Reliability of Primary Health Care Audiograms by Non-Qualified Examiners-An Analysis of 1,224 Cases.

Kokkonen, Jukka; Varonen, Sini

OBJECTIVE To evaluate the accuracy of primary health care audiograms conducted by non-qualified examiners in a non-standard acoustic environment. STUDY DESIGN Retrospective chart review. SETTING Referring primary health care institutions and hospital hearing center. PATIENTS One thousand two hundred twenty four adult patients evaluated for hearing aid fitting at North Karelia Central hospital in years 2017 and 2018. MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC), mean threshold differences, and mean absolute errors were used to assess agreement between primary health care and hospital audiograms. Primary health care audiometry sensitivity, specificity and positive (PPV) and negative (NPV) predictive values were calculated for hearing aid candidacy in general and open ear mold candidacy in particular. RESULTS ICC for both better ear hearing level (BEHL0.5,1,2,4 kHz) and pure-tone average (PTA0.5,1,2,4 kHz) in frequencies 0.5, 1, 2, and 4 kHz was 0.82, and in individual full octave frequencies from 0.125 to 8 kHz ranged from 0.70 to 0.83. Mean threshold differences in BEHL0.5,1,2,4 kHz and PTA0.5,1,2,4 kHz were 1.8 and 1.6 dB and mean absolute errors 4.9 and 5.3 dB, respectively. Sensitivity for hearing aid candidacy was 0.97, specificity 0.58, PPV 0.92, and NPV 0.79. CONCLUSIONS Primary health care audiometry is reasonably accurate, allowing preselection of patients to adequate hearing care pathways.