Several online hearing tests exist. Are they a good screening tool or a threat to your business? We asked the experts.
Online, phone, and mobile hearing tests have long been marketed by hearing aid manufacturers and non-profits as a first-step screening tool for hearing loss. However a crop of online hearing aid stores have recently begun to offer hearing tests claiming to have the same testing quality as in an audiologist’s office - a claim that isn’t true.

“In pure tone online tests, there’s no form of calibration,” says Suzanne Kimball, Assistant Professor of Audiology at the University of Oklahoma Health Sciences Center. “It’s really up to your computer and speakers to determine how much sound is being presented,” she says.

Concerns over validity

A lack of calibration and validity didn’t stop online hearing aid retailer hi HealthInnovations from claiming that its “clinically proven” online test could accurately diagnose hearing loss and allow clients to skip a visit to the doctor’s office. After taking the test, users were encouraged to buy a hearing aid that would be calibrated and sent to them in the mail. Of even more concern was that a leading insurance provider in the US agreed reimbursing clients for hearing aids purchased online.

In February 2012, The American Academy of Otolaryngology issued a public letter contesting a large American insurance company’s decision to offer coverage for hearing aids purchased via free testing through an online retailer.

The Academy cited concerns over the validity of the online test, the lack of peer-reviewed literature supporting its claims, a poor ENT referral programme, and the company’s shaky compliance with federal and state guidelines.

“We are unsure whether the program’s online test, which is at most only an initial screening tool, best serves patients when there are so many variables that could lead to patients receiving a lower level of quality care. A patient could easily miss, undervalue, or ignore red flag hearing health symptoms when completing an online screening,” the letter states.

Their complaints didn’t go unheard. In late March, the U.S. Food and Drug Administration (FDA) issued a cease and desist order to hi HealthInnovations stating that the firm did not receive proper approval to market the test.

Because the test claims to help or cure a medical condition, it must get prior approval from the FDA. Hi HealthInnovations removed the test from their website shortly after receiving the notice.

Inaccurate digital diagnoses

The danger with online hearing tests like the one  hi HealthInnovations marketed is that the results are often not as reliable as the standard hearing tests given by hearing care professionals. Kimball conducted a study in 2008 to compare the effectiveness of pure tone online hearing tests offered by online retailers to those by audiologists and found a statistically significant difference in the results.

The test grossly underestimated levels of loss, which meant that hearing aids that were ordered from that online hearing retailer were not calibrated correctly.

“As more and more baby boomers become hearing aid patients, they are more technologically savvy. They are the population that is more likely to use online testing, and in many, if not most, cases the online hearing test was completely inaccurate,” she says.

Real-life audio check

Some home hearing tests do serve a positive purpose. Most offered online by charities, universities, and hearing aid manufacturers can provide an accessible first step for screening for hearing loss.

The technology isn’t entirely new. One of the first tests was developed in the late 1990s by scientists at VU University Medical Center in Amsterdam. The original “Digit Triplets” test was done by telephone and asked participants to identify three numbers that were said above high background noise.

Unlike a pure tone test, which measures precise levels of hearing loss at specific frequencies, the idea of this test is to measure speech recognition under adverse conditions and is designed for people who have noticed a gradual loss in their hearing.
“This has been referenced as a real-life audio check,” says Tom Fiddian. “If you pass this check, then actually your ability to understand speech in everyday situations is good.”

The test has been adapted for more modern technology and can now be taken online or via mobile phone apps. Fiddian is one of the developers of an online, telephone and mobile phone app digit triplets hearing test by UK-based non-profit Action on Hearing Loss.

The test he developed is easy to take. Just turn your speakers up, and type in the numbers you hear at each prompt. If results show hearing loss, the test suggests going to a general practitioner or private hearing aid professional for a full audiogram.

Online tests can be effective

In some cases, online hearing tests do provide a useful tool for learning about individual hearing loss. In 2008, researchers at Karolinska Institutet in Sweden developed an online hearing test that was similar to a clinical pure-tone audiogram.

They found that it was an inexpensive way to screen for hearing loss in large populations and was more accurate than questionnaire-based studies. Still, researchers there cautioned that the test shouldn’t replace a clinical pure-tone audiogram conducted by a trained audiologist.

Kimball agrees online hearing tests provide a good first step for people concerned that they may have hearing loss.

“If an online hearing test is a screening to be a starting point to get someone in to get a full diagnostic, I think it is perfectly ok,” she says. “The issue comes if a diagnostic decision is made from an online hearing test.”

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