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The new age of play audiometry: prospective

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Alokh Ramachandran

on 3 October 2013

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Transcript of The new age of play audiometry: prospective

The new age of play audiometry: iPad-based play

Pure tone audiometry in children
Pure-tone audiometry, regardless of automation is a mundane task.
It is especially challenging to perform in the pediatric population where short attention span and the extent of cognitive development can be limiting factors.
Children with hearing impairment
may find audiometric testing even more difficult.
Definitive diagnosis of hearing loss is typically made through audiologic assessment of pure-tone air, bone
and speech thresholds.
Traditionally, pure-tone thresholds
are documented by asking the subject if they can hear tones of varying frequency and intensity.
While auditory brainstem reflex and otoacoustic emissions testing remain the gold standard of hearing assessment, these investigations pose some difficulty in children.
Our data suggests that using the tablet interactive audiometry method, the majority (82%, 70/85) of children
as young as 3 years of age are capable of understanding the concept of the game and completing the
hearing assessment.
In fact, 4 of the 15 patients were unable to complete the assessment due to a technical issue related to the audiologist.
Despite the supervision of an audiologist however, some children had difficulties with the tablet
audiometer. These difficulties resulted from technical deficiencies of the hardware/software (i.e. attempts to
open other software, failure to understand ‘drag and drop’, becoming distracted by visual re-enforcements) and
behaviors of the patient (i.e. boredom, poor comprehension of the game).
A number of these difficulties eventually lead to the subject being excluded from the statistical analysis.
Failure to complete the assessment also appeared to be more prevalent in children with abnormal hearing.
It is not surprising then that portable tablet computers have been widely embraced in healthcare and education.
Thus, the tablet operating system appears to the optimal environment in which to develop portable, automated diagnostic applications targeted at children.
The timely diagnosis of hearing loss in the pediatric population has significant implications for a child’s

However, audiological evaluation in this population poses unique challenges due to difficulties with
patient cooperation. The existing technology is time consuming and costly.
The objective of this study is to validate an iPad-based play audiometer that
addresses the shortcomings of existing audiometry.
Techniques to make this possible include :
Behavioral observation
Visual re-enforcement
Conditioned play audiometry.
Resource utilisation
Require two specially trained audiologists to administer.
Naturally, an
ideal solution would capitalize on the advantages of
automation, while maintaining clinical validity and age
The purpose of this study is to
(1) determine the accuracy of audiometric thresholds obtained by tablet audiometry compared to the accepted standard, conditioned play audiometry in children; and
(2) describe our experiences with administering an iPad-based hearing assessment in the pediatric population.

Interactive audiometry is a novel paradigm in the assessment of hearing thresholds, in which the patient controls the presentation and pace of sound stimuli, rather than the audiologist.

The tablet play audiometer is engineered as a decision-tree interactive game (yes/no
paradigm) or as a two alternative forced choice interaction.

The two-alternative forced choice test paradigm
is a psychophysical method for eliciting responses
from a person about his or her experiences of a stimulus whereby the user is only given two possible responses..
Tablet Audiometer
In this “game”, the child is only given one container and is tasked to drag the object into this container when it produces a sound.
Each sound producing object plays a unique warble-tone at either 500, 1000, 2000 or 4000 Hz.
The intensity of sound decreases with each presentation until the child is unable to reproducibly
sort the objects.
Subsequently, the intensity of the sounds is increased.
Once all frequencies
are tested, a standard audiogram is obtained.
The goal of the research is to develop a portable, versatile clinical audiometer designed for children. This study is the first to validate an automated play audiometer designed specifically for the pediatric population.
The device has a strong predictive value for normal
hearing and is highly sensitive for hearing loss. Finally, our results demonstrated that the tablet audiometer is a viable platform for testing children as young as 3 years of age.
Future Scope
Future directions will focus on gameplay refinement
and test-retest reliability.
Thank you!! ;)
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