Over the past few decades, we have witnessed a dramatic rise in life expectancy owing to significant advances in medical science and technology, medicine as well as increased awareness about nutrition, education, and environmental and personal hygiene. Consequently, the elderly population in many countries are expected to rise rapidly in the coming years. A rapidly rising elderly demographics is expected to adversely affect the socioeconomic systems of many nations in terms of costs associated with their healthcare and wellbeing. In addition, diseases related to the cardiovascular system, eye, respiratory system, skin and mental health are widespread globally. However, most of these diseases can be avoided and/or properly managed through continuous monitoring. In order to enable continuous health monitoring as well as to serve growing healthcare needs; affordable, non-invasive and easy-to-use healthcare solutions are critical. The ever-increasing penetration of smartphones, coupled with embedded sensors and modern communication technologies, make it an attractive technology for enabling continuous and remote monitoring of an individual’s health and wellbeing with negligible additional costs. In this paper, we present a comprehensive review of the state-of-the-art research and developments in smartphone-sensor based healthcare technologies. A discussion on regulatory policies for medical devices and their implications in smartphone-based healthcare systems is presented. Finally, some future research perspectives and concerns regarding smartphone-based healthcare systems are described.

https://www.mdpi.com/1424-8220/19/9/2164/pdf

Smartphone Sensors for Health Monitoring and Diagnosis.

Previous work has shown that brain oscillations, particularly alpha rhythms (8-12 Hz) play important roles in sensory processes involving working memory and attention. In recent years, the role of cognition (working memory and attention) has been increasingly appreciated in speech in noise perception. However, no previous study has examined brain oscillations during performance of a continuous speech perception test. The aim of this study was to measure cortical alpha rhythms during attentive listening in a commonly used speech in noise task (digits-in-noise, DiN) to better understand the neural processes associated with “top-down” cognitive processing in adverse listening environments. We recruited 14 normal hearing young adults. DiN speech reception threshold (SRT) was measured in an initial behavioral experiment. EEG activity was then collected (i) while performing the DiN near SRT, and (ii) while attending to a silent, close-caption video during presentation of identical digit stimuli that the participant was instructed to ignore. Three main results were obtained: (1) during attentive (‘active’) listening to the DiN, a number of distinct neural oscillations were observed (mainly alpha with some beta; 15-30 Hz). No stimulus induced oscillations were observed during attention to the video (‘passive’ listening); (2) overall, alpha event-related synchronization (ERS) of central/parietal sources were observed during active listening when data were grand averaged across all participants. In some participants, a smaller magnitude alpha event-related desynchronization (ERD), originating in temporal regions, was observed; (3) when individual EEG trials were sorted according to correct and incorrect digit identification, the temporal alpha ERD was consistently greater on correctly identified trials. No such consistency was observed with the central/parietal alpha ERS. These data demonstrate that changes in alpha activity are specific to listening conditions. To our knowledge, this is the first report that shows almost no brain oscillatory changes during a passive task compared to an active task in any sensory modality. Temporal alpha ERD was related to correct digit identification.

/pdf/cortical-alpha-oscillations-predict-speech-intelligibility-1scn78wrnt.pdf

Cortical Alpha Oscillations Predict Speech Intelligibility.

The number and variety of eHealth services for adults and older adults who use hearing aids (HAs) are growing rapidly. This area holds promise to increase cost-efficiency, enable better access to care, and improve patient outcomes and satisfaction. Despite the increasing interest in this field, an up-to-date picture of recent research in the area of eHealth for adults with HAs is lacking. In this state-of-the-art review we assessed the literature from the past decade about eHealth use in the HA adult patient journey. Systematic searches were conducted in CINAHL, PubMed, Scopus, and Web of Science. A total of 34 peer-reviewed empirical records were identified from the searches and from the reference lists of searched records. Records were characterized based on: eHealth platform (i.e.: offline, Internet-based, or mobile-based), service [i.e.: education and information, screening and assessment, hearing rehabilitation, or general (tele-audiology)], and phase of the patient journey (i.e.: pre-fitting, fitting, or post-fitting). The review highlighted a growing interest in the field, as revealed by an increasing trend over the search period, from 2 records in 2009-2010 up to 17 records in 2015-2016. Internet-based platforms were the most frequently used (present in more than half of the included records), with a stable trend in the period. About one-third of the records introduced services over offline platforms, whereas mobile-based platforms were used only in 6 out of 34 records, suggesting that the clinical uptake of mobile services is still limited compared to more mature offline and Internet-based platforms. Most of the eHealth services observed were related to the areas of education and information (42.5%) and hearing rehabilitation (40.4%), whereas 10.7% were related to screening and assessment, and 6.4% to general tele-audiology services. Many services covered different phases of the patient journey, especially the fitting and post-fitting phases. Overall, this review showed that the field of eHealth in the context of HA rehabilitation in adults has grown in the recent past. Research is still needed to increase the uptake and efficacy of eHealth in clinical practice, especially in terms of technology developments, technical and clinical validation, and optimization of strategies for service delivery.

/pdf/ehealth-and-the-hearing-aid-adult-patient-journey-a-state-of-i2hgb094sd.pdf

eHealth and the hearing aid adult patient journey: a state-of-the-art review.

Importance An effective and sustainable hearing loss (HL) screening strategy for the early detection of and intervention for HL in older adults is needed. Objectives To examine the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures across different population subgroups of a representative sample of people 50 years and older in England. Design, Setting, and Participants This study was a cross-sectional analysis of wave 7 of the English Longitudinal Study of Ageing (ELSA), a large, population-based, prospective cohort study that provides a unique resource for exploring issues associated with aging in England in the 21st century. The full analytic cohort was composed of 9666 individuals participating in the ELSA wave 7, which collected information from June 1, 2014, to May 31, 2015. This study further analyzed a sample of 8529 adults 50 to 89 years of age who had an assessment of their hearing by self-reported measures, and consented to assessment by a qualified nurse via a hearing screening device, and did not have an ear infection or a cochlear implant. Bivariate analyses were performed from July 1 to December 30, 2018, and multivariate analysis from January 1 to June 30, 2019. Multiple logistic regression models examined factors associated with misclassification of hearing difficulties across several categories among those with objectively identified HL. Exposures The study examined whether age, marital status, retirement status, indicators of socioeconomic position, and lifestyle factors (such as body mass index, physical activity, and tobacco and alcohol consumption) were associated with the concordance between self-reported hearing problems and manual audiometry among older adults. Main Outcomes and Measures Self-reported hearing measures, including hearing in background noise, compared with objective audiometric assessments. Results A total of 9666 study participants (5368 female [55.5%]; mean [SD] age, 67.4 [14.4] years) provided responses regarding their hearing difficulties, hearing in noise, quality of care in hearing, and hearing aid recommendation in ELSA wave 7. Within the cohort, 684 individuals (30.2%) with objectively measured HL greater than 35 dB HL at 3.0 kHz went undetected by the self-report measure, whereas the new constructed categories for moderate and moderately severe or severe HL resulted in 9.3% increased sensitivity. Factors associated with misreporting hearing difficulties (while they had objectively measured HL >35 dB HL at 3.0 kHz, in the better-hearing ear) were as follows: female sex (odds ratio [OR], 1.97; 95% CI, 1.18-3.28), no educational qualifications (OR, 1.37; 95% CI, 1.26-2.55), routine or manual occupation (OR, 1.43; 95% CI, 1.28-2.61), tobacco consumption (OR, 1.14; 95% CI, 1.08-1.90), alcohol intake above the low-risk-level guidelines (OR, 1.13; 95% CI, 1.11-2.34), and lack of moderate physical activity (OR, 1.25; 95% CI, 1.03-1.42). Age was largely associated with misreporting of moderately severe to severe HL; the odds were 5.75 (95% CI, 1.17-8.13) higher for those 65 to 74 years of age and 7.08 (95% CI, 1.41-9.30) higher for those 75 to 89 years of age to not report their hearing difficulties compared with those 50 to 64 years of age. In addition, socioeconomic indicators, such as educational level (OR, 1.95; 95% CI, 1.63-6.01) and occupation (OR, 2.07; 95% CI, 1.78-5.40), along with lifestyle factors, such as smoking (OR, 1.46; 95% CI, 1.25-2.48) and alcohol intake above the low-risk-level guidelines (OR, 1.86; 95% CI, 1.67-5.12), were factors associated with misreporting moderately severe or severe HL. Conclusions and Relevance The use of a screening measure for audiometric testing and a self-report measure is essential for accurately identifying older people with HL. The results of this study should be considered by HL researchers who analyze self-reported hearing data as a surrogate measurement of audiometric hearing to identify bias in their observed analytic research results.

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Comparison of Self-reported Measures of Hearing With an Objective Audiometric Measure in Adults in the English Longitudinal Study of Ageing

Objective: To evaluate the performance of self-reported hearing loss alone and in combination with pure tone audiometry screening in primary health care clinics in South Africa. Design: Nonprobabil...

https://journals.sagepub.com/doi/pdf/10.1177/2150132718803156

Self-Reported Hearing Loss and Pure Tone Audiometry for Screening in Primary Health Care Clinics

OBJECTIVE To evaluate the performance of smartphone-based hearing screening with the hearScreen application in terms of sensitivity, specificity, referral rates, and time efficiency at two primary health care clinics. DESIGN Nonprobability purposive sampling was used at both clinics. A total of 1236 participants (mean age: 37.8 ± SD 17.9 and range 3 to 97 years; 71.3% female) were included in the final analysis. Participants were screened using the hearScreen application following a two-step screening protocol and diagnostic pure-tone audiometry to confirm hearing status. RESULTS Sensitivity and specificity for smartphone screening was 81.7 and 83.1%, respectively, with a positive and negative predictive value of 87.6 and 75.6%, respectively. Sex [χ(1, N = 126) = 0.304, p > 0.05] and race [χ(1, N = 126) = 0.169, p > 0.05)] had no significant effect on screening outcome for children while for adults age (p < 0.01; β = 0.04) and sex (p = 0.02; β = -0.53) had a significant effect on screening outcomes with males more likely to fail. Overall referral rate across clinics was 17.5%. Initial screening test times were less than a minute (48.8 seconds ± 20.8 SD) for adults and slightly more than a minute for children (73.9 seconds ± 44.5 SD). CONCLUSIONS The hearScreen smartphone application provides time-efficient identification of hearing loss with adequate sensitivity and specificity for accurate testing at primary health care settings.

/pdf/smartphone-based-hearing-screening-at-primary-health-care-5dz6tjkuv4.pdf

Smartphone-Based Hearing Screening at Primary Health Care Clinics.

To compare outcomes of a community-based hearing screening programme using smartphone screening audiometry operated by specialist (School Health Nurses – SHNs) and non-specialist health workers (Co...

Mhealth hearing screening for children by non-specialist health workers in communities.

Background: Hearing loss prevalence data in South Africa is scarce, especially within primary health care settings. Objectives: To determine; (i) the prevalence of hearing disorders in patients ≥3 years of age attending two primary health care clinics, and (ii) the nature and characteristics of hearing disorders at these primary health care clinics. Method: A cross-sectional design was used at two primary health care clinics. Non-probability purposive sampling was used to screen participants at clinics for hearing loss with pure tone audiometry. A total of 1236 participants were screened (mean age 37.8 ±17.9 years). Diagnostic testing was available for confirmation of hearing loss on participants who failed the screening. Results: Hearing loss prevalence was 17.5% across both clinics. Most hearing losses were bilateral (70.0%) and were of a sensorineural nature (84.2%). Conclusion: Hearing loss prevalence was comparable at both primary health care clinics. Participants 40 years and older were at significantly higher risk for hearing loss. The current study is the first attempt to establish hearing loss prevalence for primary health care clinics in South Africa. Keywords: Hearing loss, primary health care clinics, South Africa.

/pdf/prevalence-of-hearing-loss-at-primary-health-care-clinics-in-3xnt1c37rc.pdf

Prevalence of hearing loss at primary health care clinics in South Africa.

OBJECTIVE
To evaluate differences in tinnitus impact, hyperacusis and hearing threshold level (HTL) between patients with unilateral and bilateral tinnitus. For patients with unilateral tinnitus, to compare audiological variables for the tinnitus ear and the non-tinnitus ear. To assess whether the presence of unilateral tinnitus increases the likelihood of interaural hearing asymmetry (relative to bilateral tinnitus) that warrants referral for an MRI scan.


DESIGN
Retrospective cross-sectional.


STUDY SAMPLE
Data regarding HTLs and responses to self-report questionnaires were collected from the records of 311 patients attending a tinnitus clinic.


RESULTS
38.5% had unilateral tinnitus and the ears with tinnitus had higher HTLs and greater HTL slopes than the ears without tinnitus. There was no significant difference in tinnitus impact and hyperacusis between patients with unilateral and bilateral tinnitus. 40% of patients with unilateral tinnitus and 13% of patients with bilateral tinnitus had a between-ear difference in HTL ≥15 dB at two adjacent frequencies (2AF15 asymmetry). Unilateral tinnitus increased the risk of 2AF15 asymmetry by a factor of 4.4.


CONCLUSIONS
Unilateral tinnitus increases the risk of having interaural asymmetry in HTLs that warrants referral for an MRI scan.

A comparison of interaural asymmetry, audiogram slope, and psychometric measures of tinnitus, hyperacusis, anxiety and depression for patients with unilateral and bilateral tinnitus.

Christine Louw

Papers

Smartphone-Based Hearing Screening at Primary Health Care Clinics.

Self-Reported Hearing Loss and Pure Tone Audiometry for Screening in Primary Health Care Clinics

Mhealth hearing screening for children by non-specialist health workers in communities.

Prevalence of hearing loss at primary health care clinics in South Africa.

A comparison of interaural asymmetry, audiogram slope, and psychometric measures of tinnitus, hyperacusis, anxiety and depression for patients with unilateral and bilateral tinnitus.