Hearing loss is the third leading cause of years lived with disability. It is estimated that 430 million people worldwide are affected, and the number of cases is expected to increase in the future. There is therefore increased pressure on hearing health systems around the world to improve efficiency and reduce costs to ensure increased access to quality hearing health care. Here, we describe the User-Operated Audiometry project, the goal of which is to introduce an automated system for user-operated audiometric testing into everyday clinic practice as a means to relieve part of this pressure. The alternative to the existing referral route is presented in which examination is executed via the user-operated system. This route is conceptualized as an interaction between the patient, the system, and the hearing care professional (HCP). Technological requirements of the system and challenges that are related to the interaction between patients, the user-operated system, and the HCPs within the specific medical setting are discussed. Lastly, a strategy for the development and implementation of user-operated audiometry is presented, which includes initial investigations, a validation study, and implementation in a real-life clinical situation.

Objective: To evaluate two user-operated audiometry methods, the AMTAS^TM PC-based audiometry and a low-cost smartphone audiometry research application (R-App). Design: A repeated-measures within-subject study design was used to compare both user-operated methods to traditional manual audiometry and to evaluate test-retest reliability of each method. Study sample: 58 subjects were recruited in the study of which 83 ears had normal hearing thresholds and 33 ears had hearing loss (pure-tone average > 25 dB HL). Average age of participants was 44.8 years, with an age range of 11–85. Results: Standard deviation of absolute differences ranged between 3.9–6.9 dB on AMTAS^TM and 4.5–6.8 dB on the R-App. The highest variability was found at the 8000 Hz frequency (R-App and AMTAS^TM test) and 3000 Hz frequency (AMTAS^TM retest). Evaluation of test-retest reliability of AMTAS^TM and R-App showed SD of absolute differences ranging between 3.5–5.8 dB and 3.1–5.0 dB, respectively. The mean threshold difference between test and retest was within ±1.5 dB on AMTAS^TM and ±1 dB on the R-App. Conclusion: Accuracy of AMTAS^TM and the R-App was within acceptable limits for audiometry and comparable to traditional manual audiometry on all tested frequencies (250–8000 Hz). Evaluation of test-retest reliability showed acceptable variation on both AMTAS^TM and R-App. Both user-operated methods could be reliably performed in a quiet non-soundproofed environment.

Introduction There is a worldwide need to enhance the capacity of audiometry testing. The objective of this study is to compare the User-operated Audiometry (UAud) system with traditional audiometry in a clinical setting, by investigating if hearing aid effectiveness based on UAud is non-inferior to hearing aid effectiveness based on traditional audiometry, and whether thresholds obtained with the user-operated version of the Audible Contrast Threshold (ACT) test correlates to traditional measures of speech intelligibility. Methods and analysis The design will be a blinded non-inferiority randomised controlled trial. 250 adults referred for hearing aid treatment will be enrolled in the study. Study participants will be tested using both traditional audiometry as well as the UAud system and they will answer the questionnaire Speech, Spatial and Qualities of Hearing Scale (SSQ12) at baseline. Participants will be randomly divided to receive hearing aids fitted based on either UAud or traditional audiometry. Three months after participants have started using their hearing aids, they will undergo a hearing in noise test with hearing aids to measure their speech-in-noise performance and answer the following questionnaires: SSQ12, the Abbreviated Profile of Hearing Aid Benefit and the International Outcome Inventory for Hearing Aids. The primary outcome is a comparison of the change in SSQ12 scores from baseline to follow-up between the two groups. Participants will undergo the user-operated ACT test of spectro-temporal modulation sensitivity as part of the UAud system. The ACT results will be compared with measures of speech intelligibility from the traditional audiometry session and follow-up measurements. Ethics and dissemination The project was evaluated by the Research Ethics Committee of Southern Denmark and judged not to need approval. The findings will be submitted to an international peer-reviewed journal and presented at national and international conferences. Trial registration number NCT05043207.

Hearing loss is a widespread problem while treatment is not always accessible, mainly because of the limited availability of hearing care professionals and clinics. In this work, part of the User-Operated Audiometry project, we investigate the acoustic environment of inexpensive non-sound-treated rooms that could be used for unsupervised audiometric testing. Measurements of 10 min of ambient noise were taken from 20 non-sound-treated rooms in libraries and private and public clinics, nine of which were measured twice. Ambient noise was compared against two traditional audiometric sound-treated rooms and Maximum Permissible Ambient noise levels by ISO 8231-1, while factoring for the attenuation by the DD450 circumaural headphones provided. In most non-sound-treated rooms, MPAs were violated only by transient sounds, while the floor-noise level was below MPAs. Non-sound-treated rooms’ ambient noise levels presented with much larger fluctuations compared to sound-treated rooms. Almost all violations occurred at low to mid-low frequencies. Our results suggest that large-scale implementation of user-operated audiometry outside traditional audiometric rooms is possible, at least under some realizable conditions. Circumaural headphones’ attenuation is probably a necessary condition for all cases. Depending on the room, an online system making decisions based on ambient noise might also be included in combination with active attenuation.

To investigate whether hearing-aid fitting based on user-operated audiometry is non-inferior to hearing-aid fitting based on traditional audiometry. This non-inferiority randomised clinical trial, took place at Odense University Hospital, Odense, Denmark. In a first visit, participants were tested with traditional audiometry as well as user-operated audiometry and filled in the Speech, Spatial and Qualities of Hearing Scale (SSQ12) at baseline. Next, they were randomly divided to receive hearing aids fitted based on either the user-operated (UAud group) or the traditional audiometry (control group) hearing thresholds. After three months of hearing-aid use, participants underwent an aided hearing-in-noise test and completed the SSQ12 again, as well as an additional battery of outcome measures. A total of 215 adults with sensorineural hearing impairment referred for bilateral hearing-aid fitting. The before-after change in SSQ12 total scores was not different between the groups as the interaction between test times and groups was -0.06 (95% CI -0.56 to 0.44, p = 0.811). The findings suggest that the HA effectiveness in the UAud group was non-inferior to those observed in the control group. This implies that integrating user-operated audiometry into the clinical system is feasible, offering potential personnel time savings without compromising patient outcomes. The trial was registered at ClinicalTrials.gov (NCT05043207).

User-operated audiometry faces multiple barriers. One of these is the concern of audiologists that patients (non-experts) placing headphones by themselves results in invalid hearing thresholds due ...