Smart phones have a great deal of potential when it comes to revolutionizing life with hearing loss.
Equipped with quality microphones and headphone output and real-time noise reduction, most phones can assess our listening environments, deliver consistent sound quality, and even improve speech clarity for phone calls. These are the strictly acoustic ways these devices can help us.
They can also wirelessly interface with some hearing aids to improve personalization and environmental optimization of settings. One example is a hearing aid app that detects when the user is driving (going faster than 10 mph) and automatically switches them in to a “car” setting that focuses on reducing road noise without inhibiting all around awareness of traffic sounds. Another day I will touch on smart phone apps for use with hearing aids, as well as use of apps instead of hearing aids (you can read about that here also). Today let’s check out “Hearing Test Apps.”
First off, what is the medical definition of a standard hearing test?
A hearing test, or audiogram, aims to find the softest volume a person can consistently (at least 2 out of every 3 times) hear pure tones of a specific range of frequencies, in both ears. A “comprehensive audiogram” also includes speech testing in which the patient repeats back the words presented to them (or points to an image corresponding to the word). It also determine the type of heairng loss the person has – conductive or sensorineural – which is very important.
When I perform an audiogram, I evaluate the patient’s ability to hear a pulsing, 1000Hz tone (“beep beep beep”) through one headphone at a time, by presenting it an one volume, waiting for a response in a particular window of time after the tones are presented, and then making the volume softer until the patient no longer responds. I then increase the volume until they respond again, then decrease it until they stop, and so on, until I find their threshold (the softest sound they can hear consistently) for 2000, 4000, 8000, 500, and 250 Hz in both ears. Then this is repeated with a different kind of headphone for some of the frequencies listed above. It isn’t rocket science, but it isn’t as simple as it may seem to get reliable results quickly and it gets increasingly complicated with different types and degrees of hearing loss, as well as the cognitive ability of the patient.
One thing a standard hearing test (in the US) does not evaluate, is how well we understand speech in the presence of background noise. There are a variety of tests to measure this but they are typically only done as part of evaluation for a cochlear implant, auditory processing abilities, or with hearing aids. Speech-in-noise testing usually provides very useful information about how the person actually hears in the real world, not just if they can hear soft beeps or understand words in absolute quiet. But speech-in-noise testing alone isn’t a “hearing test” by the medical definition and having poor speech understanding in noise doesn’t mean you have a hearing loss. My point is that this is valuable information but it is not what we are referring to when the terms “hearing test” and “hearing loss” are used.
So, are the apps even testing hearing?
Of the 5 free hearing test apps I tried on myself (Hearing-Check by Action on Hearing Loss, Hearing Check by Bxtel, uHear by Unitron, Mimi Test, and SoundCheck by Starkey), each offered something different. The test from “Action on Hearing Loss” in the UK, only tested the listener’s ability to hear English digits in increasing background noise. This is a quick, easy screening of speech understanding in noise, not a hearing test. It likely results in over-referrals to get a hearing test by an audiologist, but that is better than under-referrals.
Other apps did both speech understanding in noise and threshold testing, but in my view did not ensure as much accuracy as they could have for right verses left ears or a quiet enough test environment. Again, these issues more likely result in over-referral, so this is OK, but a test with obvious holes in it does not exactly make me want to follow its recommendations. Also, as expected, I could easily fool all of the apps in to recording poorer hearing than I truly had. Fortunately, most qualified hearing professionals should be able to tell when a person is exaggerating a hearing loss.
The only app I felt did a fairly reliable job of both quickly screening as well as more accurate threshold testing was the “Mimi Test.” It checks background noise levels (though not as often as it should), confirms right and left ear, and uses a more accurate method of evaluating threshold. In addition to this, Mimi will also be releasing an app that offers the ability to alter the output of your music or input from your microphone to compensate for any hearing loss. For some strange reason, they created hearing loss norms for age groups. This inaccurately portrays all hearing loss as age-related – what if you just have too much wax in your ears?! It also suggests that there are agreed upon norms for hearing loss with age, which there are not. Ignore the norms and focus on the results, if its outside the normal range, get a real hearing test. If you have a difference between your ears and/or other symptoms like pain, pressure, or ringing in your ears, make sure to get a test by an audiologist. This does not mean a hearing aid dispenser or a screening by a medical assistant at your general practitioner’s office.
Unitron’s “uHear” app is also pretty good and has better recommendations for follow up compared to the Mimi Test. Unitron is one of the major hearing aid manufacturers, owned by the same company as Phonak. So, when you select “find a professional” it will only find professionals that work with their hearing aids. You can just skip this and use the American Academy of Audiology’s website to do this or read my blog post on finding a good audiologist. Unitron is a good brand, however, I recommend finding someone by credentials and your ability to get to their office.
To download the apps search in the app store on your phone for the names of the apps listed above. You should be able to download them both for free on Apple and Android phones.
Should you try one of the apps?
I think you should try one or both of the ones I listed if you are curious, but not ready to schedule an appointment with an audiologist. I also think it is very valuable for documenting sudden changes in hearing immediately after noticing, while you wait to get in to see a doctor. Though, you should schedule that appointment immediately and indicate you’ve had a sudden hearing loss, you should not wait days for this appointment. Keep in mind app results may not be incredibly accurate, but are at least more likely to say something is worth getting checked out by a professional than to say your hearing is in the normal range when it is not.
To be clear, I would only recommend these apps be used by teens and adults, not young children. If you have concerns about a child’s hearing, it is simply better to have them tested by an audiologist. Children with a developmental age under 4, may get a more comprehensive test at a practice that specializes in pediatrics.
– Use newer, clean headphones, not ones that sit at the bottom of your bag, have gotten wet, and/or stepped on.
– Put the right one in your right ear and the left one in your left 🙂
– Find a quiet spot that will remain really quiet for 5-15 minutes. The apps I tested all have a background noise monitor before you start, but this doesn’t account for things like the heat coming on or cars driving past your window later on in the test.
– Take a screen shot of the results to save them in case you delete the app later.
– Invite everyone in the family to join without making abnormal results something to make fun of. Results and follow-up from these app tests have the potential to significantly improve communication in your family; no need to set up road blocks for this to happen!
Test outside the normal range and don’t know what to do next? Contact me to set up a session.
I’d love to hear how app results line up with hearing tests for anyone who does both – leave a note in the comments below!