Developingcountries(LMICs)havetheworld?shighestprevalenceofdisablinghearingloss,but hearinghealthcareservicesareoftenunavailable,sparseandsporadic.Asolutiontothisneed- supplymismatchmaybetheincreasingpenetrationofsmartphonesthatwehypothesizeare capableofdeliveringaself-containedsolutiontothemostcommonformsofdisablinghearing loss.IntheRepublicofSouthAfrica(RSA),forexample,nearly80%ofthepopulationhave accesstoasmartphone.OnWorldHearingDaythisyear,anational,freehearingtestinthe formofasmartphoneapp(hearZA)waslaunchedinRSAwith>7000teststakeninthefirst week.HearZAdeliversadigits-in-noise(DIN)testbinaurallyinjust3minutesthathasbeen validatedagainst?better-ear?conventionalaudiometry(sensitivity,specificityboth>90%).The appallowsthosefailingthetesttorequestacontactfromtheirclosestaudiologist.DINtests providesuccessivespeechstreamsofthreedigits(0-9)adaptivelydeliveredagainstabroad- band(?white?)noise.Theyarereliableandmaybeself-administeredwithoutasoundboothby enteringthedigitsheardonthesmartphonekeypad.Thepurposeoftheproposedresearchisto developfurtherfunctionsforhearZAenablingenhancedassessment,advice,andasimulation ofthebenefitthatamplificationcouldprovide?allonthesamesmartphone.
The aims ofthe researchare(i)toimprovedetectionofhearingloss,includingunilateralhearingloss,without increasingtesttime.Thiswillbeachievedusinginteraurallyantiphasicdigitstimuli;?(ii)to increasesensitivitytohearinglossusinghighpassnoisefiltering,andtointroducemonaural, follow-uptesting;?(iii)tosupportreferralbyaddingashortquestionnaireanduptakeof interventionsusinganin-appdecision-supporttool;?and(iv)todeterminethebenefitofcarefully selectedsimulationsofamplificationandnoisereductionavailableassmartphone?personal soundamplification?apps.Benefitwillbedeterminedusingbothobjectivetestsofhearingin noiseandpatient-centeredbenefitassessment.Multinomialregressionmodelingwillrelate resultsacrosstheaims.ThesuccessofhearZAdemonstratestheresourcesavailableinRSAto makethisproposalwork.Althoughapplicableworldwidetoallsmartphoneusers,thisapproach isuniquelysuitedtoLMICsbecauseofthelackofalternatives.CollaborationwithotherLMICs inAfricaandelsewhereisalreadyunderway.

Public Health Relevance

LMICshavetheworld?shighestprevalenceofdisablinghearingloss,butthelowestpenetration ofhearinghealthcareservices.Smartphoneshavethepotentialtobeaself-?containedsolution tothismiss-?match.Thisresearchwilladdfunctionsalongthecarepathwaytoasuccessful smartphoneapp,hearZA,thatcanalreadydetecthearinglosswithhighsensitivity.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21DC016241-01
Application #
9338942
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Miller, Roger
Project Start
2017-07-01
Project End
2019-06-30
Budget Start
2017-07-01
Budget End
2018-06-30
Support Year
1
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Cincinnati Children's Hospital Medical Center
Department
Type
DUNS #
071284913
City
Cincinnati
State
OH
Country
United States
Zip Code
45229