Acurácia de testes de triagem auditiva baseados em smartphone: uma revisão sistemática

Melo, Inara Maria Monteiro; Silva, Aline Roberta Xavier; Camargo, Rodolpho; Cavalcanti, Hannalice Gottschalk; Ferrari, Deborah Viviane; Taveira, Karinna Veríssimo Meira; Balen, Sheila Andreoli

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Sumário

Systematic Review • CoDAS 34 (3) • 2022 • https://doi.org/10.1590/2317-1782/20212020380 copiar

Acurácia de testes de triagem auditiva baseados em smartphone: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Verificar a acurácia dos aplicativos de smartphone para identificar a perda auditiva.

Estratégias de pesquisa

Uma revisão sistemática seguiu o checklist PRISMA-DATA. As estratégias de busca foram aplicadas nos bancos de dados Lilacs, PubMed, Scopus e Web of Science e na literatura cinzenta (Google Scholar, OpenGrey e ProQuest Dissertations and Thesis).

Critérios de seleção

O anacrônimo PIRD foi usado na revisão. Incluiu populações de qualquer gênero e todas as faixas etárias. O teste Index foi o de triagem auditiva baseado em smartphone; o teste de referência foi a audiometria tonal; o diagnóstico foi realizado por meio de dados de validade (sensibilidade e especificidade) para identificação da perda auditiva e estudos diagnósticos.

Análise de dados

Dois revisores selecionaram os estudos em um processo de duas etapas. O risco de viés foi avaliado de acordo com os critérios do QUADAS-2.

Resultados

De 1395 artigos, 104 artigos foram elegíveis para leitura de texto completo e 17 foram incluídos. Apenas quatro preencheram todos os critérios de qualidade metodológica. Todos os estudos incluídos foram publicados em inglês entre 2015 e 2020. Os aplicativos mais estudados foram: Digits-in-noise (5 artigos), uHear (4 artigos), HearScreen (2 artigos), hearTest (2 artigos) e Hearing Test (2 artigos). Todos apresentaram valores de sensibilidade e especificidade entre 75 e 100%. Os outros aplicativos foram EarScale, uHearing, Free Field Hearing e teste Free Hearing.

Conclusão

uHear, Digit-in-Noise Test, HearTest e HearScreen apresentaram valores significativos de sensibilidade e especificidade e podem ser considerados os métodos mais precisos para rastreamento de deficiência auditiva.

Descritores
Audiologia; Perda Auditiva; Smartphones; Testes Auditivos; Programas de Rastreamento; Saúde Pública

Authors/ Year/Country	Sample/Age group (mean ± SD)	App	Type of Stimulus	Gold standard test	Gold standard test pass-fail criteria	Sensitivity	Specificity	PPV/NPV	Prevalence/Accuracy
Abu-Ghanem, et al. (2015)⁽²³23 Abu-Ghanem S, Handzel O, Ness L, Ben-Artzi-Blima M, Fait-Ghelbendorf K, Himmelfarb M. Smartphone-based audiometric test for screening hearing loss in the elderly. Eur Arch Otorhinolaryngol. 2016;273(2):333-9. http://dx.doi.org/10.1007/s00405-015-3533-9. PMid:25655259. http://dx.doi.org/10.1007/s00405-015-353... ⁾ Israel	26 individuals/ 65-94 years old (84.4 ± 6.73)	uHear	Pure tone	Pure-tone threshold audiometry from 250 to 6000 Hz	Mean of 500, 1000, and 2000 Hz at 40 dB as the cut-off point.	100%	60%	33.3% 100%	4.1% 91.6%
Armstrong et al. (2020)⁽³²32 Armstrong NM, Oosterloo BC, Croll PH, Ikram MA, Goedegebure A. Discrimination of degrees of auditory performance from the digits-in-noise test based on hearing status. Int J Audiol. 2020;59(12):897-904. http://dx.doi.org/10.1080/14992027.2020.1787531. PMid:32673129. http://dx.doi.org/10.1080/14992027.2020.... ⁾ Netherlands	3422 individuals/ 51-98 years old	Digits-in-Noise (DIN) test	Digits-in-noise	Pure-tone threshold audiometry from 250 to 8000 Hz.	Mean of 500, 1000, 2000 and 4000 Hz at 25 dB as the cut-off point.	For mild hearing loss = 69% For moderate hearing loss = 94%	For mild hearing loss = 75% For moderate hearing loss = 95%	*	*
Barczik and Serpanos (2018)⁽²⁵25 Barczik J, Serpanos YC. Accuracy of smartphone self-hearing test applications across frequencies and earphone styles in adults. Am J Audiol. 2018;27(4):570-80. http://dx.doi.org/10.1044/2018_AJA-17-0070. PMid:30242342. http://dx.doi.org/10.1044/2018_AJA-17-00... ⁾ United States	22 individuals/ 18-84 years old (48.7)	uHear uHearing Test	Pure tone Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Mean of 500, 1000, and 2000 Hz at 25 dB as the cut-off point.	UHear Earbud earphones = 90-100% Supra-aural headphones=100% Circumaural headphones = 88,9-100% uHearing Test Earbud earphones = 10,5-75% Supra-aural headphones=85,7-90,5% Circumaural headphones = 10,5-70%	uHear Earbud earphones = 85,5-100% Supra-aural headphones=6,5-25% Circumaural headphones = 33-96,3% uHearing Test Earbud earphones = 91,7-100% Supra-aural headphones=87-86,7% Circumaural headphones = 100%	uHear Earbud earphones = 81,3-100%/ 92,3-100% Supra-aural headphones=31-52,6% Circumaural headphones = 55,6-86,7% uHearing Test Earbud earphones = 88,2-100%/ 59,5-81,5% Supra-aural headphones=90,9-93,6% Circumaural headphones = 100%/ 59,5-93,3%	*
Chu et al. (2019)⁽²⁶26 Chu YC, Cheng YF, Lai YH, Tsao Y, Tu TY, Young ST, et al. A mobile phone-based approach for hearing screening of school-age children: cross-sectional validation study. JMIR Mhealth Uhealth. 2019;7(4):e12033. http://dx.doi.org/10.2196/12033. PMid:30932870. http://dx.doi.org/10.2196/12033... ⁾ Taiwan	85 individuals/ 11-12 years old (11 ±0,5)	EarScale app	Pure tone	Pure-tone threshold audiometry from 500 to 4000Hz	Mean of 500, 1000, 2000 Hz and 4000 Hz more than 25 dB in the sound-treated booth were designated as hearing impairment.	95,2-100%	100%	*	*
Corona et al. (2020)⁽³⁶36 Corona AP, Ferrite S, Bright T, Polack S. Validity of hearing screening using hearTest smartphone-based audiometry: performance evaluation of different response modes. Int J Audiol. 2020;59(9):666-73. http://dx.doi.org/10.1080/14992027.2020.1731767. PMid:32134341. http://dx.doi.org/10.1080/14992027.2020.... ⁾ Brazil	300 adults/ 15-92 years old (53±) 40 children/ 5-14 years old (9±)	hearTest	Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Mean of 500, 1000, 2000 and 4000 Hz at 25 dB as the cut-off point.	Adults = 98% Children = 100%	Adults = 100% Children = 98%	Adults = 86,7% 99,2% Children = 83,3% 100%	*
Durgut et al. (2020)⁽³⁰30 Durgut O, Ekim B, Dikici O, Solmaz F, Ağırgöl B, Özbakan A. Evaluation of hearing thresholds by using a mobile application in children with otitis media with effusion. Audiol Neurotol. 2020;25(3):120-4. http://dx.doi.org/10.1159/000505309. PMid:31962328. http://dx.doi.org/10.1159/000505309... ⁾ Turkey	50 individuals/ 5-15 years old (8.18±2.58)	HearingTest	Pure tone	Pure-tone threshold audiometry from 500 to 4000 Hz	Mean of 500, 1000, and 2000 Hz at 20 dB as the cut-off point.	93,6%	26,4%	53% 33%	47% 58%
Louw et al. (2017)⁽²⁸28 Louw C, Swanepoel DW, Eikelboom RH, Myburgh HC. Smartphone-based hearing screening at primary health care clinics. Ear Hear. 2017;38(2):e93-100. http://dx.doi.org/10.1097/AUD.0000000000000378. PMid:27764002. http://dx.doi.org/10.1097/AUD.0000000000... ⁾ South Africa	1236 individuals Above 16 years olds (37.8±17.9)	HearScreen	Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Mean of 500, 1000, 2000 Hz and 4000 Hz was greater than 25 dB for children or greater than 35 dB for adults.	81.7%	83.1%	86.6% 99.4%	*
Mahomed-Asmail et al. (2016)⁽²⁷27 Mahomed-Asmail F, Swanepoel DW, Eikelboom RH, Myburgh HC, Hall III J. Clinical validity of hearScreen™ smartphone hearing screening for school children. Ear Hear. 2016;37(1):e11-7. http://dx.doi.org/10.1097/AUD.0000000000000223. PMid:26372265. http://dx.doi.org/10.1097/AUD.0000000000... ⁾ South Africa	1070 individuals/ 5–12 years old (8 ± 1.1)	HearScreen	Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Gold standard test results revealed hearing loss when a threshold is higher than 25 dB HL at 0.5, 1, 2, or 4 kHz.	75%	98.5%	52.9% 99.4%	*
Masalski et al. (2018)⁽²⁹29 Masalski M, Grysiński T, Kręcicki T. Hearing tests based on biologically calibrated mobile devices: comparison with pure-tone audiometry. JMIR Mhealth Uhealth. 2018;6(1):e10. http://dx.doi.org/10.2196/mhealth.7800. PMid:29321124. http://dx.doi.org/10.2196/mhealth.7800... ⁾ Poland	70 individuals/ 18–71 years old (36±11)	HearingTest	Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Hearing loss was diagnosed when the threshold exceeded 30 dB at one of the following frequencies: 500Hz, 1 kHz, 2 kHz, or 25 dB at more than one, or when the hearing threshold exceeded 50 dB at 4 kHz.	98%	79%	*	*
Peer and Fagan (2015)⁽²⁴24 Peer S, Fagan JJ. Hearing loss in the developing world: evaluating the iPhone mobile device as a screening tool. S Afr Med J. 2015;105(1):35-9. http://dx.doi.org/10.7196/SAMJ.8338. PMid:26046161. http://dx.doi.org/10.7196/SAMJ.8338... ⁾ South Africa	25 individuals/ 15–80 years old (*)	uHear	Pure tone	Pure-tone threshold audiometry from 250 to 6000Hz	For the auditory screening, presence or absence of moderate or worse hearing loss (pure-tone average >40 dB) in each ear was determined via formal audiometry, considering 40 dB as the critical auditory threshold for disabling hearing loss.	100%	Waiting room = 64% Quiet room = 74% Acoustically treated room = 88%	100% in all environments Waiting room = 32% Quiet room = 72.7% Acoustically treated room = 100%	84% Waiting room = 50% Quiet room = 78% Acoustically treated room = 90%
Potgieter et al. (2018)⁽¹⁰10 Potgieter JM, Swanepoel DW, Myburgh HC, Smits C. The South African English smartphone digits-in-noise hearing test: effect of age, hearing loss, and speaking competence. Ear Hear. 2018;39(4):656-63. http://dx.doi.org/10.1097/AUD.0000000000000522. PMid:29189432. http://dx.doi.org/10.1097/AUD.0000000000... ⁾ South Africa	458 individuals/ 16-90 years old (27±16)	Digits-in-Noise (DIN) test	Digits-in-noise	Pure-tone threshold audiometry from 250 to 8000 Hz.	Mean of 500, 1000, 2000 and 4000 Hz at 25 dB as the cut-off point.	94%	77%	*	*
Potgieter et al. (2018)⁽³¹31 Potgieter JM, Swanepoel DW, Smits C. Evaluating a smartphone digits-in-noise test as part of the audiometric test battery. S Afr J Commun Disord. 2018;65(1):e1-6. http://dx.doi.org/10.4102/sajcd.v65i1.574. PMid:29781704. http://dx.doi.org/10.4102/sajcd.v65i1.57... ⁾ South Africa	109 individuals/ 16–89 years old (72±7.2)	Digits-in-Noise (DIN) test	Digits-in-noise	Pure-tone threshold audiometry from 250 to 8000 Hz	Mean of 500, 1000, 2000 and 4000 Hz at 25 dB as the cut-off point.	88%	88%	98.3% 75.5%	*
Sandström et al. (2020)⁽³⁵35 Sandström J, Swanepoel DW, Laurent C, Umefjord G, Lundberg T. Accuracy and reliability of smartphone self-test audiometry in community clinics in low income settings: a comparative study. Ann Otol Rhinol Laryngol. 2020;129(6):578-84. http://dx.doi.org/10.1177/0003489420902162. PMid:31965808. http://dx.doi.org/10.1177/00034894209021... ⁾ South Africa	63 individuals/ 20-88 years old (52±*)	hearTest	Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Mean of 500, 1000, 2000 and 4000 Hz at 20 dB as the cut-off point.	90,6%	94,2%	*	38,1% *
Sousa et al. (2019)⁽³³33 Sousa KC, Swanepoel DW, Moore DR, Myburgh HC, Smits C. Improving sensitivity of the digits-in-noise test using antiphasic stimuli. Ear Hear. 2020;41(2):442-50. http://dx.doi.org/10.1097/AUD.0000000000000775. PMid:31425362. http://dx.doi.org/10.1097/AUD.0000000000... ⁾ South Africa	145 individuals/ 18-84 years old (*)	Digits-in-Noise (DIN) test	Digits-in-noise	Pure-tone threshold audiometry from 250 to 8000 Hz.	Mean of 500, 1000, 2000 and 4000 Hz at 25 dB as the cut-off point.	Antiphasic DIN = 85% Diotic DIN = 83%	Antiphasic DIN = 67% Diotic DIN = 80%	*	*
Sousa et al. (2020)⁽³⁴34 Sousa KC, Smits C, Moore DR, Myburgh HC, Swanepoel DW. Pure-tone audiometry without bone-conduction thresholds: using the digits-in-noise test to detect conductive hearing loss. Int J Audiol. 2020;59(10):801-8. http://dx.doi.org/10.1080/14992027.2020.1783585. PMid:32609044. http://dx.doi.org/10.1080/14992027.2020.... ⁾ South Africa	158 individuals/ 18-92 years old (61±17)	Digits-in-Noise (DIN) test	Digits-in-noise	Pure-tone threshold audiometry from 250 to 8000 Hz.	Mean of 500, 1000, 2000 and 4000 Hz at 25 dB as the cut-off point.	97,2%	93,4%	*	*
Swami et al. (2017)⁽³⁷37 Swami H, Bhargava A, Sabarigirish K, Arvind BM. A comparative study of smartphone based app with free field hearing for possible use as a screening test. Int J Otorhinolaryngol Head Neck Surg. 2017;3(3):710-4. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20173052. http://dx.doi.org/10.18203/issn.2454-592... ⁾ India	200 individuals/ 17-65 years old (*)	Free field hearing (FFH) Free Hearing Test (“freehearingtestsoftware.com”)	Words Pure tone	Pure-tone threshold audiometry from 250 to 8000 Hz	Mean air conduction thresholds at a 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz higher than 20 dB were considered normal.	FFH: 73% Free Hearing Test: 98%	FFH: 99% Free Hearing Test: 95%	Free Hearing Test = 95.1% Free Hearing Test = 97.9%	50% 96.5%
Szudek et al. (2012)⁽²²22 Szudek J, Ostevik A, Dziegielewski P, Robinson-Anagor J, Gomaa N, Hodgetts B, et al. Can uHear me now? Validation of an iPod-based hearing loss screening test. J Otolaryngol Head Neck Surg. 2012;41(S1):S78-84. PMid:22569055.⁾ Canada	100 individuals/ 20-91 years old (46±*)	uHear	Pure tone	Pure-tone threshold audiometry from 250 to 6000Hz	Mean of 500, 1000, 2000 and 4000 Hz at 40 dB as the cut-off point.	100%	90%	*	*

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[1] Conflict of interests: nothing to declare.