Marcel Vlaming Vlaming Nbruh Industry

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NBRUH, Industry meeting, 18 June 2009

Hearing screening by internet: what this will mean for future

hearing care?

Dr. Marcel VlamingNBRUH consultant

VU medical centre, [email protected]


Hearing Screening• Importance for general public

– undiscovered hearing loss– acknowledge possibility of own hearing loss– pave the way for professional care (hearing aids or other)

• Requirements– Quick, easy, anonymous– Reliable for telescreening

• no need for absolute calibration• independence of equipment and situation• foolproof explanation

– Accessible from at home– Low demands on technology– Sensible guidance and presentation of test results

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perc

enta

ge o

f sub

ject

s

0

20

40

60

80

100

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90-9

4

0

20

40

60

80

male

female

43% of the adults >60 yrs have a significant hearing loss for speech in noise

Only 22% of them have hearing aids

∗ Smits et al. Ear and Hearing (2006)


Telephone and Internet• Telephone

– easy to use, widespread– landline phones provide consistent quality

standard– drawbacks: monaural; limited spectrum; no

visual feedback• Internet

– no costs for end user– better audio quality possible– enhanced audiovisual interaction– makes explanatory texts and graphics possible– drawbacks: uncertain quality of technical

equipment; too complicated for inexperienced users

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Use of a PC by age

• Approx. 35 to 40 percent of firstHA users in Germany use a PC (Internet) today.

0

10

20

30

40

50

60

70

80

90

100

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-85

Altersgruppen

Männer (West)Männer (Ost)Frauen (West)Frauen (Ost)

Männer (West)Männer (Ost)Frauen (West)Frauen (Ost)

2002

1996

1996

2002Estimate 2009

First HA


Digit Triplet test

• Screening test• 3 - digits in background noise• Up-down procedure• 50% threshold• Automatic (self administrable)

• By phone• National campaigns: NL, UK, DE, CH, FR• Other countries to follow: In preparation: USA, PL

• By Internet• National campaign: NL, RNID• HearCom portal: DE, NL, UK, FR, SE, PL, GR

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Internet


Speech-in-noise

Sign

al-to

-noi

se ra

tio

Volu

me

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Typical course of the3-digit speech in noise test

trial number

SN

R (d

B)

0 5 10 15 20 25

-15

-10

-5

0

5

SRT


Correlation with audiogram

∗Smits et al. Int. J. Audiology (2004)

Correlation: R = 0,77 PASS

REFER

‘good’

‘moderate’

‘poor’

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Test Results• Good

Your hearing is within the normal range. If in future you notice any problems with your hearing, please see your GP.

• InsufficientYour hearing is below normal. This is very common. However, you may wish to see your GP for a more detailed assessment of your hearing.

• PoorYour hearing is well below normal and you are likely to benefit from a hearing aid. Please see your GP and ask to be referred to an audiologist for a full hearing assessment.


Internet Screening Test Battery

www.HearCom.eu

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2: AVE Based localisation Test

• Virtual acoustics using headphones

• Sounds generated in real time on a server according to the user’s line of sight.

• Head position moved by slider• One of several telephones is

ringing. User has to indicate the ringing phone.

• Language independent.


2: AVE Based Localisation Test

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2: AVE localisation test

• Low correlation to audiogram • Medium correlation to questionnaires on

hearing disability

Measures a different aspect of hearing disability


3: Questionnaire: Hearing disabilities

• 18 questions relating to– Speech perception in

quiet– Speech perception in

noise– Sound localisation– Recognition of sounds– Detection of sounds

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3: HearCom QuestionnaireScoring:• not applicable• almost never 0.00• occasionally 0.33• frequently 0.67• almost always 1.00

Best Ear Audiogram (BEA):Correlation: R2 = 0,63

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Do listeners follow the advice?

Evaluation of the Dutch National Hearing Test by telephoneAnalyses of 881 questionnaires


Titel

• T

hearing-status category

good insufficient poor

%

0102030405060708090

100

no initiativeAudiological CenterENT-specialisthearing aid dispenserGP

∗ Smits et al. Clin. Otolaryngol. (2006)

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Guidance After the Tests: HearCompanion Service

• Intended as eRehabilitationservice

• Will supplement, not replace, existing audiological provisions

• May be especially valuable in countries having less developed audiological services

• Information is presented in the form of staged guidance as users undertake their personal aural rehabilitation ‘journey’


HearCompanion – Service Structure

• Content presented as six information ‘sets’`(A..D), to guide user through the key stages.

• Each set focuses on immediately relevant issues & prepares user for next stage.

• Additional information by Glossary or ‘Non-structured’approach for more knowledgeable users.

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HearCompanion – Results from the User Tests

• 97% of the 160 trialists thought the idea of the on-line guidance service was ‘good’, ‘very good’ or ‘excellent’

• Certain other issues were considered as potential additions to the service:

– Video content, e.g. earmould insertion– Establishment of an on-line peer-to-peer

forum– An 'Ask the experts' feature– Broadening of the content’s scope – 'fine tune' own hearing devices – Support of psychological aspects of

hearing loss. 5,7%

41,4%

8,6%

10,0%

10,0%

2,9%

17,1%

1,4%

1,4%

1,4%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

Excellent Very Good Good Bad Very Bad

% o

f res

pons

es

NetherlandsUKGermany


Future: Internet developments:from Presentation to Participation

Co-Create ?Participate Collaborate

Web 1.0e-Business

Access Find Share

Web 2.0me-Business

Web 3Dwe-Business

On the basis of IBM-Roadmap

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Future for Internet hearing services: Web3D

• Virtual World in the Internet– Based on 3D technologies– Users create their avatar to

represent themselves– move through the virtual world – meet other users, get information,

buy products and services, …

• New opportunities for hearing care– Simulated hearing care process– “Real” diagnostic tests– Virtual fitting– Simulated use of hearing aids– Direct link to real life hearing care


Virtual WorldsAugmentation• Impression of reality• Additional information

Simulation• Synthetic presentation offers freedom for

creativity• Cost Savings (e.g. virtual 3D prototyping)

Immersive Experience• Content is part of the environments • User interacts with the environments

Intimate• Ego- and Birds-Eye-perspective possible• Anonymity, users decide on what they

present

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ConclusionsHearing screening by Internet is a valid tool for first assessment of hearing problems

Easy, short, inexpensive, privateScreenings tests

Digit-triplet speech-in-noise (Internet and telephone)Localization Questionnaire

40 to 50 % follow the recommendationInternet follow-up: HearCompanionFuture: Internet hearing care with Web3D

Health & Medicine

Marcel Vlaming Vlaming Nbruh Industry