1. Hearing screening by internet:
what this will mean for future
hearing care?
Dr. Marcel Vlaming
NBRUH consultant
VU medical centre, Amsterdam
m.vlaming@vumc.nl
www.HearCom.eu
NBRUH, Industry meeting, 18 June 2009
Hearing Screening
• Importance for general public
– undiscovered hearing loss
– acknowledge possibility of own hearing loss
– pave the way for professional care (hearing aids or other)
• Requirements
– Quick, easy, anonymous
– Reliable for telescreening
• no need for absolute calibration
• independence of equipment and situation
• foolproof explanation
– Accessible from at home
– Low demands on technology
– Sensible guidance and presentation of test results
NBRUH, Industry meeting, 18 June 2009
1

2. male
100
80
60
43% of the adults >60
40
percentage of subjects
yrs have a significant
20
hearing loss for speech
0
in noise female
80
60
Only 22% of them have 40
hearing aids 20
0
60-64
65-69
70-74
75-79
80-84
85-89
90-94
∗ Smits et al. Ear and Hearing (2006)
NBRUH, Industry meeting, 18 June 2009
Telephone and Internet
• Telephone
– easy to use, widespread
– landline phones provide consistent quality
standard
– drawbacks: monaural; limited spectrum; no
visual feedback
• Internet
– no costs for end user
– better audio quality possible
– enhanced audiovisual interaction
– makes explanatory texts and graphics possible
– drawbacks: uncertain quality of technical
equipment; too complicated for inexperienced
users
NBRUH, Industry meeting, 18 June 2009
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3. Use of a PC by age
First HA
100
90 Estimate 2009 2002 • Approx. 35 to 40
80 2002
70
Männer (West)
Männer (Ost) percent of first
60
Frauen (West)
Frauen (Ost)
HA users in
50
1996
Germany use a
40
30 Männer (West)
PC (Internet)
1996
20
Männer (Ost)
Frauen (West)
today.
10 Frauen (Ost)
0
4
9
4
9
4
9
4
9
5
-4
-4
-5
-5
-6
-6
-7
-7
-8
40
45
50
55
60
65
70
75
80
Altersgruppen
NBRUH, Industry meeting, 18 June 2009
Digit Triplet test
• Screening test
• 3 - digits in background noise
• Up-down procedure
• 50% threshold
• Automatic (self administrable)
• By phone
• National campaigns: NL, UK, DE, CH, FR
• Other countries to follow: In preparation: USA, PL
• By Internet
• National campaign: NL, RNID
• HearCom portal: DE, NL, UK, FR, SE, PL, GR
NBRUH, Industry meeting, 18 June 2009
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4. Internet
NBRUH, Industry meeting, 18 June 2009
Speech-in-noise
Signal-to-noise ratio
Volume
NBRUH, Industry meeting, 18 June 2009
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5. Typical course of the
3-digit speech in noise test
5
0
SNR (dB)
-5
-10
-15
0 5 10 15 20 25
trial number
SRT
NBRUH, Industry meeting, 18 June 2009
Correlation with audiogram
‘poor’
REFER
‘moderate’
PASS
Correlation: R = 0,77 ‘good’
∗Smits et al. Int. J. Audiology (2004)
NBRUH, Industry meeting, 18 June 2009
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6. Test Results
• Good
Your hearing is within the normal range. If in future you
notice any problems with your hearing, please see your
GP.
• Insufficient
Your hearing is below normal. This is very common.
However, you may wish to see your GP for a more
detailed assessment of your hearing.
• Poor
Your hearing is well below normal and you are likely to
benefit from a hearing aid. Please see your GP and ask
to be referred to an audiologist for a full hearing
assessment.
NBRUH, Industry meeting, 18 June 2009
Internet Screening Test Battery
www.HearCom.eu
NBRUH, Industry meeting, 18 June 2009
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7. 2: AVE Based localisation Test
• Virtual acoustics using
headphones
• Sounds generated in real time on
a server according to the user’s
line of sight.
• Head position moved by slider
• One of several telephones is
ringing. User has to indicate the
ringing phone.
• Language independent.
NBRUH, Industry meeting, 18 June 2009
2: AVE Based Localisation Test
NBRUH, Industry meeting, 18 June 2009
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8. 2: AVE localisation test
• Low correlation to audiogram
• Medium correlation to questionnaires on
hearing disability
Measures a different aspect of hearing
disability
NBRUH, Industry meeting, 18 June 2009
3: Questionnaire: Hearing
disabilities
• 18 questions relating to
– Speech perception in
quiet
– Speech perception in
noise
– Sound localisation
– Recognition of sounds
– Detection of sounds
NBRUH, Industry meeting, 18 June 2009
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9. NBRUH, Industry meeting, 18 June 2009
3: HearCom Questionnaire
Scoring:
• not applicable
• almost never 0.00
• occasionally 0.33
• frequently 0.67
• almost always 1.00
Best Ear Audiogram (BEA):
Correlation: R2 = 0,63
NBRUH, Industry meeting, 18 June 2009
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10. Do listeners follow the advice?
Evaluation of the Dutch National Hearing
Test by telephone
Analyses of 881 questionnaires
NBRUH, Industry meeting, 18 June 2009
100
Titel
90
• T 80 GP
70 hearing aid dispenser
60 ENT-specialist
50 Audiological Center
%
no initiative
40
30
20
10
0
good insufficient poor
hearing-status category
∗ Smits et al. Clin. Otolaryngol. (2006)
NBRUH, Industry meeting, 18 June 2009
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11. Guidance After the Tests:
HearCompanion Service
• Intended as eRehabilitation
service
• Will supplement, not replace,
existing audiological provisions
• May be especially valuable in
countries having less developed
audiological services
• Information is presented in the
form of staged guidance as users
undertake their personal aural
rehabilitation ‘journey’
NBRUH, Industry meeting, 18 June 2009
HearCompanion – Service
Structure
• Content presented as six
information ‘sets’`(A..D), to
guide user through the key
stages.
• Each set focuses on
immediately relevant issues &
prepares user for next stage.
• Additional information by
Glossary or ‘Non-structured’
approach for more
knowledgeable users.
NBRUH, Industry meeting, 18 June 2009
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12. HearCompanion – Results from
the User Tests
60,0%
• 97% of the 160 trialists thought the idea
1,4%
Netherlands of the on-line guidance service was
50,0%
10,0%
UK ‘good’, ‘very good’ or ‘excellent’
Germany
• Certain other issues were considered as
40,0%
potential additions to the service:
% of responses
– Video content, e.g. earmould insertion
30,0%
– Establishment of an on-line peer-to-peer
forum
41,4%
20,0% 17,1%
– An 'Ask the experts' feature
10,0%
– Broadening of the content’s scope
10,0% 2,9%
– 'fine tune' own hearing devices
8,6% 1,4%
5,7%
1,4%
– Support of psychological aspects of
0,0%
Excellent Very Good Good Bad Very Bad
hearing loss.
NBRUH, Industry meeting, 18 June 2009
Future: Internet developments:
from Presentation to Participation
Web 1.0 Web 2.0 Web 3D
e-Business me-Business we-Business
Access Find Share Participate Collaborate Co-Create ?
On the basis of IBM-Roadmap
NBRUH, Industry meeting, 18 June 2009
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13. Future for Internet hearing services:
Web3D
• Virtual World in the Internet
– Based on 3D technologies
– Users create their avatar to
represent themselves
– move through the virtual world
– meet other users, get information,
buy products and services, …
• New opportunities for hearing care
– Simulated hearing care process
– “Real” diagnostic tests
– Virtual fitting
– Simulated use of hearing aids
– Direct link to real life hearing care
NBRUH, Industry meeting, 18 June 2009
Virtual Worlds
Augmentation
• Impression of reality
• Additional information
Simulation
• Synthetic presentation offers freedom for
creativity
• Cost Savings (e.g. virtual 3D prototyping)
Immersive Experience
• Content is part of the environments
• User interacts with the environments
Intimate
• Ego- and Birds-Eye-perspective possible
• Anonymity, users decide on what they
present
NBRUH, Industry meeting, 18 June 2009
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14. Conclusions
Hearing screening by Internet is a valid tool for first
assessment of hearing problems
Easy, short, inexpensive, private
Screenings tests
Digit-triplet speech-in-noise (Internet and telephone)
Localization
Questionnaire
40 to 50 % follow the recommendation
Internet follow-up: HearCompanion
Future: Internet hearing care with Web3D
NBRUH, Industry meeting, 18 June 2009
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