Web- and app-based tools for remote hearing assessment: a scoping review

Remote hearing screening and assessment may improve access to, and uptake of, hearing care. This review, the most comprehensive to date, aimed to (i) identify and assess functionality of remote hearing assessment tools on smartphones and online platforms, (ii) determine if assessed tools were also evaluated in peer-reviewed publications and (iii) report accuracy of existing validation data. Protocol was registered in INPLASY and reported according to PRISMA-Extension for Scoping Reviews. In total, 187 remote hearing assessment tools (using tones, speech, self-report or a combination) and 101 validation studies met the inclusion criteria. Quality, functionality, bias and applicability of each app were assessed by at least two authors. Assessed tools showed considerable variability in functionality. Twenty-two (12%) tools were peer-reviewed and 14 had acceptable functionality. The validation results and their quality varied greatly, largely depending on the category of the tool. The accuracy and reliability of most tools are unknown. Tone-producing tools provide approximate hearing thresholds but have calibration and background noise issues. Speech and self-report tools are less affected by these issues but mostly do not provide an estimated pure tone audiogram. Predicting audiograms using filtered language-independent materials could be a universal solution.远程听力筛查与评估或可提升听力保健服务的可及性与接受度。本次综述为迄今最全面的相关研究，旨在：① 识别并评估智能手机与在线平台上的远程听力评估工具的功能特性；② 确认所评估的工具是否已在同行评议出版物中得到验证；③ 报告现有验证数据的准确性。本研究方案已在INPLASY注册，并按照《系统综述与元分析优先报告条目扩展版：范围综述》（PRISMA-Extension for Scoping Reviews）进行报告。最终共有187款远程听力评估工具（采用纯音、语音、自我报告或组合方式）以及101项验证研究符合纳入标准。每款工具的质量、功能、偏倚风险与适用性均由至少两名研究者独立评估。所评估的工具在功能上存在显著差异。其中22款（占比12%）工具已通过同行评议，14款工具的功能表现符合要求。验证结果及其质量差异悬殊，很大程度上取决于工具的类别。绝大多数工具的准确性与可靠性尚未明确。采用纯音生成的工具可提供近似的听力阈值，但存在校准与背景噪声干扰问题。语音与自我报告类工具受上述问题影响较小，但大多无法生成估算的纯音听阈图。采用经过滤波处理的非语言依赖性材料来预测听阈图，或可成为通用解决方案。