2. Accuracy Testing of iPhone Application for Hearing Screen Meredith Peck Communication Sciences and Disorders April 22, 2016

3. Research Question The purpose of this research project was to test the accuracy of an iPhone app for hearing screening. In other words, does the app play the proper pure tones for both pitch (frequency) and loudness (intensity)?

4. Pure Tones Frequency o Perceived as pitch o Measured in Hertz (Hz) Intensity o Perceived as loudness level o Measured in decibels (dB) 500 Hz Pure Tone 4000 Hz Pure Tone

5. Background Information HEARING LOSS ON A GLOBAL SCALE 1 of 8 most prevalent health conditions worldwide 276 million affected by a moderate or severe hearing loss 361 million individuals have a mild hearing loss

6. THE IMPACT ON HEARING LOSS Feelings of depression and isolation Language acquisition for children Cognitive decline for adults Background Information

7. SCREENING FOR HEARING SLP screen includes three pure tones that are acoustically important for speech Screen results equate in PASS or REFER If referral, audiologists complete full hearing evaluations, including threshold testing Background Information

8. First Years. (2011, September). How to read an audiogram: Auditory thresholds.

9. GROWTH IN TECHNOLOGY In 2015, TechCrunch reported 2. 6 billion smartphone subscriptions globally. Background Information TechCrunch. (2015, June 2). 6.1B smartphone users globally by 2020, overtaking basic fixed phone subscriptions.

10. Potential Implications for App If this hearing screen app is accurate, it can be used: o In rural areas o As educational tool o For prevention o More cost effective If this hearing screen app is not accurate, people might falsely believe in hearing loss

11. Hearing Test with Audiogram app Note: app is no longer available in iTunes

12. How do we know what intensity and frequency tones should be presented? SHLS graduate clinician performing hearing screen with audiometer

13. Comparison Data Frequency of Tone (Hz) ANSI Tolerance Range (Hz) ANSI Tolerance Range (dB SPL) 250247 – 253+/- 3.0 500495 – 505+/- 3.0 1000990 – 1010+/- 3.0 20001980 – 2020+/- 3.0 40003960 – 4040+/- 3.0 80007920 – 8080+/- 5.0 ANSI = American National Standards Institute

14. Close up of oscilloscope Sound level meters Oscilloscope microphone iPhon e Close up of oscilloscope Sound level meters Oscilloscope microphone iPhon e Close up of oscilloscope Sound level meters Oscilloscope microphone iPhon e Methods

15. Results Level 75 ToneFrequency (Hz) Intensity (dB SPL) 1 (1000 Hz) 1,02570 2 (2000 Hz) 2,016*75* 3 (4000 Hz) 4,000*75* 4 (8000 Hz) 7,937*77* 5 (250 Hz) 25544 6 (500 Hz) 505*61 * Indicates value falls within the ANSI tolerance range

16. Results Level 100 ToneFrequency (Hz) Intensity (dB SPL) 1 (1000 Hz) 1,02086 2 (2000 Hz) 1,984*92 3 (4000 Hz) 3,968*92 4 (8000 Hz) 7,937*94 5 (250 Hz) 250*55 6 (500 Hz) 51075 * Indicates value falls within the ANSI tolerance range

17. Limitations o Location had ambient noise in room o Study utilized speakers, rather than ear phones o iPhone is not ANSI calibrated o iPhone app is no longer available to public

18. Future Research Use sophisticated equipment/environment Use of ear buds versus speakers Compare multiple applications

19. The “Hearing Test with Audiogram” application does not present all tones within prescribed tolerance levels for both frequency and intensity.Conclusion

20. Implication This research study shows that the “Hearing Test with Audiogram” app should not be used to screen for hearing.

21. Questions?

22. Acknowledgments Dr. Michelle Parry Dr. Lissa Power-deFur Dr. Mani Aguilar Kelley Chaney Erin Weisenberger DEC for printing

23. References Ferguson, M. (2012). Delivery of hearing healthcare and education using the Internet. ENT & Audiology News, 21(3), 68-69. Gordon N. Stowe and Associates, Inc. (2012). Understanding your Calibration Certificate (1059). LouderTV. (2012). Hearing Assistance on iPhone 3GS/4/4S, iPod Touch, iPad: Accuracy of the hearing test. Retrieved from http://loudertv.blogspot.com/2012/07/accuracy-of-hearing- test.html Martínez-Pérez, B., de la Torre-Díez, I., & López-Coronado, M. (2013). Mobile health applications for the most prevalent conditions by the World Health Organization: Review and analysis. Journal of Medical Internet Research, 15(6).