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.