Development and Validation of a Self-Administered Online Hearing Test

We describe the development and validation of a self-administered online hearing test, which screens for hearing loss and provides an estimated audiogram. The hearing test computes test results from age, self-reported hearing abilities, and self-assessed pure-tone thresholds. It relies on regression, Bayesian and binary classification, leveraging probabilistic effects of age as well as interfrequency and interaural relationships in audiograms. The test was devised based on development data, collected prospectively in an online experiment from a purposive convenience sample of 251 adult American, Australian, Canadian, and Swiss participants, 58% of whom had hearing loss. Later, we externally validated the hearing test. Validation data were collected prospectively from a representative sample of 156 adult Belgian participants, 15% of whom had hearing loss. Participants completed the hearing test and audiometric assessments at home. The results for the primary screening outcome showed that the hearing test screened for mild hearing losses with a sensitivity of 0.83 [95%-confidence interval (CI): 0.65, 0.96], specificity of 0.94 [CI: 0.89, 0.98], positive predictive value of 0.70 [CI: 0.57, 0.87], and negative predictive value of 0.97 [CI: 0.94, 0.99]. Results for the secondary audiogram estimation outcome showed mean differences between estimated and gold standard hearing thresholds ranging from 2.1 to 12.4 dB, with an average standard deviation of the differences of 14.8 dB. In conclusion, the hearing test performed comparably to state-of-the-art hearing screeners. This test, therefore, is a validated alternative to existing screening tools, and, additionally, it provides an estimated audiogram.