Revisão Sistemática

Accuracy of smartphone-based hearing screening tests: a systematic review

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

Downloads: 0
Views: 224


Purpose: To verify the accuracy of smartphone apps to identify hearing loss. Research strategies: A systematic review followed the PRISMA-DATA checklist. The search strategies were applied across four databases (Lilacs, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey, and ProQuest Dissertations and Thesis). Selection criteria: The acronym PIRD was used in review. This included populations of any gender and all age groups. The Index test is the smartphone-based hearing screening test; the Reference test is the puretone audiometry, which is considered the gold reference for hearing diagnostics; the diagnosis was performed via validity data (sensitivity and specificity) to identify hearing loss and diagnostic studies. Data analysis: Two reviewers selected the studies in a two-step process. The risk of bias was assessed according to the criteria of the QUADAS-2. Results: Of 1395 articles, 104 articles were eligible for full-text reading and 17 were included. Only four met all criteria for methodological quality. All of the included studies were published in English between 2015 and 2020. The applications Digits-in noise Test (5 articles), uHear (4 articles), HearScreen (2 articles), hearTest (2 articles) and Hearing Test (2 articles) were the most studied. All this application showed sensitivity and specificity values between 75 and 100%. The other applications were EarScale, uHearing Test, Free field hearing (FFH) and Free Hearing Test. Conclusion: uHear, Digit-in-Noise Test, HearTest and HearScreen have shown significant values of sensitivity and specificity and can be considered as the most accurate methods for screening of hearing impairment.


Audiology; Hearing Loss; Smartphone; Hearing Test; Mass Screening; Public Health


1. WHO: World Health Organization [Internet]. WHO global estimates on prevalence of hearing loss: prevention of deafness. Switzerland: WHO; 2018 [cited 2022 Feb 02]. Available from: Global-estimates-on-prevalence-of-hearing-loss-for-website.pptx

2. WHO: World Health Organization [Internet]. Deafness and hearing loss. Switzerland: WHO; 2021 [cited 2022 Feb 02]. Available from: https://

3. Jayawardena A, Waller B, Edwards B, Larsen-Reindorf R, Anomah JE, Frimpong B, et al. Portable audiometric screening platforms used in lowresource settings: a review. Cambridge: Cambridge University Press; 2019. p. 74-9.

4. Swanepoel D, Clark JL. Hearing healthcare in remote or resource-constrained environments. J Laryngol Otol. 2019;133(1):11-7. S0022215118001159. PMid:30022744.

5. Swanepoel DW, Sousa KC, Smits C, Moore DR. Mobile applications to detect hearing impairment: opportunities and challenges. Bull World Health Organ. 2019;97(10):717-8. PMid:31656337.

6. Ratanjee-Vanmali H, Swanepoel DW, Laplante-Lévesque A. Patient uptake, experience, and satisfaction using web-based and face-to-face hearing health services: process evaluation study. J Med Internet Res. 2020;22(3):e15875. PMid:32196459.

7. Sousa KC, Swanepoel DW, Moore DR, Smits C. A smartphone national hearing test: performance and characteristics of users. Am J Audiol. 2018;27(3S):448-54. PMid:30452748.

8. Rocha TAH, Fachini LA, Thumé E, Silva NC, Barbosa AC, Carmo MD, et al. Saúde Móvel: novas perspectivas para a oferta de serviços em saúde. Epidemiol Serv Saude. 2016;25(1):159-70. PMid:27861688.

9. GSMA [Internet]. The mobile economy. 2019 [cited 2020 Nov 13]. Available from:

10. 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.

11. Martínez-Pérez B, De La Torre-Díez I, López-Coronado M. Mobile health applications for the most prevalent conditions by the world health organization: review and analysis. J Med Internet Res. 2013;15(6):e120. PMid:23770578.

12. Sethi RKV, Ghanad I, Kanumuri V, Herrmann B, Kozin ED, Remenschneider AK. Mobile hearing testing applications and the diagnosis of sudden sensorineural hearing loss: a cautionary tale. Otol Neurotol. 2018;39(1):e1- 4. PMid:29227445.

13. Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, et al. Long-term effectiveness of screening for hearing loss: the screening for auditory impairment - which hearing assessment test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 2010;58(3):427-34. http://dx.doi. org/10.1111/j.1532-5415.2010.02738.x. PMid:20398111.

14. Demorest ME, Wark DJ, Erdman SA. Development of the screening test for hearing problems. Am J Audiol. 2011;20(2):100-10. http://dx.doi. org/10.1044/1059-0889(2011/10-0048). PMid:22158633.

15. Smits C, Theo Goverts S, Festen JM. The digits-in-noise test: assessing auditory speech recognition abilities in noise. J Acoust Soc Am. 2013;133(3):1693- 706. PMid:23464039.

16. Williams-Sanchez V, McArdle RA, Wilson RH, Kidd GR, Watson CS, Bourne AL. Validation of a screening test of auditory function using the telephone. J Am Acad Audiol. 2014;25(10):937-51. jaaa.25.10.3. PMid:25514447.

17. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, et al. Preferred Reporting items for a systematic review and metaanalysis of diagnostic test accuracy studies the PRISMA-DTA statement. JAMA. 2018;319(4):388-96. PMid:29362800.

18. Greenhalgh T, Peacock R. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. BMJ. 2005;331(7524):1064-5. PMid:16230312.

19. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. http:// PMid:27919275.

20. Campbell JM, Klugar M, Ding S, Carmody DP, Hakonsen SJ, Jadotte YT, et al. Diagnostic test accuracy: methods for systematic review and meta-analysis. Int J Evid-Based Healthc. 2015;13(3):154-62. http://dx.doi. org/10.1097/XEB.0000000000000061. PMid:26355602.

21. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. PMid:19622551.

22. 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.

23. 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:// PMid:25655259.

24. 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. PMid:26046161.

25. 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. PMid:30242342.

26. 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: crosssectional validation study. JMIR Mhealth Uhealth. 2019;7(4):e12033. http:// PMid:30932870.

27. 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. AUD.0000000000000223. PMid:26372265.

28. Louw C, Swanepoel DW, Eikelboom RH, Myburgh HC. Smartphone-based hearing screening at primary health care clinics. Ear Hear. 2017;38(2):e93- 100. PMid:27764002.

29. 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. PMid:29321124.

30. 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.

31. Potgieter JM, Swanepoel DW, Smits C. Evaluating a smartphone digits-innoise test as part of the audiometric test battery. S Afr J Commun Disord. 2018;65(1):e1-6. PMid:29781704.

32. 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:// PMid:32673129.

33. 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. PMid:31425362.

34. 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. PMid:32609044.

35. 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. PMid:31965808.

36. 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.

37. 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.

38. De Luca Canto G, Pachêco-Pereira C, Aydinoz S, Major PW, Flores-Mir C, Gozal D. Diagnostic Capability of biological markers in assessment of obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2015;11(1):27-36. PMid:25325575.

39. Thodi C, Parazzini M, Kramer SE, Davis A, Stenfelt S, Janssen T, et al. Adult hearing screening: follow-up and outcomes. Am J Audiol. 2013;22(1):183- 5. PMid:23800816.

40. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15(3):231-40. tmj.2008.0099. PMid:19382860.

41. Amlani AM. Improving patient compliance to hearing healthcare services and treatment through self-efficacy and smartphone applications. The Hearing Review. 2015;22(2):16-20.

42. Swanepoel W, Myburgh HC, Howe DM, Mahomed F, Eikelboom RH. Smartphone hearing screening with integrated quality control and data management. Int J Audiol. 2014;53(12):841-9. 14992027.2014.920965. PMid:24998412.

43. Soncini F, Costa MJ, Oliveira TMT, Lopes LFD. Correlation between sentences recognition thresholds in quiet and tonal thresholds. Rev Bras Otorrinolaringol. 2003;69(5):672-7. 72992003000500013.

44. Theunissen M, Swanepoel DW, Hanekom J. Sentence recognition in noise: variables in compilation and interpretation of tests. Int J Audiol. 2009;48(11):743-57. PMid:19951143.

45. Jacobs PG, Silaski G, Wilmington D, Gordon S, Helt W, McMillan G, et al. Development and evaluation of a portable audiometer for highfrequency screening of hearing loss from ototoxicity in homes/clinics. IEEE Trans Biomed Eng. 2012;59(11):3097-103. TBME.2012.2204881. PMid:22801480.

46. Sbompato AF, Corteletti LCBJ, Moret ALM, Jacob RT. Hearing in Noise Test Brazil: standardization for young adults with normal hearing. Braz J Otorhinolaryngol. 2015;81(4):384-8. bjorl.2014.07.018. PMid:26130593.

47. Smits C, Watson CS, Kidd GR, Moore DR, Goverts ST. A comparison between the Dutch and American-English digits-in-noise (DIN) tests in normal-hearing listeners. Int J Audiol. 2016;55(6):358-65. http://dx.doi. org/10.3109/14992027.2015.1137362. PMid:26940045.

48. Koole A, Nagtegaal AP, Homans NC, Hofman A, Jong RJB, Goedegebure A. Using the digits-in-noise test to estimate age-related hearing loss. Ear Hear. 2016;37(5):508-13. PMid:26871876.

49. Dawes P, Fortnum H, Moore DR, Emsley R, Norman P, Cruickshanks K, et al. Hearing in middle age: a population snapshot of 40- to 69-year olds in the united kingdom. Ear Hear. 2014;35(3):e44-51. http://dx.doi. org/10.1097/AUD.0000000000000010. PMid:24518430.

621fcd21a953953af824a763 codas Articles


Share this page
Page Sections