Mobile Application for Hearing Conditioning Before the Hearing Test

Abstract

Background: Hearing testing in children is challenging in a busy audiology clinic. Most children feel uncomfortable due to unfamiliar places and people during hearing tests. Children with temper tantrums increase the clinician's task load during hearing testing, eventually postponing the testing session. Furthermore, these problems aggravate while testing children with multiple disability or associate problems. A clinician counsel parents to condition the child to respond to sound using noise-making toys. However, in the clinic, the hearing thresholds are obtained from stimuli such as pure tone and noise of different frequencies and speech stimuli. Unfortunately, the children conditioned using noise-making toys (trained) do not experience the stimuli (untrained) they hear in the clinic. Furthermore, it is difficult for the parents to carry out the training sessions without supervision. All these factors result in increased test time, postponement of tests, and multiple visit to clinic eventually leading to delayed diagnosis and rehabilitation and at times dropout. It is hypothesized that if the stimuli used in test setting and conditioning are same, with a structured conditioning paradigm provided to parents, facilitates conditioning of the child. This reduces the test time in the clinic and facilitates early diagnosis and rehabilitation. Thus, there is a need to develop an app-based method to deliver the stimuli in a controlled manner. It accentuates effective pairing between stimulus and response. Objectives: a) to compare the clinician's task load in the pure tone audiometry (PTA) testing among children conditioned using the conventional and the app-based methods before and after conditioning to respond to sounds. b) to correlate the overall task load of the clinician between before and after conditioning, and c) To determine the number of sessions required to complete the PTA testing in children conditioned using the conventional and app-based methods. Method: Comparative research design was utilized to determine the effectiveness of the conditioning method for hearing before PTA testing. A total of 30 participants (age = > 2 years to <3.6 years) were recruited using the convenient sampling method to allocate the children into two groups conditioned with either conventional (n=15) or app-based methods (n=15). The NASA task load tool assessed clinician workload in the PTA testing among children before and after conditioning in each method. In addition, the number of sessions required to complete PTA testing among children conditioned using each method was determined. Results: The parameters of the clinician's task load in the PTA testing were significantly lesser in those children conditioned using the app-based method than the conventional method. As expected, irrespective of the conditioning method, the clinician's task load was significantly lesser after conditioning than before conditioning. Besides, there was no correlation in the overall task load of the clinician before and after conditioning. It was true for each conditioning method. Furthermore, the number of sessions required to complete the PTA testing in children conditioned using the app-based method was significantly lesser than the conventional method. Conclusions: App-based conditioning produces a strong pair between stimulus and response among children. At least three weeks are required for conditioning to effectively respond to sound using the app-based method for assessing hearing threshold. A significant clinician's task load was found than the conventional method.