Computer-assisted audiometry versus manual audiometry.

OBJECTIVE

The Otogram is an automated computer-assisted audiometer that allows patients to self-administer audiometry for their pure-tone audiogram. There has been no research published in a peer-reviewed journal, validating its use in an otology outpatient clinic. We therefore proposed to investigate and compare the inter-rater and intrarater accuracy and reliability of audiologists and of the Otogram in an English-speaking British population.

DESIGN

Prospective nonrandomized validation study.

SETTING

Secondary otolaryngology center and otology outpatient clinic.

PARTICIPANTS

Forty-eight NHS patients referred to an otology outpatient clinic.

MAIN OUTCOME MEASURES

Each patient had 2 pure-tone audiograms. Hearing thresholds in decibels hearing level were ascertained by fully trained British audiologists and by the Otogram.

RESULTS

Using the weighted kappa statistic, the level of agreement in air-conduction (kappa = 0.965) and bone-conduction (kappa = 0.927) thresholds between the audiologist and the Otogram on the same patient was equivalent to the inter-rater level of agreement between pairs of audiologists. Approximately 94% of air-conduction thresholds and 91% of bone-conduction thresholds measured by the Otogram fell within 10 dB of thresholds measured by an audiologist. Intrarater comparisons between audiologists were very good for air-conduction (kappa = 0.978) and bone-conduction (kappa = 0.964). The intrarater level of agreement between repeated Otogram thresholds was just as good for air-conduction (kappa = 0.974) and bone-conduction (kappa = 0.945) thresholds.

CONCLUSION

The Otogram is just as reliable as audiologists at determining hearing thresholds. We recommend that the Otogram can be safely used in a controlled clinical setting supervised by audiologists.