Are conversation and whispered voice hearing tests comparable to pure tone audiometry for assessment of hearing loss? A retrospective analysis.

Background: Pure tone audiometry (PTA) is considered the standard method of hearing assessment. However, technical and logistical challenges preclude its usage for hearing screening at primary healthcare facilities. Free field hearing (FFH) tests such as conversation voice (CV) and whispered voice (WV) tests have been used for hearing assessment. However, their correlation to PTA and accuracy in detection of hearing loss are doubtful. This study aims to determine if FFH tests can be used for estimation of hearing thresholds.
Methods: A retrospective analytical study was conducted at the otorhinolaryngology department. Spearman's correlation coefficient ( ρ ) was determined between FFH recognition distance and average air conduction PTA thresholds. A statistical regression model was developed to estimate hearing thresholds from the FFH recognition distance. The FFH tests were studied for their accuracy in detection of hearing loss.
Results: The audiometric records of 437 persons (874 ears) were analysed. The CV and WV tests were found to have a high correlation ( ρ  = -0.757 and -0.758, respectively) with average PTA thresholds in persons with hearing loss. The WV test was found to have a 94.7% sensitivity, 90.8% specificity, 97.6% positive predictive value, 80.9% negative predictive value, and 93.9% accuracy in detection of hearing loss.
Conclusion: FFH tests such as WV test can be used to estimate the hearing thresholds and screen for hearing loss when audiometric tests are not logistically feasible, such as at primary-level healthcare facilities, remote locations, and in schools. However, such tests should not be regarded as a substitute to PTA.
Competing Interests: All authors have none to declare.
(© 2023 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)