Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss

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Limited access to hearing loss evaluation and treatment, due to demographic and socioeconomic conditions, particularly in remote areas, hinders early detection and intervention. Website audiometry Screen-H, accessible on mobile phones, tablets, and computers, offers a fast, painless, and non-invasive solution. Purpose This study aimed to assess the agreement between Screen-H and gold standard pure-tone audiometry. Methods In this analytical observational study with a cross-sectional design, participants over 10 years old with hearing loss were consecutively sampled at the Audiology Clinic of Otorhinolaryngology-Head and Neck Surgery, Dr. Hasan Sadikin General Hospital, Bandung. The sensitivity and specificity of Screen-H® were evaluated, and the Kappa score measured agreement with pure-tone audiometry. Results We included 321 patients, comprising 150 women (47%) and 171 men (53%). Screen-H® showed 82.8% sensitivity and 94.1% specificity in the right ear, and 80.8% sensitivity and 93.1% specificity in the left ear. Conclusion The high specificity and sensitivity of Screen-H, combined with its speed, ease of use, non-invasiveness, and cost-effectiveness, make it an effective screening tool for hearing loss in environments with noise levels ≤ 40 dB HL, starting from 35 dB HL stimuli. 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F1000Research 2024, 13 :416 ( https://doi.org/10.12688/f1000research.146735.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss [version 1; peer review: 1 approved with reservations] Melati Sudiro 1 , Wijana Hasansulama 1 , Rano Digdayan Makerto https://orcid.org/0000-0002-6596-4025 1 , Raden Ayu Hardianti Saputri 1 Melati Sudiro 1 , Wijana Hasansulama 1 , Rano Digdayan Makerto https://orcid.org/0000-0002-6596-4025 1 , Raden Ayu Hardianti Saputri 1 PUBLISHED 29 Apr 2024 Author details Author details 1 Otorhinolaryngology-Head and Neck Surgery, Universitas Padjadjaran, Bandung, West Java, Indonesia Melati Sudiro Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Wijana Hasansulama Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Software, Supervision, Writing – Review & Editing Rano Digdayan Makerto Roles: Data Curation, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation Raden Ayu Hardianti Saputri Roles: Conceptualization, Data Curation, Formal Analysis, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Hearing loss, affecting 16.8% of Indonesians, impacts quality of life and daily activities. Limited access to hearing loss evaluation and treatment, due to demographic and socioeconomic conditions, particularly in remote areas, hinders early detection and intervention. Website audiometry Screen-H, accessible on mobile phones, tablets, and computers, offers a fast, painless, and non-invasive solution. Purpose This study aimed to assess the agreement between Screen-H and gold standard pure-tone audiometry. Methods In this analytical observational study with a cross-sectional design, participants over 10 years old with hearing loss were consecutively sampled at the Audiology Clinic of Otorhinolaryngology-Head and Neck Surgery, Dr. Hasan Sadikin General Hospital, Bandung. The sensitivity and specificity of Screen-H® were evaluated, and the Kappa score measured agreement with pure-tone audiometry. Results We included 321 patients, comprising 150 women (47%) and 171 men (53%). Screen-H® showed 82.8% sensitivity and 94.1% specificity in the right ear, and 80.8% sensitivity and 93.1% specificity in the left ear. Conclusion The high specificity and sensitivity of Screen-H, combined with its speed, ease of use, non-invasiveness, and cost-effectiveness, make it an effective screening tool for hearing loss in environments with noise levels ≤ 40 dB HL, starting from 35 dB HL stimuli. READ ALL READ LESS Keywords diagnostic test, hearing loss, pure-tone audiometry, website audiometry Corresponding Author(s) Melati Sudiro ( [email protected] ) Close Corresponding author: Melati Sudiro Competing interests: Hopefully this research can be published on f1000research so that the Screen-H audiometry website software has a basis in international journals and can be recognized for its use on a national and international scale. Grant information: Financial support was received from the Universitas Padjadjaran no.537/UN6.WR3/TU.00/2023 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Sudiro M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Sudiro M, Hasansulama W, Digdayan Makerto R and Ayu Hardianti Saputri R. Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :416 ( https://doi.org/10.12688/f1000research.146735.1 ) First published: 29 Apr 2024, 13 :416 ( https://doi.org/10.12688/f1000research.146735.1 ) Latest published: 29 Apr 2024, 13 :416 ( https://doi.org/10.12688/f1000research.146735.1 ) Introduction Hearing loss occurs when the sound transmission from the outer ear to the brain, is impaired. 1 In children, it is associated with impairments in expressive and receptive language skills, challenges in social interactions, stress management issues, increased frustration, and lowered self-esteem. 2 – 6 In adults, hearing loss affects communication, daily activities, work, social life, and self-confidence. Furthermore, it is linked to occupational restrictions, leading to economic issues. 2 – 6 Early detection of hearing loss is essential for timely and accurate intervention. 5 , 7 Pure-tone audiometry is considered the gold standard for diagnosing hearing loss; however, limitations in infrastructure, availability of trained personnel, and the requirement for soundproofed environments can delay hearing loss evaluations, causing gaps in hearing screening in rural or remote areas. 5 , 7 An alternative approach is hearing screening using Screen-H , which offers a rapid, painless, non-invasive solution that is accessible through mobile phones, tablets, and computers, provided there is a signal and headphones for sound stimulation. 7 – 11 This study aimed to evaluate the agreement between Screen-H and pure-tone audiometry. Methods The study population comprised patients with hearing loss seeking treatment at the Audiology Clinic of Otorhinolaryngology, Head and Neck Surgery, at Dr. Hasan Sadikin General Hospital, Bandung. This analytical observational research employed a cross-sectional design and a diagnostic test to evaluate the performance of Screen-H. The diagnostic test assessed multiple measures, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and accuracy. The reliability of the study was assessed using the Kappa Index. Data processing and analysis were conducted using Microsoft Excel 365 https://www.microsoft.com/id-id/microsoft-365/free-office-online-for-the-web . The inclusion criteria for this study were individuals aged over 10 years who demonstrated a cooperative demeanor and havDatae agreed to research consent. The exclusion criteria included the inability to undergo pure tone audiometry, craniofacial anomalies, and congenital abnormalities. This study received approval from the ethics committee of Padjadjaran University, under reference number 255/UN6.KEP/EC/2023 which was published on 28 February2023, and was conducted from May to July 2023. Pure tone audiometry was performed in a soundproof room. Screen-H hearing tests were administered in a room with a noise level ≤ 40 dB using Sennheiser HD 201 headphones, chosen for their noise reduction capability of 15-20 dB HL, a stimulus output of up to 108 dB HL, and a frequency range of 21-18000 Hz. The calibration process for Screen-H relied on a sound reference approach, measuring sound intensity and subsequently record it to establish a reference point. Post-calibration, it was determined that the sound intensity emitted by Screen-H aligned with that of pure tone audiometry. The typical ambient sound level in the test room was measured at 40 dB SPL. 12 During the hearing screening, the initial stimulus intensity commonly ranged from 30-40 dB HL, with the recommended initial intensity for Screen-H set at 35 dB HL. 12 Hearing tests were performed using Screen-H and pure tone audiometry (Resonance, EN60645-1/-2, New Holland) as the gold standard. Screen-H has been patented and we as researchers have permission to use the application and Software available from: screenout.id. We use pure tone audiometry (Resonance, EN60645-1/-2, New Holland) which has permission to use from the local health department. All subjects underwent examinations first with Screen-H and then with pure tone audiometry. During the Screen-H test, subjects were exposed to auditory stimuli through headphones at specific frequencies of 500, 1,000, 2,000, 4,000, and 8,000 Hz, with intensity levels set at 35, 55, and 75 dB. 13 Results A total of 321 participants met the inclusion and exclusion criteria, comprising 280 individuals with hearing impairment and 41 with normal hearing. The most prevalent age range for hearing loss complaints was between 26 and 35 years. Table 1 presents the prevalence rates of hearing loss among males and females, showing a rate of 53% for males and 47% for females. Sensorineural hearing loss was identified as the most common type, with chronic suppurative otitis media being the leading cause. Table 1. Characteristics of eesearch subjects. Variable N=321 % Age 10-11 8 2.4 12-16 24 7.4 17-25 50 15.5 26-35 68 21 36-45 59 18.3 46-55 54 16.8 56-65 44 13.7 > 65 14 4.3 Gender Man 171 53.3 Woman 150 46.7 Type Normal 41 12.8 Sensorineural hearing loss 130 40.5 Conductive 84 26.2 Mixed 66 20.6 Diagnosis Chronic suppurative otitis media 127 39.6 Cerumen 50 15.6 Presbycusis 34 10.6 Acute otitis media 34 10.6 Ototoxic 33 10.3 Noise induces 14 4.4 Sudden deafness 10 3.1 Congenital 6 1.9 Meniere's disease 3 0.9 Stenosis 3 0.9 Tumor 2 0.6 Otosclerosis 1 0.3 Tables 2 and 3 present results indicating that Screen-H closely adheres to pure tone audiometry in both the right and left ears, as evidenced by high Kappa values. Table 2. Right ear hearing threshold. Variable Pure Tone Audiometry Kappa >25 dB HL ≤25 dB HL N=169 N=152 Screen-H® >35 dB HL 140 (83%) 9 (6%) 0.764 ≤35 dB HL 29 (17%) 143 (94%) Table 3. Left ear hearing threshold. Variable Pure Tone Audiometry Kappa >25 dB HL ≤25 dB HL N=188 N=133 Screen-H® >35 dB HL 152 (81%) 8 (6%) 0.726 ≤35dB HL 36 (19%) 125 (94%) Table 4 shows that Screen-H exhibits strong sensitivity, very high specificity, very high PPV and NPV in the right ear, with sufficient NPV, high accuracy, high PLR, high NLR in the left ear. The Kappa value suggests greater suitability for the right ear compared to the left. Table 4. Screen-H® diagnostic test. Right Ear Left Ear Sensitivity 82.8% 80.8% Specificity 94.1% 93.9% PPV 94% 95% NPV 83.1% 77.6% Accuracy 88.2% 86.2% PLR 13.99 13.44 NLR 0.182 0.20 Kappa 0.764 0.726 Discussion Hearing loss affects individuals across all ages. 4 , 14 Our study included patients ranging from 11 to 83 years, with the most prevalent age group being 26 to 35 years. There is higher prevalence of hearing loss in men compared to women, which can be attributed to several risk factors and comorbidities. 15 The current study revealed that sensorineural hearing loss was the most common type, accounting for 40.5% of cases, followed by conductive hearing loss at 26%. Various factors contributed to these types of hearing loss, including chronic suppurative otitis media, presbycusis, ototoxicity, noise-induced hearing loss, sudden sensorineural deafness, congenital hearing loss, and Meniere's disease. Additionally, cerumen presence was a contributor to conductive hearing loss. Chronic suppurative otitis media has been linked with various types of hearing loss, including conductive, sensorineural, and mixed types. 16 Particularly, sensorineural hearing loss can develop when chronic otitis media persists for more than 14 days, leading to increased levels of CD45+ macrophages, which act as inflammatory mediators in the cochlea. These macrophages are closely associated with the damage to the external hair cells. 16 Prolonged infection and inflammation beyond 14 days can lead to irreversible auditory function impairment. primarily affecting Based on Xia’s research, the damage primarily affects the outer hair cells while sparing the inner hair cells. 11 , 16 , 17 Conductive hearing loss, on the other hand, results from impaired sound transmission from the outer to the inner ear. In this study, factors such as chronic otitis media, cerumen prop, acute otitis media, external acoustic canal stenosis, tumors, and otosclerosis accounted for the 26% incidence of conductive hearing loss. 18 Screen-H has greater specificity compared to sensitivity, as the test is more effective at accurately identifying individuals without hearing loss than those with hearing loss. The accuracy of the test in both the right and left ears demonstrated robust values, indicating that the audiometry testing conducted on the Screen-H possesses statistically significant accuracy. The Kappa value is strong for the right ear and satisfactory for the left ear. Other studies have reported sensitivity and specificity rates of 82% and 95%, respectively, which are comparable to the findings of our current study. 19 Another study revealed a sensitivity of 93%, specificity of 88%, a positive predictive value of 87%, and a negative predictive value of 94%. 20 These findings align with our investigation, indicating that the Screen-H assessment has adequate statistical significance in accurately identifying individuals with either hearing loss or normal hearing. The impact of environmental noise on website audiometry examinations is major, especially when tests are carried out at intensities >40 dB HL. 21 , 22 In this study, Screen-H examinations were performed in areas where the environmental noise was ≤40 dB HL, and headphones with a noise-canceling capability of around 15-20 dB HL were used. This setup ensured that the 35 dB stimulus was effectively received. In addition, the earphones can affect the results of audiological assessments and whether the earphones are positioned by trained examiners or by examinees can affect audiological judgments. 11 The negative effects of background noise may further support that examinations performed in soundproof booths have better diagnostic accuracy. 19 The influence of ambient noise, which results in incorrect smartphone audiometry test results, leading to the use of soundproof booths can improve the diagnostic accuracy of smartphone-based hearing tests. 11 Pure tone audiometry, known for its high cost and limited accessibility, is typically available only in larger healthcare facilities. This presents a challenge for many individuals in Indonesia, especially considering the country’s archipelagic geography, which further complicates access to hearing examination services. Therefore, there is an urgent need for a hearing loss detection method that is accessible to all Indonesians, cost-effective, available in the Indonesian language, and does not require the assistance of professional personnel. This study has limitations, notably the use of Sennheiser HD 201 headphones, which are not standard audiometry equipment. This factor could potentially influence the study results. Conclusion Screen-H demonstrated excellent capabilities in hearing loss screening due to its speed, ease of use, non-invasive nature, high sensitivity (80.8%-82.8%) and specificity (93.9%-(94.1%), and cost-effectiveness. It can effectively be used as a screening tool for hearing loss in environments with noise levels ≤ 40 dB, starting with a stimulus of 35 dB. Ethics and Consent This research has been approved by the Ethics Committee of Padjadjaran University with number 255/UN6.KEP/EC/2023 which was published on February 28, 2023 and was conducted from May to July 2023. All participants were informed about subject of the study and signed written consent. Author contributions MS performed examination to the subject, analysis, and interpretation of the patient’s data, also was a major contributor in writing the manuscript. All authors had full access to all data in the study ad had final responsibility for the decision on submit for publication. Data availability statement Figshare: Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss, https://doi.org/10.6084/m9.figshare.25416769.v1 The project contains the following underlying data: • Data file 1. Datasets.xlsx Data are available under the terms of the CC by 4.0 Acknowledgments We gratefully acknowledge all the study participants for their time and commitment to this study. Our thanks also go to the Faculty of Medicine, Universitas Padjadjaran, and Dr. Hasan Sadikin General Hospital, Bandung, for their indispensable support, which made this study possible. Parts of this study were presented at ORLIAC 2023, International symposium on October 25–27, 2023, Bali, Indonesia. Reference 1. Anastasiadou S, Al Khalili Y: Hearing Loss. Stat Pearls. 1st ed.Treasure Island: Stat Pearls; 2022; 6 p. 2. Sohal KS, Moshy JR, Owibingire S, et al. : Hearing Loss in Children: A Review. JAMA - J Am Med Assoc. 2020; 324 (21): 2195–2205. Publisher Full Text 3. Joint Committee on Infant Hearing: Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. Utah: J Early Hear Detect Interv; 2019; vol. 4 . ; 1–44. 4. World Health Organization: Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018; 1–40. 5. Joyce Li LY, Wang SY, Wu CJ, et al. : Screening for hearing impairment in older adults by smartphone-based audiometry, self-perception, HHIE screening questionnaire, and free-field voice test: Comparative evaluation of the screening accuracy with standard pure-tone audiometry. JMIR Mhealth Uhealth. 2020; 8 (10): 1–10. 6. Suwento R: Standar Pelayanan Kesehatan Indera Pendengaran Di Puskesmas. Jakarta: Komnas PGPKT; 2007. 7. Bexelius C, Honeth L, Ekman A, et al. : Evaluation of an internet-based hearing test - Comparison with established methods for detection of hearing loss. J. Med. Internet Res. 2008; 10 (4): 1–10. 8. Rizqi Septiana N: Widowati Kesehatan dan Keselamatan Kerja E, Ilmu Kesehatan Masyarakat J, Ilmu Keolahragaan Universitas Negeri Semarang F. Gangguan Pendengaran Akibat Bising. 2017; 1 (1): 73–82. 9. Armia Putri B, Halim R, Suryani NH: Studi Kualitatif Gangguan Pendengaran Akibat Bising/Noise Induced Hearing Loss (NIHL) Pada Marshaller Di Bandar Udara Sultan Thaha Kota Jambi Tahun 2020. J. Kesmas Jambi. 2021; 5 (1): 41–53. Publisher Full Text 10. Kamenov K, Chadha S: Methodological quality of clinical guidelines for universal newborn hearing screening. Dev. Med. Child Neurol. 2021; 63 (1): 16–21. PubMed Abstract | Publisher Full Text 11. Chen CH, Lin HYH, Wang MC, et al. : Diagnostic accuracy of smartphone-based audiometry for hearing loss detection: Meta-analysis. JMIR Mhealth Uhealth. 2021; 9 (9): 1–14. Publisher Full Text 12. Colsman A, Supp GG, Neumann J, et al. : Evaluation of Accuracy and Reliability of a Mobile Screening Audiometer in Normal Hearing Adults. Front. Psychol. 2020; 11 (April): 1–12. Publisher Full Text 13. Hoth S, Baljić I: Current audiological diagnostics. GMS Curr Top Otorhinolaryngol - Head Neck Surg. 2017. 14. Kementerian Kesehatan Republik Indonesia: Riset kesehatan dasar 2013. Jakarta: Kementerian Kesehatan; 2013; 244–250. 15. Huang B, Cao G, Duan Y, et al. : Gender Differences in the Association Between Hearing Loss and Cognitive Function. Am. J. Alzheimers Dis. Other Dement. 2019; 35 : 1–8. 16. Xia A, Thai A, Cao Z, et al. : Chronic suppurative otitis media causes macrophage-associated sensorineural hearing loss. J. Neuroinflammation. 2022; 19 (1): 1–15. 17. Haile LM, Kamenov K, Briant PS, et al. : Hearing loss prevalence and years lived with disability, 1990-2019: Findings from the Global Burden of Disease Study 2019. Lancet. 2021; 397 (10278): 996–1009. PubMed Abstract | Publisher Full Text | Free Full Text 18. Michels TC, Duffy MT, Rogers DJ: Hearing loss in adults: Differential diagnosis and treatment. Am. Fam. Physician. 2019; 100 (2): 98–108. PubMed Abstract 19. Dutta A, Khan S, Akhtar Z: Use of mobile phone based hearing app Hear WHO for self detection of hearing loss.2023; 1 (1): 3–6. 20. Vijayasingam A, Frost E, Wilkins J, et al. : Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis. Thorax. 2020; 75 (8): 632–639. PubMed Abstract | Publisher Full Text 21. Rahim TH, Sunjaya DK, Hilmanto D, et al. : Hearing Screening Alternative Using a Website-Based Application.2023; 27 (3): 123–127. 22. Bright T, Pallawela D: Validated smartphone-based apps for ear and hearing assessments: A review. JMIR Rehabil Assist Technol. 2016; 3 (2): 1–12. Publisher Full Text 23. Corona AP, Ferrite S, Bright T, et al. : Validity of hearing screening using hearTest smartphone-based audiometry: performance evaluation of different response modes. Int. J. Audiol. 2020; 59 (9): 666–673. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 29 Apr 2024 ADD YOUR COMMENT Comment Author details Author details 1 Otorhinolaryngology-Head and Neck Surgery, Universitas Padjadjaran, Bandung, West Java, Indonesia Melati Sudiro Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Wijana Hasansulama Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Software, Supervision, Writing – Review & Editing Rano Digdayan Makerto Roles: Data Curation, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation Raden Ayu Hardianti Saputri Roles: Conceptualization, Data Curation, Formal Analysis, Supervision, Writing – Review & Editing Competing interests Hopefully this research can be published on f1000research so that the Screen-H audiometry website software has a basis in international journals and can be recognized for its use on a national and international scale. Grant information Financial support was received from the Universitas Padjadjaran no.537/UN6.WR3/TU.00/2023 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 29 Apr 2024, 13:416 https://doi.org/10.12688/f1000research.146735.1 Copyright © 2024 Sudiro M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Sudiro M, Hasansulama W, Digdayan Makerto R and Ayu Hardianti Saputri R. Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :416 ( https://doi.org/10.12688/f1000research.146735.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 29 Apr 2024 Views 0 Cite How to cite this report: Pastucha M. Reviewer Report For: Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :416 ( https://doi.org/10.5256/f1000research.160851.r404394 ) The direct URL for this report is: https://f1000research.com/articles/13-416/v1#referee-response-404394 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 Sep 2025 Małgorzata Pastucha , World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.160851.r404394 Title: Although the authors compared their results with a diagnostic gold standard and were therefore able to report the type of hearing loss, the tool under evaluation based only on air-conduction thresholds doesn’t allow for a full diagnostic work-up. Its function ... Continue reading READ ALL Title: Although the authors compared their results with a diagnostic gold standard and were therefore able to report the type of hearing loss, the tool under evaluation based only on air-conduction thresholds doesn’t allow for a full diagnostic work-up. Its function is more consistent with a screening tool rather than a diagnostic one. I would suggest adjusting the title accordingly, e.g., by removing the term “diagnostic tool” to avoid overstating its capabilities. Abstract: In the Methods section, the specific name of the clinic where the study was conducted is given. This is unnecessary in the abstract, where the focus should be on the study design, population and main procedures. Details of the institution are more appropriate for the full text of the Methods section. Keywords: I would recommend replacing “diagnostic test” with “screening tool”, as this more accurately reflects the scope and purpose of the study. Introduction: First sentence (“Hearing loss occurs when the sound transmission from the outer ear to the brain is impaired”) is too simplistic and may be misleading. Hearing loss results from impairments across the auditory system, affecting detection and/or processing, and not only sound transmission. I suggest expanding this statement to more accurately reflect the underlying mechanisms. In the second paragraph, the transition to “An alternative approach is hearing screening using Screen-H” is too abrupt. Before introducing Screen-H, it would be useful to briefly present other existing mobile or web-based hearing screening tools. This would provide a broader context, supported by recent literature, and then naturally lead to the rationale for evaluating Screen-H as one of these solutions. The overall structure of the Introduction could be made clearer by organizing it into: (a) the importance and consequences of hearing loss, (b) current diagnostic standards and their limitations, (c) a broader overview of mobile and web-based hearing screening methods, and (d) the rationale for evaluating Screen-H. This structure would guide the reader step by step and provide a stronger rationale for the study. Methods: Descriptions of diagnostic accuracy measures (sensitivity, specificity, PPV, NPV, PLR, NLR, accuracy, Kappa) should be moved to the end of the Methods section, under “Statistical analysis,” rather than appearing at the beginning. The sentence “Data processing and analysis were conducted using Microsoft Excel 365 https://www.microsoft.com/ ...” should be revised by removing the web link, as it is unnecessary and does not add value to the text. The last paragraph contains repeated information about the audiometer (Resonance, EN60645-1/-2, New Holland). Please remove the duplication. I recommend dividing the methods section into subsections such as Participants, Tonal audiometry, Screen-H, Test procedure, Statistical analysis. This would make the whole section more clearly organised. In the subsection on Screen-H, please provide a more detailed description of the tool. Since the aim of the study is to evaluate its agreement with the gold standard, the device and its functioning should be described in sufficient detail. The study procedure should be described with enough detail to allow replication. Currently, essential information is missing, for example: who performed the tests, whether both tests were conducted on the same day, and in what order. Results: I am not convinced by the way the results compare between tonal audiometry and Screen-H. Pure-tone audiometry applies the conventional threshold of ≤25 dB HL as normal hearing, while Screen-H uses 35 dB HL. This creates a mismatch: individuals with mild hearing loss (26–35 dB HL) are considered normal by Screen-H but impaired by pure-tone audiometry. Directly comparing these cut-offs (Tables 2 and 3) may lead to biased estimates of agreement. Please reconsider this approach or provide a clear justification for using different threshold values. The Results section focuses extensively on general characteristics of hearing loss in the sample (age, sex distribution, type and cause of hearing loss). While these data are important, they are not directly related to the main study objective, which is the agreement between Screen-H and pure-tone audiometry. The emphasis should be placed on agreement measures. Table 1 presents the most common type and cause of hearing loss, but these findings are not linked in any way to the performance of Screen-H. If these variables are not analyzed in relation to Screen-H results, they may be better placed in a descriptive section or omitted altogether. The discussion of results is very limited. The results should be interpreted in more depth, focusing on the actual level of agreement, strengths, and weaknesses of Screen-H compared to the reference standard. Currently, the interpretation is superficial and does not explain the relevance of the findings. Discussion: The paragraph on “Chronic suppurative otitis media…” is too extensive and shifts the focus away from the main aim of the paper. While it is acceptable to briefly mention possible causes of hearing loss, the article is primarily about evaluating a screening tool. Moreover, the Results section did not present sensitivity or specificity by type of hearing loss, so the detailed discussion of etiologies is not supported by the study findings and could be shortened considerably. The Discussion includes sections (e.g., comparison of testing inside vs. outside a soundproof) that were not directly studied in this paper. These digressions weaken the connection between the Discussion and the actual results. The authors should focus more closely on the aspects that were directly analyzed — namely, the agreement between Screen-H and pure-tone audiometry, and the interpretation of the diagnostic accuracy values obtained. Overall, the Discussion is too general and does not sufficiently interpret the specific findings of this study. It would benefit from a more focused analysis of the presented results, highlighting the strengths and limitations of Screen-H in the studied population, rather than broad background information or findings from unrelated studies. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: audiologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Pastucha M. Reviewer Report For: Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :416 ( https://doi.org/10.5256/f1000research.160851.r404394 ) The direct URL for this report is: https://f1000research.com/articles/13-416/v1#referee-response-404394 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 29 Apr 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 29 Apr 24 read Małgorzata Pastucha , Institute of Physiology and Pathology of Hearing, Warsaw, Poland Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Pastucha M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Sep 2025 | for Version 1 Małgorzata Pastucha , World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland 0 Views copyright © 2025 Pastucha M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Title: Although the authors compared their results with a diagnostic gold standard and were therefore able to report the type of hearing loss, the tool under evaluation based only on air-conduction thresholds doesn’t allow for a full diagnostic work-up. Its function is more consistent with a screening tool rather than a diagnostic one. I would suggest adjusting the title accordingly, e.g., by removing the term “diagnostic tool” to avoid overstating its capabilities. Abstract: In the Methods section, the specific name of the clinic where the study was conducted is given. This is unnecessary in the abstract, where the focus should be on the study design, population and main procedures. Details of the institution are more appropriate for the full text of the Methods section. Keywords: I would recommend replacing “diagnostic test” with “screening tool”, as this more accurately reflects the scope and purpose of the study. Introduction: First sentence (“Hearing loss occurs when the sound transmission from the outer ear to the brain is impaired”) is too simplistic and may be misleading. Hearing loss results from impairments across the auditory system, affecting detection and/or processing, and not only sound transmission. I suggest expanding this statement to more accurately reflect the underlying mechanisms. In the second paragraph, the transition to “An alternative approach is hearing screening using Screen-H” is too abrupt. Before introducing Screen-H, it would be useful to briefly present other existing mobile or web-based hearing screening tools. This would provide a broader context, supported by recent literature, and then naturally lead to the rationale for evaluating Screen-H as one of these solutions. The overall structure of the Introduction could be made clearer by organizing it into: (a) the importance and consequences of hearing loss, (b) current diagnostic standards and their limitations, (c) a broader overview of mobile and web-based hearing screening methods, and (d) the rationale for evaluating Screen-H. This structure would guide the reader step by step and provide a stronger rationale for the study. Methods: Descriptions of diagnostic accuracy measures (sensitivity, specificity, PPV, NPV, PLR, NLR, accuracy, Kappa) should be moved to the end of the Methods section, under “Statistical analysis,” rather than appearing at the beginning. The sentence “Data processing and analysis were conducted using Microsoft Excel 365 https://www.microsoft.com/ ...” should be revised by removing the web link, as it is unnecessary and does not add value to the text. The last paragraph contains repeated information about the audiometer (Resonance, EN60645-1/-2, New Holland). Please remove the duplication. I recommend dividing the methods section into subsections such as Participants, Tonal audiometry, Screen-H, Test procedure, Statistical analysis. This would make the whole section more clearly organised. In the subsection on Screen-H, please provide a more detailed description of the tool. Since the aim of the study is to evaluate its agreement with the gold standard, the device and its functioning should be described in sufficient detail. The study procedure should be described with enough detail to allow replication. Currently, essential information is missing, for example: who performed the tests, whether both tests were conducted on the same day, and in what order. Results: I am not convinced by the way the results compare between tonal audiometry and Screen-H. Pure-tone audiometry applies the conventional threshold of ≤25 dB HL as normal hearing, while Screen-H uses 35 dB HL. This creates a mismatch: individuals with mild hearing loss (26–35 dB HL) are considered normal by Screen-H but impaired by pure-tone audiometry. Directly comparing these cut-offs (Tables 2 and 3) may lead to biased estimates of agreement. Please reconsider this approach or provide a clear justification for using different threshold values. The Results section focuses extensively on general characteristics of hearing loss in the sample (age, sex distribution, type and cause of hearing loss). While these data are important, they are not directly related to the main study objective, which is the agreement between Screen-H and pure-tone audiometry. The emphasis should be placed on agreement measures. Table 1 presents the most common type and cause of hearing loss, but these findings are not linked in any way to the performance of Screen-H. If these variables are not analyzed in relation to Screen-H results, they may be better placed in a descriptive section or omitted altogether. The discussion of results is very limited. The results should be interpreted in more depth, focusing on the actual level of agreement, strengths, and weaknesses of Screen-H compared to the reference standard. Currently, the interpretation is superficial and does not explain the relevance of the findings. Discussion: The paragraph on “Chronic suppurative otitis media…” is too extensive and shifts the focus away from the main aim of the paper. While it is acceptable to briefly mention possible causes of hearing loss, the article is primarily about evaluating a screening tool. Moreover, the Results section did not present sensitivity or specificity by type of hearing loss, so the detailed discussion of etiologies is not supported by the study findings and could be shortened considerably. The Discussion includes sections (e.g., comparison of testing inside vs. outside a soundproof) that were not directly studied in this paper. These digressions weaken the connection between the Discussion and the actual results. The authors should focus more closely on the aspects that were directly analyzed — namely, the agreement between Screen-H and pure-tone audiometry, and the interpretation of the diagnostic accuracy values obtained. Overall, the Discussion is too general and does not sufficiently interpret the specific findings of this study. It would benefit from a more focused analysis of the presented results, highlighting the strengths and limitations of Screen-H in the studied population, rather than broad background information or findings from unrelated studies. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise audiologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Pastucha M. Peer Review Report For: Screen-H Website Audiometry as a Diagnostic Tool for Hearing Screening in Patients with Hearing Loss [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :416 ( https://doi.org/10.5256/f1000research.160851.r404394) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-416/v1#referee-response-404394 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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