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Original research
Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis
  1. Anitha Vijayasingam1,
  2. Emily Frost2,
  3. Julie Wilkins2,
  4. Lise Gillen3,
  5. Presanna Premachandra3,
  6. Kate Mclaren1,
  7. Desmond Gilmartin1,
  8. Lorenzo Picinali4,
  9. Alberto Vidal-Diez5,
  10. Simone Borsci5,6,
  11. Melody Zhifang Ni5,
  12. Wai Y Tang7,8,
  13. Deborah Morris-Rosendahl7,8,
  14. Jonny Harcourt9,
  15. Caroline Elston10,
  16. N J Simmonds1,8,
  17. Anand Shah1,8
  1. 1 Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 Department of Audiology, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Department of Audiology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
  4. 4 Dyson School of Design Engineering, Imperial College London, London, UK
  5. 5 London In Vitro Diagnostics Collaborative, Department of Surgery and Cancer, Imperial College London, London, UK
  6. 6 Department of Cognitive Psychology and Ergonomics, Faculty of Behavioural Management and Social sciences, University of Twente, Enschede, Overijssel, Netherlands
  7. 7 Clinical Genetics and Genomics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  8. 8 National Heart and Lung Institute, Imperial College London, London, UK
  9. 9 Department of Ear, Nose and Throat, Imperial College Healthcare NHS Trust, London, UK
  10. 10 Department of Cystic Fibrosis, King's College Hospital NHS Foundation Trust, London, London, UK
  1. Correspondence to Dr Anand Shah, Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; s.anand{at}


Introduction Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF.

Methods Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined.

Results Prevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz.

Conclusions Adults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.

  • cystic fibrosis
  • systemic disease and lungs
  • respiratory Infection

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  • Funding This study was funded through a Clinical Innovation and Excellence award from the UK Cystic Fibrosis Trust and the NHS Darzi Fellowship in Clinical Leadership programme. Alberto Vidal-Diez and Melody Ni received funding from the National Institute of Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

  • Competing interests AS has received grant funding from Vertex Pharmaceuticals and Gilead Sciences and received personal fees for lecturing from Gilead Sciences. NJS has received personal fees for consultancy and lecturing from Vertex, Teva and Zambon Pharmaceuticals, Chiesi Ltd, Novartis International, Pulmocide Ltd, Roche and Gilead Sciences. CE has received personal fees for consultancy and lecturing from Gilead Sciences, Teva and Zambon Pharmaceuticals.

  • Patient consent for publication Not required.

  • Ethics approval Study materials and protocols were approved by the South-Central Research Ethics Committee (REC reference: 18/SC/0057) with informed written consent obtained at participant's clinic visit or inpatient stay.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. De-identified participant data is available on request from corresponding author. ORCID ID: 0000-0001-5257-520X.

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