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可提升听力保健服务的可及性与使用率。本综述为目前规模最全面的相关研究，旨在达成三大目标：（一）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；（二）确认所评估的工具是否已在同行评审出版物中得到验证；（三）报告现有验证数据的准确性。本研究方案已在国际系统评价与元分析方案注册平台（INPLASY）完成注册，并严格遵循《范围综述PRISMA扩展声明》（PRISMA-Extension for Scoping Reviews）进行报告。最终共有187款远程听力评估工具（涵盖纯音、语音、自我报告或三者结合的检测方式）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层面存在显著差异。其中仅22款（占比12%）工具已在同行评审出版物中得到验证，且仅有14款工具的功能符合可接受标准。验证结果及其质量差异悬殊，这在很大程度上取决于工具所属的类别。绝大多数工具的准确性与可靠性尚未明确。生成纯音的工具可估算听力阈值，但存在校准问题与背景噪声干扰。语音类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。通过经过滤波处理的非语言依赖性材料来预测纯音听阈图，或许可成为通用的解决方案。