Abstract
Background: High prevalence of hearing loss and its physical, mental, and social impacts when unaddressed underscore a need for early identification. However, in-person hearing assessment may be inaccessible in certain countries and areas. As such, numerous smartphone-based and web-based applications (apps) have been developed to perform remote hearing assessment, and yet many of them remain unvalidated. Purpose: The purpose of this study was to evaluate the performance, ecological validity, and usability of two freely available smartphone-based hearing assessment apps-Hearing Test (Android) and Mimi Hearing Test (iOS)-alongside a web-based app, MDHearing Aid. Research Design: This is a cross-sectional validation study. Study Sample: This study included 60 adults with hearing thresholds no greater than 20 dB HL or any degree of sensorineural hearing loss. Data Collection and Analysis: Participants completed standard audiometric testing followed by assessments using three apps in a controlled laboratory setting. The assessments were repeated by participants at home the subsequent day. The mHealth App Usability Questionnaire (MAUQ) was administered to evaluate the apps' usability. Performance metrics included sensitivity, specificity, accuracy, and test-retest reliability. Intraclass correlation coefficient (ICC) estimates were calculated to measure the apps' accuracy, test-retest reliability, and ecological validity. Results: All apps had moderate to good sensitivity (0.67-1.00) and specificity (0.72-0.99). The Hearing Test app showed poor accuracy at lower frequencies (ICC: 0.24-0.53) and moderate to good accuracy above 1000 Hz (ICC: 0.74-0.83). The Mimi Hearing Test showed poor accuracy at lower frequencies (ICC: 0.27-0.50) and moderate to good accuracy above 2000 Hz (ICC: 0.68-0.85). The web-based MDHearing Aid test showed moderate to good accuracy across frequencies (ICC: 0.64-0.85). All apps had moderate to excellent test-retest reliability (ICC: 0.66-0.99) and showed poor ecological validity below 500 Hz (ICC: 0.20-0.51) and moderate to excellent ecological validity above 1000 Hz (ICC: 0.54-0.95). Usability was rated highly across all apps, with MAUQ scores ranging from 5.4 to 5.9 out of 7. Conclusions: The examined apps exhibit varied accuracy levels and generally reasonable sensitivity, specificity, test-retest reliability, ecological validity, and usability. With additional validation, the Hearing Test app may be useful for hearing screening and monitoring in adults. There is a necessity for further research to unlock the examined apps' full clinical potential.