e-Health technologies for adult hearing screening

The development of hearing diagnosis methods and hearing screening methods are not isolated phenomena: they are intimately related to changes in the cultural background and to advances in fields of medicine and engineering. In the recent years, there has been a rapid evolution in the development of fast, easy and reliable techniques for lowcost hearing screening initiatives. Since adults and elderly people typically experience a reduced hearing ability in challenging listening situations [e.g., in background noise, in reverberation, or with competing speech (Pichora Fuller & Souza, 2003)], these newly developed screening tests mainly rely on the recognition of speech stimuli in noise, so that the real experienced listening difficulties can be effectively targeted (Killion & Niquette, 2000). New tests based on the recognition of speech in noise are being developed on portable, battery- operated devices (see, for example, Paglialonga et al., 2011), or distributed diffusely using information and communication technologies. The evolutions of e-Health and telemedicine have shifted focus from patients coming to the hearing clinic for hearing health evaluation towards the possibility of evaluating the hearing status remotely at home. So far, two ways of distributing the hearing test have primarily been used: ordinary telephone networks (excluding mobile networks) and the internet. When using the telephone network for hearing screening, the predominantly test is a speech-in-noise test often referred to as the digit triplet test where the subjects hearing status is evaluated as the speech-to-noise threshold for spoken digits. This test is today available in some ten countries in Europe, North America and Australia. The use of internet as testing platform allows several different types of hearing assessment tests such as questionnaires, different types of speech in noise tests, temporal gap detection, sound localization (minimum audible angle), and spectral (un)masking tests. Also, the use of the internet allows audiovisual presentations as well as visual interaction and cues in the tests for a more ecological approach. Even if several new and novel approaches for hearing assessment using the internet are surfacing, the validated tests are based on questionnaires or speech-in-noise. Although the internet allows for a broader flora of pure auditory and audiovisual tests for hearing health assessment, calibration problems such as timing uncertainty, output levels and modes of presentation (speakers or earphones) limits the usability at present.