The Accuracy of Self-Administered Web- and App-Based Tools for Audiometric Tests—A Systematic Review

Abstract

Objectives: This systematic review aimed to evaluate the diagnostic accuracy of self-administered web- and app-based tools for audiometric testing compared to pure-tone audiometry (PTA), the clinical gold standard. Methods: Studies were eligible if they involved human participants, evaluated self-administered digital tools for audiometric testing, reported diagnostic accuracy metrics (e.g., sensitivity, specificity, and accuracy), were published between 2014 and 2024, and were written in English. Studies were excluded if they did not compare to PTA, were reviews, or did not assess self-administered tools. MEDLINE, Web of Science, Scopus, and EMBASE were systematically searched throughout November 2024. Study quality was assessed using the QUADAS-2 tool, evaluating four domains: patient selection, index test, reference standard, and flow and timing. Most studies showed some concern for a risk of bias. Results: Twelve studies, including a total of 2453 participants and evaluating 15 applications, met the inclusion criteria. The studies reported wide variability in diagnostic accuracy. Sensitivity ranged from 18% to 100%, specificity from 35.5% to 99.1%, and accuracy from 14% to 97.4%. SHOEBOX and Screenout demonstrated high diagnostic accuracy, while other apps showed inconsistent results across studies and settings. Heterogeneity in definitions of hearing loss, test environments, device and headphone types and a lack of standardized reporting limited comparability. Most studies were conducted in non-soundproof environments, and some had unclear or a high risk of bias. Conclusions: Self-administered audiometric apps and web tools show promise for remote hearing screening but require further validation and methodological standardization. Clinicians should interpret the results cautiously given the current variability in performance.