and 50 years, and 26.4% were older than 50 years. Age, self-reported English-speaking competence, and self-reported hearing difficulty were significant predictors of the speech reception threshold. Conclusions: High test uptake, particularly among younger users, and high overall referral rate indicates that the hearZA app addresses a public health need. The test also reaches target audiences, including those with self-reported hearing difficulty and those with normal hearing who should monitor their hearing ability.
... The test, which uses a digits-in-noise test paradigm determining speech perception ability in background noise, provides a result in 2 min. The hearZA application is employed as (a) a strategic public awareness tool for hearing health, (b) an accurate screening tool for hearing loss, (c) a personalized hearing health tracker, (d) an in-app decision support tool encouraging action on hearing loss, and (e) a referral network to link people to their closest hearing health providers based on geolocation in partnership with national audiologic societies (Swanepoel, 2017a). ...
... As a social innovation, it was developed and validated at the University of Pretoria and made available commercially by the hearX group (Pretoria, South Africa; Potgieter et al., 2016Potgieter et al., , 2018. To ensure that the national hearing test app can be offered free of charge, strategic partnerships with various sponsors, of which the largest mobile operator in South Africa (Vodacom) is the primary sponsor, needed to be developed alongside the support of the national audiology associations (Swanepoel, 2017a). The success of this social entrepreneurship project has seen almost 50,000 persons tested and thousands referred to local hearing health specialists. ...
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Purpose This article explores different meanings of innovation within the context of audiology and the Internet. Case studies are used to illustrate and elaborate on the new types of innovation and their levels of impact. Method The article defines innovation, providing case studies illustrating a taxonomy of innovation types. Results Innovation ranges from minor changes in technology implemented on existing platforms to radical or disruptive changes that provide exceptional benefits and transform markets. Innovations within the context of audiology and the Internet can be found across that range. The case studies presented demonstrate that innovations in hearing care can span across a number of innovation types and levels of impact. Considering the global need for improved access and efficiency in hearing care, innovations that demonstrate a sustainable impact on a large scale, with the potential to rapidly upscale this impact, should be prioritized. Conclusions It is unclear presently what types of innovations are likely to have the most profound impacts on audiology in the coming years. In the best case, they will lead to more efficient, effective, and widespread availability of hearing health on a global scale.
... The high availability of mobile devices such as smartphones (8)(9)(10)(11)(12)(13)(14) and tablets (15,16) make them a convenient platform for software development (applications or "apps") in the health area. A review study (17) showed medical applications that permeate all clinical care, contributing from health promotion to intervention. ...
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Purpose: To evaluate the accuracy of affordable instruments for hearing screening of adults and the elderly. Methods: This study was carried out with users of a Hearing Health Service of the Unified Health System. All were screened with the MoBASA smartphone application, the Telehealth audiometer (TH) and the electronic version of the Hearing Handicap Inventory for the Elderly - screening version - eHHIE-S. The examiners were blinded to the results of the screening tests and pure tone audiometry (PTA). Hearing impairment was considered for those with a PTA quadritonal mean greater than 40 dB in the best ear. Sensitivity, specificity and positive and negative predictive values (PPV and NPV, respectively) were calculated. The Kappa index was used as an agreement indicator between the PTA and the screening results. Results: The sample consisted of 80 individuals between 18 and 94 years old (55.18 ± 20.21). In the PTA test, 21 individuals (26.25%) had typical hearing and 59 (73.75%) hearing loss. In the hearing screening tests, sensitivity, specificity, PPV and NPV values greater than 75% were observed with the MoBASA as well as in terms of sensitivity and NPV of the TH and the eHHIE-S. The TH and the eHHIE-S specificity and PPV were less than 75%. The Kappa index indicated a substantial agreement (0.6) between the PTA and the MoBASA screening results. The TH and the eHHIE-S showed regular agreement (0.3). Conclusion: MoBASA proved to be an accurate method for hearing screening of adults and the elderly with disabling hearing loss.
... The known mobile health applications for screening and diagnostics include otoscopy, pure-tone screening and testing, speech-in-noise testing, and electrophysiology. The tests can be self-initiated, whereby the client downloads a hearing test app and the results are sent to the clinician (e.g., Swanepoel, 2017) for asynchronous communication about the results. Alternatively, the tests can be run synchronously, whereby the clinician remotely supervises or conducts the test while the client or an on-site technician sets up the test. ...
In a relatively short period of time, modern societies have been transformed by the ubiquitous uptake of advanced and portable mobile communication, computation, and sensors available on smartphones. Looking forward, it is anticipated that smartphones will have an increasingly important role in health management including the delivery of hearing healthcare and operation of hearing instruments. Objective: This paper provides a brief overview of the role of smartphones in audiologic rehabilitation and hearing research and reports on the findings of a survey assessing attitudes of audiologists towards smartphone integration in hearing healthcare. Design: A total of 258 audiologists working in the United States completed the 10-item survey. Results: The key finding from the survey is that practitioners generally expressed a high willingness to integrate smartphone technology in patient care. Counterintuitively, it was observed that clinicians with the least number of years of experience had relatively more negative attitudes toward smartphone integration in hearing healthcare than clinicians with comparatively more years of experience. Conclusions: The findings suggest that the attitudes of audiologists likely do not represent a barrier regarding smartphone integration in audiologic rehabilitation.
... This is in line with current research, in which mobile applications and mobile software-based audiometers are becoming more commonplace. [11][12][13][14] Our previous work indicated the capacity of the hEAR mobile application to replicate audiologist-collected screening data, but with a strong dependence upon headphone reproduction capacity. 15 This study examined the use of commercially available headphones when combined with a full-spectrum mobile application and their capability of reproducing audiologist-quality hearing screenings. ...
Introduction With the need for hearing screenings increasing across multiple populations, a need for automated options has been identified. This research seeks to evaluate the hardware requirements for automated hearing screenings using a mobile application. Objective Evaluation of headphone hardware for use with an app-based mobile screening application. Methods For the purposes of this study, hEAR, a Bekesy-based mobile application designed by the research team, was compared with pure tone audiometric tests administered by an audiologist. Both hEAR and the audiologist's test used 7 frequencies (125 Hz, 250 Hz, 500 Hz, 1,000 Hz, 2000 Hz, 4,000 Hz and 8,000 Hz) adopting four different sets of commercially available headphones. The frequencies were regarded as the independent variable, whereas the sound pressure level (in decibels) was the dependent variable. Thirty participants from a university in Texas were recruited and randomly assigned to one of two groups, whose only difference was the order in which the tests were performed. Data were analyzed using a generalized estimating equation model at α = 0.05. Results Findings showed that, when used to collect data with the mobile app, both the Pioneer HDJ-2000 (Pioneer, Bunkyo, Tokyo, Japan) (p > 0.05) and the Sennheiser HD280 Pro (Sennheiser, Wedemark, Hanover, Germany) (p > 0.05) headphones presented results that were not statistically different from the audiologist's data across all test frequencies. Analyses indicated that both headphones had decreased detection probability at 4kHz and 8kHz, but the differences were not statistically significant. Conclusion Data indicate that a mobile application, when paired with appropriate headphones, is capable of reproducing audiologist-quality data.
Purpose This study compared the test characteristics, test–retest reliability, and test efficiency of three novel digits-in-noise (DIN) test procedures to a conventional antiphasic 23-trial adaptive DIN (D23). Method One hundred twenty participants with an average age of 42 years ( SD = 19) were included. Participants were tested and retested with four different DIN procedures. Three new DIN procedures were compared to the reference D23 version: (a) a self-selected DIN (DSS) to allow participants to indicate a subjective speech recognition threshold (SRT), (b) a combination of self-selected and adaptive eight-trial DIN (DC8) that utilized a self-selected signal-to-noise ratio (SNR) followed by an eight-trial adaptive DIN procedure, and (c) a fixed SNR DIN (DF) approach using a fixed SNR value for all presentations to produce a pass/fail test result. Results Test–retest reliability of the D23 procedure was better than that of the DSS and DC8 procedures. SRTs from DSS and DC8 were significantly higher than SRTs from D23. DSS was not accurate to discriminate between normal-hearing and hard of hearing listeners. The DF and DC8 procedures with an adapted cutoff showed good hearing screening test characteristics. All three novel DIN procedure durations were significantly shorter (< 70 s) than that of D23. DF showed a reduction of 46% in the number of presentations compared to D23 (from 23 presentations to an average of 12.5). Conclusions The DF and DC8 procedures had significantly lower test durations than the reference D23 and show potential to be more time-efficient screening tools to determine normal hearing or potential hearing loss. Further studies are needed to optimize the DC8 procedure. The reference D23 remains the most reliable and accurate DIN hearing screening test, but studies in which the potentially efficient new DIN procedures are compared to pure-tone thresholds are needed to validate these procedures.
For people living with some sensory or cognitive impairment, including many older adults, the disabling or empowering effects of physical and social settings can be crucial. An inclusive environment that nurtures participation is based on considering the needs of an individual alongside the affordability and social constraints, employing available technology and knowledge in efficient manners. While the assistive IoT and smart environments may offer unique opportunities, they may share similar issues with many other contemporary approaches and AT that stay as prototypes, hindering their adoption and widespread employment. This chapter presents some of the implementations of the IoT and smart environments for aged care and empowering people living with dementia or some sensory impairment. It also discusses some of the challenges regarding their deployments.
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