Audiometric Analysis in Mobile Hearing Screening Clinics

Mobile Hearing Screening Clinics

1. Introduction

Mobile Hearing Screening Clinics; With the increase in lifespan and the better understanding and recognition of the signs of disabling diseases, global socioeconomic reality has changed. Among the most common disabling diseases in the 21st century and which represent major concerns in public health policies are those that are related to hearing and communicational problems. Hearing loss affects at least 250-600 million people, and it is the second most frequent cause of severe disability in the world. In Brazil, data from the Ministry of Health show that the leading cause of hearing loss that is preventable and modifiable is the exposure to noise at work and outside of work. In 1997, the Brazilian National Congress passed law 9431/1997 that made deafness a mandatory notification disease, raising the possibility of prevention and early diagnosis so that appropriate and effective therapies may be established.

Just as it happens with other diseases, for hearing impairments, early diagnosis and follow-up may be the best way to preserve the patients’ quality of life. Preventive care and health promotion have been important topics in public health policies. They are also a reality in many countries, where Mobile Hearing Screening Clinics have been performing hearing screening tests and raising awareness for hearing diseases for some years. Nevertheless, it is observed that there are several limitations in applying the hearing screening tests available for the adult population, as well as the infrequency of hearing tests in adolescence aged between 11-19 years old. High-pitched hearing loss or hypoacusis, usually, is an imperceptible disorder by the affected individual because it develops slowly, influencing the patient’s life at a slow and unattended rate.

2. The Importance of Hearing Screening

Hearing is essential for young children because they must develop their spoken-language skills within the critical period of infancy and early childhood. Children with congenital hearing loss who do not receive timely intervention will experience deficits in communication, reading, academic maturity, and social adaptation. The constraints children experience in language development will be nearly invisible to most unless they are fortunate enough to be screened and identified very early, and are very closely monitored. Only later, when it is nearly impossible to catch up on the lost language, will these invisible constraints be reliably identified.

The United Nations Convention on the Rights of the Child promotes the right of the child “to express its views freely in all matters affecting the child, the views of the child being given due weight in accordance with age and maturity of the child.” The first step of this process is allowing the child to hear and form its language abilities. People of all ages, especially those in harsh working conditions, should be screened and recommended for follow-up medical care regularly by mobile hearing screening clinics. The information gathered by geographically deployed technology should not only determine risk, but help educate and identify affected individuals who can utilize such information to improve their and others’ quality of life.

3. Mobile Hearing Screening Clinics

Even though all the risks and dangers are well known, it is a sad fact that many people do not take their hearing health seriously until very late in their life, often even after they have experienced severe someone describing the situation when asked, simply says: ‘My hearing is okay’, whereas some other people agree to have their hearing tested but do not follow the recommendations for a proper follow-up of the test results. Somewhat more success seems to be achieved with people who do not have regular access to medical specialists and are willing to use mobile health clinics. It is known that various illnesses and diseases cannot be cost efficient? Not all possible tests can be included in a single screening service, so the choice of tests is very important. There are several levels of hearing screening procedures: from very comprehensive, according to the latest accepted recommendations, to as basic as only answering a few questions. As far as audiometry is concerned, measurements based on pure tones have proven to be the most reliable, so the test should include, at least, the acquisition of pure tone thresholds.

3.1. Advantages of Mobile Clinics

Traditional methods for the assessment of hearing, diagnosis, and treatment of those suffering from hearing loss worldwide are restricted by limitations of workforce, infrastructure, knowledge, and experience. There is a growing recognition that more cost-effective and technically robust clinical and early screening services are needed in all settings to provide appropriate intervention in order to address the use of hearing technology.

Mobile hearing screening clinics are probably the only suitable option for rural areas. Mobile hearing screening clinics have been conducted internationally, particularly in communities where tinnitus was prevalent, to assess hearing loss using self-report questionnaires, otoscopy, and audiometric tests. However, most of these studies assess the benefits of mobile screening clinics and did not consider the implications of haircuts and environmental sound restrictions in the testing bus areas. Despite the collected ethanol solution, there are no strict cleaning procedures between participants, and alcoholic wipes are used to clean the insert earphones.

The operation of traditional hearing screening clinics consumes time and labor. The measurements made by researchers are noisy and of poor quality given the behavior and low compliance of the children and the testing time. The development of novel audiology practices offers a potential solution that can handle some of these barriers to achieve the aim of reaching those in need.

It uses up-to-date equipment and techniques to rapidly diagnose or monitor the full spectrum of hearing loss. During mobile hearing tests, some patients were screened to determine if they needed further assessment and received prompt advice on the next steps. Mobile hearing testing is ideal for preschool children, given that schools and daycare centers are covered. Any individual wanting to check on their hearing and those employed in businesses are also vulnerable to hearing loss. Each step of mobile hearing testing and data collection, analysis, and assessment is controlled and streamlined by high-quality health systems. Each data audit improves the quality and structuring of the testing clinic while challenging the limits of the mobile clinic and weighted audiometric data.

3.2. Challenges and Limitations

Mobile hearing screening programs are designed to screen personnel in various types of lay and religious organizations, schools, and day care centers. Screening in mobiles presents challenges not experienced in hospitals or other fixed locations. Proper sterilization would not be practical, and participants would interact with various sources of contagion. Participants could also directly receive the test results and take necessary action (for those who receive objective tests that require no interpretation). Time and noise limitations exist in screening trucks, increasing the complexity of choosing a valid test. Another challenge is the small percentage of participants with hearing loss. Initial screening was designed to identify those with a hearing loss, while only a small number of participants would then be sent to take a more comprehensive assessment that would require audiology center resources.

Some participants may have mild loss of normal hearing or temporary hearing loss that does not justify further evaluation with an extensive test. Validating two-stage data usage is discussed in Section 3.4. Previous studies have investigated people willing to visit a primary care center for evaluating hearing complaints. However, the characteristics of people who voluntarily seek mobile hearing screening testing have not been studied. Studies of data obtained during the screening survey are rare.

4. Audiometric Testing

Four different tests are performed at each of the four frequencies (500, 1000, 2000, and 4000 Hz) during audiometric testing using different methods to decrease the confounding effect of learning during audiometry testing and to avoid the order effect of the tests. These tests are as follows: (1) pure tone hearing thresholds (HTs) at 500, 1000, 2000, and 4000 Hz, where a subject’s hearing is assessed by increasing the intensity of the stimulus in each ear from 0 dB HL as presented in brackets in the following tests up to maximum loudness detection; (2) conditioned play audiometry (CPA); (3) speech recognition thresholds (SRTs) and speech recognition percentages of the spondees called SRS (in brackets, 0 dB indicates that the method used to present speech is monitored via the audiometer to avoid any inter-stimulus noise in balancing test while the presentation level is 0 dB SL); and (4) speech discrimination scores (SDS at 40 dB SL).

A maximum testing limit of 20 dB HT is set for all four audiometry tests at each frequency. If test results exceed this limit, this illustrates an abnormal HT response. All these tests are performed with the subjects’ earphones. A step size of 10 dB or 10 dB is utilized in all pure tone threshold assessments. This measurement limit is, however, not quantified in the clinical audiometry procedure that is commonly used, while most hearing tests aim to assess the entire 15 dB HT per frequency (similar to that used in other mobile hearing screening clinics, for example). This study has discovered a maximum testing cap of 20 dB HT for mobile hearing screening clinics.

4.1. Pure Tone Audiometry

Pure tone audiometry (PTA) is based on the technique of assessing the subject’s hearing level by the presentation of pure tones. A standard reference audiometry test normally uses pitch frequencies in the auditory regions commonly occurring in human speech. These regions are 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz. By comparing the subjects’ hearing level outcome of the wave obtained from the auditory stimuli with the standard reference level known as normal speech, the test not only provides an indication of the level of auditory gain the subject has, but also forms an illustration of the auditory health of the subject in comparison to a known reference. By comparing the subjects’ hearing levels with corresponding standard references, insights on the level of possible treatment could be established.

The examined air conduction thresholds are the pure tone averaging of both ears at the following audiometric levels in dB HLs: 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz. A screener, comprising of an audiometer, computer, and an audiometry application software is used to test for hearing levels at a pre-selected test booth, without any trained healthcare professional intervention. The various testing components and procedures are illustrated in Section IV. Device Development and Customizations within the Screening Model Introduced. The results are then directly passed forward to the hearing specialist in a more detailed checkup in the mobile clinic, minimizing the consultation time in the clinic. The result is an audiometric analysis outcome known as an audiogram, which records the hearing level at each frequency. Data obtained within the mobile screening clinic is then posted to a mobile clinic server as soon as the screening activity concludes, paving the way for post-screening treatment activities.

4.2. Speech Audiometry

Clinical information is derived not only from audiometric testing but also from speech audiometry. These tests are included for familiarization. In future versions of this clinic, they will be conducted under controlled environmental conditions. Given the limitations of the bus environment and time constraints, they may not be conducted as often as other audiometric examinations, except under specific circumstances. These circumstances occur most frequently in cases where the outer hair cells (OHCs) are affected, leading to speech discrimination test confirmation or in cases of difficulties experienced by the audiologist in reaching a diagnosis.

The RU76 combined with the complex speech signals provides detailed information on the type of auditory impairment by offering an additional check for differential diagnostic purposes. This combined possibility is rarely used; however, others did follow-up concerning speech reactions to confirm an audiometric diagnosis. The first of these studies was completed in 1945 to check for the auditory impairment of mine workers using speech frequencies of 40 executives with secretion-related hypoacousis. The authors incorporated a speech power-to-tone audiometry speech hearing loss detection index, which led to the initial development of the 55-DB detection limit for speech power audiometry.

5. Data Management and Analysis

Data analysis programming involved a series of operations that identified the target population, analyzed the absolute hearing loss, and conducted a quality assurance check. In addition to strictly necessary amplitudes as indicated by threshold respondents, the relative frequencies corresponded to cumulative percentile hearing loss were calculated based on the population norm for each audiometric frequency. Because the cumulative percentile relative frequencies characterize the populations but not the specific individuals in it, we expect distributions of ear-specific values which define the presence of hearing impairment by its designation as an organic descriptor of threshold-shifted populations. The temporary settings for this definition indicated that within differing location contexts, specific mobile ROC units served mobile hearing screenings which served augmentative lightweight purposes plus augmentative lightweight referrals for significant threshold elevations. Practical applications suggest that access to the comprehensive information locally will further define the populations, determine the need for and availability of incentives, and plan eligible audiologic examination location requirements for identified NHAs. Discrete data analysis capabilities reflected flexible, economical, and non-comfortable or non-interference characteristics. This paper showed the results of the programmed routine for real screening data and estimated annual data.

5.1. Digital Audiograms

Audiograms are the key measure of hearing and are the gold standard for documenting and quantifying hearing disorders. The audiogram is measured by a sequential procedure employing specific tonal stimuli with the patient actively responding with a physical response. This “occupational” constraint of audiological testing is the primary source of costs and inconvenience in hearing health care. However, in a research or screening setting and as for other clinical tests, the process can be standardized, automated, and performed using information technology. Using a computer and responding using a computer interfaced keyboard allow testing to be faster and more efficient. The data generated further offers the possibility of database management, review, and analysis.

New low-cost computer solutions for the audiometric analysis process are making the audiogram test much more easily applied for important public health applications that have not been previously possible. The research and evaluation of hearing in essential applications in human and public health, particularly for children, depend on this new approach that extends the audiogram test protocol to lower ages, greater diversity of populations, more levels of assessment, and increases in terms of sensitivity, specificity, and accuracy to generate evidence that shows that hearing health care is working and or where it is not. Today, the observation of the condensation, organization, ours is for institutional control, monitoring and evaluation, data quality, and privacy to serve the public semantic web of science and technology, explore the visualization for policy, education, information, and outreach.

5.2. Statistical Analysis Techniques

As a starting point, descriptive measures including tabulation, measures of central tendency, dispersion, and correlation analysis will be conducted to explore the univariate distribution of the various related themes, as well as pairwise associations within these data. The mean, median, standard deviation, range, and frequency tables will be tabulated accordingly. For bivariate and higher order associations such as gender and age, right and left ear screening outcomes, and further questions and objectives presented, tests such as Pearson’s chi-squared test and logistic regression will be carried out, using the software to conduct all statistical analyses. The alpha level of significance was set to p < 0.05 and 95% confidence intervals (CI) were calculated where applicable. Due to the exploratory and hypothesis-generating nature of these data, no interventions or experimental testing for hypothesis will be carried out, and no a priori sample size calculations were conducted.

6. Future Directions and Innovations

In conclusion, this paper reviews the present landscape in community hearing screening, heralding a promising future. Presently, there is a landscape replete with unstandardized tests, executed in unstandardized clinic formats. This flock of noisy gadgets requires the intervention of an audiologist for manual administration, scoring, and interpretation of several tests of differing design. This approach carries the promise of inconsistency, errors in interpretation, and poor sensitivity and specificity. Standard audiological practice uses audiologists to administer validated tests. We interpret these results on the basis of combined outcome display. Only now, hearing screening is likely to move into the modern digital age occupied by telehealth, e-health, m-health, wearables, IoT, AI, and potentially perform data mining, administer multi-domain health checks, and do longitudinal tracking.

The future of community hearing science is signaled by three closely posed policy questions. Firstly, could we deliver a significant upgrade in services to a population group with the lowest per capita spend and solve many of the knowledge supply problems by accommodating less rather than more information into a longer 20-min tele-audiology oversight? If the world of hearing assessment services subsequently turned out to be optimal when performed against 6 tests rather than 4, could we prescribe a follow-up in personal care services?

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