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Introduction Remote interpretation of automated audiometry offers the potential to enable asynchronous tele-audiology assessment and diagnosis in areas where synchronous tele-audiometry may not be possible or practical. The aim of this study was to compare remote interpretation of manual and automated audiometry. Methods Five audiologists each interpreted manual and automated audiograms obtained from 42 patients. The main outcome variable was the audiologist's recommendation for patient management (which included treatment recommendations, referral or discharge) between the manual and automated audiometry test. Cohen's Kappa and Krippendorff's Alpha were used to calculate and quantify the intra- and inter-observer agreement, respectively, and McNemar's test was used to assess the audiologist-rated accuracy of audiograms. Audiograms were randomised and audiologists were blinded as to whether they were interpreting a manual or automated audiogram. Results Intra-observer agreement was substantial for management outcomes when comparing interpretations for manual and automated audiograms. Inter-observer agreement was moderate between clinicians for determining management decisions when interpreting both manual and automated audiograms. Audiologists were 2.8 times more likely to question the accuracy of an automated audiogram compared to a manual audiogram. Discussion There is a lack of agreement between audiologists when interpreting audiograms, whether recorded with automated or manual audiometry. The main variability in remote audiogram interpretation is likely to be individual clinician variation, rather than automation.

Introduction Standard criteria exist for diagnosing different types of hearing loss, yet audiologists interpret audiograms manually. This pilot study examined the feasibility of standardised interpretations of audiometry in a telehealth model of care. The aim of this study was to examine diagnostic accuracy of automated audiometry in adults with hearing loss in an asynchronous telehealth model using pre-defined diagnostic protocols. Materials and methods We recruited 42 study participants from a public audiology and otolaryngology clinic in Perth, Western Australia. Manual audiometry was performed by an audiologist either before or after automated audiometry. Diagnostic protocols were applied asynchronously for normal hearing, disabling hearing loss, conductive hearing loss and unilateral hearing loss. Sensitivity and specificity analyses were conducted using a two-by-two matrix and Cohen's kappa was used to measure agreement. Results The overall sensitivity for the diagnostic criteria was 0.88 (range: 0.86-1) and overall specificity was 0.93 (range: 0.86-0.97). Overall kappa ( k) agreement was 'substantial' k = 0.80 (95% confidence interval (CI) 0.70-0.89) and significant at p < 0.001. Discussion Pre-defined diagnostic protocols applied asynchronously to automated audiometry provide accurate identification of disabling, conductive and unilateral hearing loss. This method has the potential to improve synchronous and asynchronous tele-audiology service delivery.

Objective: Examine the accuracy of automated audiometry in a clinically heterogeneous population of adults using the KUDUwave automated audiometer., Design: Prospective accuracy study. Manual audiometry was performed in a sound-treated room and automated audiometry was not conducted in a sound-treated environment., Study Sample: 42 consecutively recruited participants from a tertiary otolaryngology department in Western Australia., Results: Absolute mean differences ranged between 5.12-9.68 dB (air-conduction) and 8.26-15 dB (bone-conduction). A total of 86.5% of manual and automated 4FAs were within 10 dB (i.e. ±5 dB); 94.8% were within 15 dB. However, there were significant (p < 0.05) differences between automated and manual audiometry at 250, 500, 1000, and 2000 Hz (air-conduction) and 500 and 1000 Hz (bone-conduction). The effect of age (≥55 years) on accuracy (p = 0.014) was not significant on linear regression (p > 0.05; R(2) =( ) 0.11). The presence of a hearing loss (better ear ≥26 dB) did not significantly affect accuracy (p = 0.604; air-conduction), (p = 0.218; bone-conduction)., Conclusions: This study provides clinical validation of automated audiometry using the KUDUwave in a clinically heterogeneous population, without the use of a sound-treated environment. Whilst threshold variations were statistically significant, future research is needed to ascertain the clinical significance of such variation.