Tuned’s highly researched and curated online audiological battery is as accurate as an online test battery can be at this time. We offer patients a complete a hearing workup consisting of robust questionnaires to catch red flags (a need for referral) as well as to gain insight into the patient’s history, a pure tone threshold screening test (validation is in progress), and a well-validated Digits-In-Noise (DIN) test (Potgieter et al., 2016 & Potgieter et al., 2018).

The online DIN is strongly associated with the 4- frequency (.5, 1, 2 and 4 kHz) pure tone average (PTA) and can provide complementary info on speech recognition difficulties in noise. Additionally, it shows high accuracy using a variety of transducers making it uniquely suited to serve as part of an online hearing test battery. The DIN is used by the World Health Organization mobile hearing screener app hearWHO (Swanepoel et al., 2018).

Theoretically, self-administered, online hearing tests can be conducted with promising accuracy (Honeth et al., 2010 & Masalski & Kręcicki, 2013) Practically speaking, however, online hearing tests are a work-in-progress. Countless exist, although very few have been validated, and of those, the validation studies have not produced strong evidence (Irace et al., 2021). Regarding threshold of hearing tests, we are constrained by physics. Unless we know the transducer sensitivity (how it converts voltage into SPL) as well as the device (laptop, mobile phone, tablet etc.) audio output level, we are unable to properly calibrate the system, thus unable to accurately obtain true dB HL levels. Research has shown that up to 22 dB differences between transducers exist (Zanet et al., 2021) , and there may be even greater differences as the work didn’t analyze pure tones. However, online hearing screeners, combined with other, supra threshold tests (like a speech-in-noise test) and questionnaires can provide a reasonable baseline from which we can provide valuable care, make device recommendations (most of which have embedded, calibrated hearing tests), and identify and refer patients with red flags.

We know that one day the calibration issue will be mitigated. Telehealth and teleaudiology is, fortunately, here to stay, and many new, hearing-device and audiology-oriented companies, many of which have teams of expert audiologists on board, have released their own online hearing tests with creative approaches to calibration. One test requires a person with normal hearing thresholds to complete the test first so that 0 dB HL is approximated. Another test attempts to calibrate by comparing a recording of hands rubbing together to your own hands rubbing together. A computational audiology group even tackles these challenges using AI, machine learning and big data. Perhaps some people out there are inventing new tests that have not been used in the clinic before (if that’s you, let’s talk!) We will get there, because there is a need for being able to properly diagnose patients’ hearing profiles from afar whether due to location, physical, time or financial constraints. Meanwhile, the calibration issue is a serious one, so let’s keep in mind that the threshold tests are screeners and it is never wrong to recommend that a patient obtains an in-person, pure-tone audiogram for detailed information.

The purpose of evaluating hearing is to determine 1) if the patient has a medical condition that can be diagnosed and potentially treated, 2) the degree of hearing loss a patient has, and 3) recommendations for patient (whether those recommendations pertain to hearing loss, hearing loss prevention, tinnitus, hyperacusis, or something else entirely), and 4) to use as a counseling tool. With Tuned, we have created a robust Work Up that aims to meet all of these goals.

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