The development and evaluation of the Finnish digit triplet test

Objectives: The aim of the study was to develop a reliable and easily accessible screening test for primary detection of hearing impairment.

Methods: Digits 0–9 were used to form quasirandom digit triplets. First, digit specific intelligibility functions and speech recognition thresholds (SRTs) were determined. To homogenize the test material digits with steep intelligibility function slopes were chosen and level correction up to ±2?dB were applied to the digits as needed. Evaluation measurements were performed to check for systematic differences in intelligibility between the test lists and to obtain normative reference function for normal-hearing listeners.

Results: The mean SRT and the final slope of the test lists were ?10.8?±?0.1?dB signal-to-noise ratio (SNR) and 21.7?±?1.8%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and slope of the test subjects were ?10.8?±?0.5?dB SNR and 23.4?±?5.2%/dB (measurements at constant level; inter-subject variability). The mean SRT for normal-hearing young adults for a single adaptive measurement is ?9.8?±?0.9?dB SNR.

Conclusion: The Finnish digit triplet test is the first self-screening hearing test in the Finnish language. It was developed according to current standards, and it provides reliable and internationally comparable speech intelligibility measurements.     

The influence of lexical-access ability and vocabulary knowledge on measures of speech recognition in noise

Objective: The main objective was to investigate the effect of linguistic abilities (lexical-access ability and vocabulary size) on different measures of speech-in-noise recognition in normal-hearing listeners with various levels of language proficiency. Design: Speech reception thresholds (SRTs) were measured for sentences in steady-state (SRT_stat) and fluctuating noise (SRT_fluc), and for digit-triplets in steady-state noise (DIN). Lexical-access ability was measured with a lexical-decision test and a word-naming test. Vocabulary size was also measured. For the SRT, keyword scoring and sentence scoring were compared. Study sample: To introduce variation in linguistic abilities, three groups of 24 young normal-hearing listeners were included: higher-educated native, lower-educated native, and higher-educated non-native listeners. Results: Lexical-access ability was most accurately measured with combined results of lexical decision and word naming. Lexical-access ability explained 60% of the variance in SRT. The effect of linguistic abilities on SRTs was up to 5.6 dB for SRT_stat and 8 dB for SRT_fluc. Using keyword scoring reduced this effect by approximately 1.5 dB. For DIN the effect of linguistic ability was less than 1 dB. Conclusions: Lexical-access ability is an important predictor of SRTs in normal-hearing listeners. These results are important to consider in the interpretation of speech-in-noise scores of hearing-impaired listeners.     

Smartphone hearing screening with integrated quality control and data management

Abstract

Objective: To determine if a smartphone application could be used as a calibrated screening audiometer with real-time noise monitoring for school screening using automated test sequences. Design: The investigation comprised three studies. Study 1 evaluated calibration accuracy across four Samsung S5301 smartphones (Android v4.0.4) using commercial Sennheiser HD202 headphones. Study 2 involved referencing smartphone microphone sensitivity to narrowband noise intensity as measured in octave bands by a sound-level meter between 30 and 75 dB SPL (5 dB increments). Study 3 compared screening outcomes of smartphone based and conventional hearing screening. Study sample: Study 2: 15 normal-hearing subjects (age range, 18–22 years; all female). Study 3: 162 children (324 ears) aged 5 to 7 years. Results: Smartphone calibration at 20, 30, and 40 dB was within 1 dB of recommended reference equivalent thresholds levels. Microphone calibration for noise monitoring had maximum variability across phones of 0.9, 0.6, and 2.9 dB at 1, 2, and 4 kHz, respectively, from reference intensities (30 to 75 dB SPL). Screening outcomes demonstrated no significant difference between smartphone and conventional audiometry with an overall referral rate of 4.3% and 3.7%, respectively. Conclusions: The newly developed smartphone application can be accurately calibrated for audiometry with valid real-time noise monitoring, and clinical results are comparable to conventional screening.     

Relations between psychophysical measures of spatial hearing and self-reported spatial-hearing abilities

Objective: The aim of the present study was to investigate how well the virtual psychophysical measures of spatial hearing from the preliminary auditory profile predict self-reported spatial-hearing abilities. Design: Virtual spatial-hearings tests (conducted unaided, via headphones) and a questionnaire were administered in five centres in Germany, the Netherlands, Sweden, and the UK. Correlations and stepwise linear regression models were calculated among a group of hearing-impaired listeners. Study sample: Thirty normal-hearing listeners aged 19–39 years, and 72 hearing-impaired listeners aged 22–91 years with a broad range of hearing losses, including asymmetrical and mixed hearing losses. Results: Several significant correlations (between 0.24 and 0.54) were found between results of virtual psychophysical spatial-hearing tests and self-reported localization abilities. Stepwise linear regression analyses showed that the minimum audible angle (MAA) test was a significant predictor for self-reported localization abilities (5% extra explained variance), and the spatial speech reception threshold (SRT) benefit test for self-reported listening to speech in spatial situations (6% extra explained variance). Conclusions: The MAA test and spatial SRT benefit test are indicative measures of everyday binaural functioning. The binaural SRT benefit test was not found to predict self-reported spatial-hearing abilities.     

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment

Objective: The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA). Design: After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility. Study sample: Data was obtained from 315 ears of 177 subjects with hearing losses ranging from ? 5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz). Results: Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs. Conclusion: The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ～47 dB HL, and above it is determined by listening in quiet.     

Assessing speech recognition abilities with digits in noise in cochlear implant and hearing aid users

Objective: The primary objective of the study was to investigate the feasibility, reliability, and validity of the Dutch digits in noise (DIN) test for measuring speech recognition in hearing aid and cochlear implant users and compare results to the standard sentences-in-noise (SIN) test. Design: The relation between speech reception thresholds for DIN test and SIN test was analysed to determine the validity of the DIN test. As linguistic skills were expected to make different contributions in these tests, their influence was analysed. Study sample: Participants were 12 normal-hearing listeners, 24 hearing aid users, and 24 cochlear implant users. Results: The DIN test was feasible for more participants than the SIN test. Intraclass correlation coefficients showed high reliability. The standard error of measurement was smaller for the DIN test than for the SIN test. DIN test and SIN test were highly correlated (r = 0.95 and r = 0.56 for NH+ HA and CI users respectively). In the regression analysis no significant contribution of basic linguistic skills or personal factors was found. Conclusion: In the assessment of speech recognition in noise of aided hearing-impaired listeners with hearing aids or cochlear implants, the DIN test is a feasible, reliable and valid test.     

Evaluation of a wireless remote microphone in bimodal cochlear implant recipients

Objective: To evaluate the benefit of a wireless remote microphone (MM) for speech recognition in noise in bimodal adult cochlear implant (CI) users both in a test setting and in daily life. Design: This prospective study measured speech reception thresholds in noise in a repeated measures design with factors including bimodal hearing and MM use. The participants also had a 3-week trial period at home with the MM. Study sample: Thirteen post-lingually deafened adult bimodal CI users. Results: A significant improvement in SRT of 5.4?dB was found between the use of the CI with the MM and the use of the CI without the MM. By also pairing the MM to the hearing aid (HA) another improvement in SRT of 2.2?dB was found compared to the situation with the MM paired to the CI alone. In daily life, participants reported better speech perception for various challenging listening situations, when using the MM in the bimodal condition. Conclusion: There is a clear advantage of bimodal listening (CI and HA) compared to CI alone when applying advanced wireless remote microphone techniques to improve speech understanding in adult bimodal CI users.     

Development of the Russian matrix sentence test

Objective: To develop the Russian matrix sentence test for speech intelligibility measurements in noise. Design: Test development included recordings, optimization of speech material, and evaluation to investigate the equivalency of the test lists and training. For each of the 500 test items, the speech intelligibility function, speech reception threshold (SRT: signal-to-noise ratio, SNR, that provides 50% speech intelligibility), and slope was obtained. The speech material was homogenized by applying level corrections. In evaluation measurements, speech intelligibility was measured at two fixed SNRs to compare list-specific intelligibility functions. To investigate the training effect and establish reference data, speech intelligibility was measured adaptively. Study sample: Overall, 77 normal-hearing native Russian listeners. Results: The optimization procedure decreased the spread in SRTs across words from 2.8 to 0.6 dB. Evaluation measurements confirmed that the 16 test lists were equivalent, with a mean SRT of ? 9.5 ± 0.2 dB and a slope of 13.8 ± 1.6%/dB. The reference SRT, ? 8.8 ± 0.8 dB for the open-set and ? 9.4 ± 0.8 dB for the closed-set format, increased slightly for noise levels above 75 dB SPL. Conclusions: The Russian matrix sentence test is suitable for accurate and reliable speech intelligibility measurements in noise.     

Speech-in-noise screening tests by internet,Part 3: Test sensitivity for uncontrolled parameters in domestic usage

Abstract

Objective: The online speech-in-noise test ‘Earcheck’ is sensitive for noise-induced hearing loss (NIHL). This study investigates effects of uncontrollable parameters in domestic self-screening, such as presentation level and transducer type, on speech reception thresholds (SRTs) obtained with Earcheck. Design: Subjects performed 26 Earchecks that differed regarding presentation level (65, 71, and 77 dBA), presentation mode (monotic or diotic), and masking noise (two different low-pass filtered noises) in the lab. To investigate effects of test environment, participants conducted eight additional Earchecks at home using different transducer types (headphones or loudspeakers). Study sample: Thirty noise-exposed workers, either normal-hearing (n = 10), or with different degrees of NIHL (n = 20), participated. Results: There was a minor effect of presentation levels exceeding 65 dBA in severely impaired listeners. Diotic presentation mode yielded lower SRTs compared to monotic presentation mode. Normal-hearing test results at home were poorer than in the laboratory, whereas hearing-impaired subjects performed better in domestic testing. Using loudspeakers deteriorated SRTs significantly in comparison to headphones, but only in hearing-impaired subjects. Conclusions: A monotic presentation mode using headphones is recommended for domestic screening. Since domestic testing affects SRT results, a follow up study using a large study population should assess Earcheck's validity when performed at home.     

Characteristics and international comparability of the Finnish matrix sentence test in cochlear implant recipients

Objectives: The first Finnish sentence-based speech test in noise—the Finnish matrix sentence test—was recently developed. The aim of this study was to determine the characteristics of the new test with respect to test-retest reliability, speech recognition curve, and international comparability in Finnish cochlear implant (CI) recipients. Design: The speech reception thresholds (SRT) were measured by means of an adaptive test procedure and compared with the results of the traditional Finnish word test. Additional measurements for concurrent slope and SRT estimation were conducted to determine the speech recognition curve and to check the test-retest reliability. Study sample: The measurements were performed on 78 Finnish CI recipients. In a subset of 25 patients, additional measurements for test-retest reliability and slope determination were performed. Results: The mean SRT was ? 3.5 ± 1.7 dB SNR, with only a weak correlation with the Finnish word test. Test-retest reliability was within ± 1 dB and the mean slope of the speech recognition curve was 14.6 ± 3.6 %/dB. The rehabilitation results were similar to the results published for the German matrix test. Conclusions: The Finnish matrix test was found to be suitable and efficient in CI recipients with similar characteristics as the German matrix test.     

Adaptation of the STARR test for adult Italian population: A speech test for a realistic estimate in real-life listening conditions

Objectives: To introduce the Italian adaptation of the STARR test based on a roving-level adaptive method to mimic challenging real-life listening conditions for use in people with auditory prostheses. Design: Normative data were collected and interlist-variability, as well as learning effects, were investigated using a within-subject design with repeated measures. Study sample: A group of 32 normal-hearing (NH) adults participated in the study. Results: The average speech reception threshold (SRT) for NH subjects was??8.4 dB SNR. The variability of mean SRTs across test lists was relatively small (≤1 dB for all test lists). The statistically significant differences between lists were eliminated after applying correction factors. On the basis of variability for the corrected SRTs within each subject, a difference of 2.8 dB in SRT was meaningful for outcome comparisons using one test list per condition and 2 dB using two lists per condition. Statistical analysis did not show any significant learning effects. Conclusions: Findings in NH listeners suggested that the Italian STARR test could be a promising supplement to existing speech assessment tools. Further studies in populations with hearing impairment could contribute to cross-language studies.     

Internationally comparable screening tests for listening in noise in several European languages: The German digit triplet test as an optimization prototype

Abstract

Objective: A review is given of internationally comparable speech-in-noise tests for hearing screening purposes that were part of the European HearCom project. This report describes the development, optimization, and evaluation of such tests for headphone and telephone presentation, using the example of the German digit triplet test. In order to achieve the highest possible comparability, language- and speaker-dependent factors in speech intelligibility should be compensated for. Materials and methods: The tests comprise spoken numbers in background noise and estimate the speech reception threshold (SRT), i.e. the signal-to-noise ratio (SNR) yielding 50% speech intelligibility. Results: The respective reference speech intelligibility functions for headphone and telephone presentation of the German version for 15 and 10 normal-hearing listeners are described by a SRT of ?9.3?±?0.2 and ?6.5?±?0.4 dB SNR, and slopes of 19.6 and 17.9%/dB, respectively. Reference speech intelligibility functions of all digit triplet tests optimized within the HearCom project allow for investigation of the comparability due to language specificities. Conclusions: The optimization criteria established here should be used for similar screening tests in other languages.     

Construction and evaluation of the Mandarin Chinese matrix (CMNmatrix) sentence test for the assessment of speech recognition in noise

Abstract

Objective: Development of the Mandarin Chinese matrix (CMNmatrix) sentence test for speech intelligibility measurements in noise according to the international standard procedure.

Design: A 50-word base matrix representing the distribution of phonemes and lexical tones of spoken Mandarin was established. Hundred sentences capturing all the co-articulations of two consecutive words were recorded. Word-specific speech recognition functions, speech reception thresholds (SRT: signal-to-noise ratio (SNR), that provides 50% speech intelligibility) and slopes were obtained from measurements at fixed SNRs. The speech material was homogenised in intelligibility by applying level corrections up to ± 2?dB. Subsequently, the CMNmatrix test was evaluated, the comparability of test lists was measured at two fixed SNRs. To investigate the training effect and establish the reference data, speech recognition was measured adaptively.

Study sample: Overall, the study sample contained 80 normal-hearing native Mandarin-speaking listeners.

Results: Multi-centre evaluation measurements confirmed that test lists are equivalent in intelligibility, with a mean SRT of ?10.1?±?0.1?dB SNR and a slope of 13.1?±?0.9 %/dB. The reference SRT is ?9.3?±?0.8 and ?11.2?±?1.2?dB SNR for the open- and closed-set response format, respectively.

Conclusion: The CMNmatrix test is suitable for accurate and internationally comparable speech recognition measurements in noise.     

Development and evaluation of the British English coordinate response measure speech-in-noise test as an occupational hearing assessment tool

Objective: The studies described in this article outline the design and development of a British English version of the coordinate response measure (CRM) speech-in-noise (SiN) test. Our interest in the CRM is as a SiN test with high face validity for occupational auditory fitness for duty (AFFD) assessment. Design: Study 1 used the method of constant stimuli to measure and adjust the psychometric functions of each target word, producing a speech corpus with equal intelligibility. After ensuring all the target words had similar intelligibility, for Studies 2 and 3, the CRM was presented in an adaptive procedure in stationary speech-spectrum noise to measure speech reception thresholds and evaluate the test–retest reliability of the CRM SiN test. Study sample: Studies 1 (n?=?20) and 2 (n?=?30) were completed by normal-hearing civilians. Study 3 (n?=?22) was completed by hearing impaired military personnel. Results: The results display good test–retest reliability (95% confidence interval (CI)?r?≤?0.65), and the CRM is sensitive to hearing impairment. Conclusion: The British English CRM using stationary speech-spectrum noise is a “ready to use” SiN test, suitable for investigation as an AFFD assessment tool for military personnel.     

The French digit triplet test: A hearing screening tool for speech intelligibility in noise

Abstract

A French speech intelligibility screening test in noise that applies digit triplets as stimuli has been developed and evaluated for both telephone and broadband headphone use. After optimizing the speech material based on the intelligibility of the individual digits, norms for normal-hearing subjects were established. speech reception thresholds (SRTs) of ?6.4 ± 0.4 and ?10.5 ± 0.3 dB SNR, and slopes of 17.1 and 27.1 %/dB were obtained for telephone and broadband headphone presentation, respectively. The French digit triplet test by telephone was then implemented as an automatic self-screening test by home telephone, and further evaluated in normal-hearing and hearing-impaired listeners. A test-retest variability of 0.7 dB was found and the correlation between SRT and pure-tone average (PTA_0.5,1,2,4) was 0.77. One month after launching the test, 20 000 calls were registered. It can be concluded that both versions of the newly developed test have steep slopes and small SRT differences across normal-hearing listeners. The screening test by telephone is highly reliable and proves to fulfill the need for an easily accessible and objective hearing screening.

Sumario

Se desarrolló y evaluó una prueba de tamiz de inteligibilidad del lenguaje en ruido, utilizando ternas de dígitos como estímulo, tanto para teléfono como para auriculares de banda ancha. Después de optimizar el material lingüístico basado en la inteligibilidad de los dígitos individuales, se establecieron las normas para los sujetos normoyentes. Se obtuvieron umbrales de recepción del lenguaje (SRTs) de -6.4 ± 0.4 y -10.5 ± 0.3dB SNR y pendientes de 17.1 y 27.1%/dB para teléfono y auriculares de banda ancha, respectivamente. Se implementó la prueba de terna de dígitos en francés por teléfono como una prueba de tamiz autoaplicable por teléfono en casa y después se evaluó en normoyentes e hipoacúsicos. Se encontró una variabilidad de test-re-test de 0.7 dB y la correlación entre SRT y el promedio de tonos puros (PTA_0.5,1,2,4) fue de 0.77. Un mes después de lanzar la prueba, se registraron 20,000 llamadas. Se puede concluir que ambas versiones de la prueba recientemente desarrollada tiene pendientes pronunciadas y pequeñas diferencias del SRT entre los normoyentes. La prueba de tamiz por teléfono es altamente confiable y demuestra que satisface las necesidades de una prueba de tamiz auditivo fácil, accesible y objetiva.     

Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation

Objective: To examine post-implantation benefit and time taken to acclimate to the cochlear implant for adult candidates with more hearing in the contralateral non-implanted ear than has been previously considered within local candidacy guidelines. Design: Prospective, within-subject experimental design. Study sample: Forty postlingual hearing-impaired adult subjects with a contralateral ear word score in quiet ranging from 27% to 100% (median 67%). Results: Post-implantation improvement of 2.4?dB and 4.0?dB was observed on a sentence in coincident babble test at presentation levels of 65 and 55?dB SPL respectively, and a 2.1?dB benefit in spatial release from masking (SRM) advantage observed when the noise location favoured the implanted side. Significant post-operative group mean change of between 2.1 and 3.0 was observed on the sub-scales of the speech, spatial, and qualities (SSQ) questionnaire. Degree of post-implantation speech reception threshold (SRT) benefit on the coincident babble test and on perception of soft speech and sounds in the environment was greater for subjects with less contralateral hearing. The degree of contralateral acoustic hearing did not affect time taken to acclimate to the device. Conclusions: The findings from this study support cochlear implantation for candidates with substantial acoustic hearing in the contralateral ear, and provide guidance regarding post-implantation expectations.     

Polish sentence tests for measuring the intelligibility of speech in interfering noise

The aim of this study was to develop Polish sentence tests for accurate measuring of speech intelligibility in masking interfering noise. Two sets of sentence lists have been developed. The first set was composed of 25 lists and was used for sentence intelligibility scoring. The second set was composed of 22 lists and was used for word intelligibility scoring. The lists in each set have been phonemically and statistically balanced. The speech reception threshold (SRT) and slope of the psychometric function at the SRT point (S₅₀) were determined in normal-hearing subjects. It was found that the mean SRT and mean list-specific S_50list for the first set were equal to ?6.1 dB and 25.5%/dB, respectively. The mean SRT and the mean list-specific S_50list for the second set were:?7.5 dB and 20.8%/dB. Due to a relatively steep slope of the psychometric functions, the Polish sentence tests were shown to be accurate materials for speech intelligibility measurements against interfering noise. They are the first sentence speech-in-noise tests developed for Slavonic languages.     

Smartphone threshold audiometry in underserved primary health-care contexts

Objective: To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. Design: A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. Study sample: A total of 94 subjects (mean age 41 years?±?17.6 SD and range 18–88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. Results: In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15?dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within?≤10 dB in 80.6% of cases with an average threshold difference of??1.6 dB?±?9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of ?1.0 dB?±?7.1 SD. Conclusions: Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.     

Wireless Connectivity for People with Hearing Loss: Behavioral Validation of the Smartphone for Remote Microphone Technology

As part of a National Institutes of Health–National Institute on Deafness and Other communication Disorders (NIH-NIDCD)–supported project to develop open-source research and smartphone-based apps for enhancing speech recognition in noise, an app called Smartphone Hearing Aid Research Project Version 2 (SHARP-2) was tested with persons with normal and impaired hearing when using three sets of hearing aids (HAs) with wireless connectivity to an iPhone. Participants were asked to type sentences presented from a speaker in front of them while hearing noise from behind in two conditions, HA alone and HA + SHARP-2 app running on the iPhone. The signal was presented at a constant level of 65 dBA and the signal-to-noise ratio varied from −10 to +10, so that the task was difficult when listening through the bilateral HAs alone. This was important to allow for improvement to be measured when the HAs were connected to the SHARP-2 app on the smartphone. Benefit was achieved for most listeners with all three manufacturer HAs with the greatest improvements recorded for persons with normal (33.56%) and impaired hearing (22.21%) when using the SHARP-2 app with one manufacturer''s made-for-all phones HAs. These results support the continued development of smartphone-based apps as an economical solution for enhancing speech recognition in noise for both persons with normal and impaired hearing.     

Evaluation of an internet-based speech-in-noise screening test for school-age children

Objective: To evaluate a Dutch online speech-in-noise screening test (in Dutch: “Kinderhoortest”) in normal-hearing school-age children. Sub-aims were to study test–retest reliability, and the effects of presentation type and age on test results. Design: An observational cross-sectional study at school. Speech reception thresholds (SRTs) were obtained through the online test in a training condition, and two test conditions: on a desktop computer and smartphone. The order of the test conditions was counterbalanced. Study sample: Ninety-four children participated (5–12 years), of which 75 children were normal-hearing (≤25?dB HL at 0.5?kHz,?≤20?dB HL at 1–4?kHz). Results: There was a significant effect for test order for the two test conditions (first or second test), but not for presentation type (desktop computer or smartphone) (repeated measures analyses, F(1,75)?=?12.48, p?F(1,75)?=?0.01, p?=?0.982). SRT significantly improved by age year (first test: 0.25?dB SNR, 95% CI: –0.43 to –0.08, p?=?0.004. Second test: 0.29?dB SNR, 95% CI: –0.46 to –0.11; p?=?0.002). Conclusions: The online test shows potential for routine-hearing screening of school-age children, and can be presented on either a desktop computer or smartphone. The test should be evaluated further in order to establish sensitivity and specificity for hearing loss in children.