Caution with app-based hearing self-tests with vulnerable populations: preliminarily findings of digits-in-noise (DIN) testing vs. pure tone audiometry (PTA) in a rural, low-resource outreach clinic in Huruma, Tanzania

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Background Shortages in Ear and hearing care (EHC) workforce, including audiologists, is one of the leading barriers to accessing EHC in LMICs. App-based hearing assessment tools have been developed to help bridge this gap by providing low-cost access to hearing screening. A review of hearing assessment apps reported sensitivity values ranging from 0.982 to 1.00, however, studies focussed on high income populations. The hearWHO app uses Digits in Noise (DIN) testing to indicate speech recognition thresholds (SRTs). Since its launch in 2019 it has been used extensively around the world, however, uptake has been comparatively low in the global south. This study aimed to explore the utility of the hearWHO app in a low resource setting in rural Tanzania. Methods A total of 52 patients self-presented to ear, nose and throat (ENT) outreach clinics with ear related problems over a 3-day period in Huruma hospital in the Rombo district of Tanzania. All patients underwent clinical history and examination with 29 additionally completing pure tone audiometry (PTA) and an app-based digits in noise (DIN) hearing test, using the HearWHO app. Results Overall diagnostic performance was modest, with a sensitivity of 0.45 and specificity of 0.11, yielding a positive predictive value of 0.53, a negative predictive value of 0.08, and an overall accuracy of 0.35. Discussion This study raises important questions regarding the design and utility of app-based hearing tests in LMICs. Test uptake is likely influenced by the test language and familiarity with smartphone technology. Apps designed for use in low-resource settings should be co-designed in partnership with the communities they are intended for and developed in context-specific settings.

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