The true cost of booth-less audiometry is incurred by either the hearing healthcare practitioner or the patient/s. A balance needs to be struck between cost-effective implementation of boothless audiometry in the practice whilst ensuring continued accurate patient audiometric measurements.
The number of people living with hearing loss is significantly high and is on the rise. The World Health Organization (WHO) has estimated that over 900 million people worldwide will have disabling hearing loss by the year 2050. The majority of individuals with hearing loss live in low- to middle income countries where there is a paucity of hearing healthcare resources (i.e. audiologist, ENT, and evaluation equipment). Even in developed countries the ratio of clinician to patient is low, with one audiologist for every 20000 people.
Besides the lack of human resources, one of the major contributors to the lack of audiometric services is the immobile and costly sound treated booth. As a result, there has been an increase in the manufacturing of boothless audiometers to meet the increasing demand for hearing healthcare services - but not all boothless audiometers are equal.
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THE TRUE COST
For a cost-effective implementation of bothless audiometry, either for the patients test results or the practitioners finances, one has to consider both the initial and recurring fees of having the audiometer and utilizing it, but more importantly the ambient noise attenuation levels and test battery of the equipment.
The true cost of boothless audiometry lies with our patients. In general, boothless audiometry comes with two major limitations - insufficient ambient noise attenuation and a limited test battery for appropriate diagnosis, treatment, and referrals. Insufficient ambient noise attenuation test battery can lead to inaccurate audiometric measurements. In addition to this, the limited test battery may result in patients going back-and-forth, from one practitioner to another for additional tests such as bone conduction or speech audiometry. This can prove costly and time consuming to the patient.
What is crucial when proving hearing health care services using boothless audiometers, is to ensure that the equipment can attenuate ambient noise sufficiently for testing down to 0 dB HL and 15 dB HL in diagnostic and screening assessment, respectively. Many audiometers or transducers are designed for use inside of a sound-treated booth, as a result, the use of such devices outside of sound booth settings may result in inaccurate test results due to excessive ambient noise.
Secondly it is of importance to ensure the right equipment is purchased for the services that your audiology clinic will be providing. A large number of boothless audiometers are limited in their ability to conduct certain crucial audiological assessments - many which would be provided in traditional audiology settings. Such assessment tools would allow you, as the clinician, to provide comprehensive diagnostic evaluations to your patients to ensure that the right diagnosis (differential diagnosis) is made, the appropriate management and treatment is provided, and referrals are direct - if necessary.
PRICING AND FEATURES COMPARISON
In the interest of reviewing the financial and/or clinical cost incurred by the hearing healthcare practitioner, a table below details average price lists and audiometric features of boothless audiometers. This list was shortened to four well known (according to the author’s knowledge) boothless audiometers. The features detailed in the table below were extracted from the studies listed below and from manufacturers websites. In addition, the audiometer prices were extracted from multiple sources (i.e. manufacture website, publications etc). It is important to contact the manufacturer for an accurate quotation.
- Yancey, K. L., Cheromei, L. J., Muhando, J., Reppart, J., Netterville, J. L., & Jayawardena, A. D. (2019). Pediatric hearing screening in low-resource settings: Incorporation of video-otoscopy and an electronic medical record. International journal of pediatric otorhinolaryngology, 126, 109633.
- Jayawardena, A., Waller, B., Edwards, B., Larsen-Reindorf, R., Anomah, J. E., Frimpong, B., ... & Basura, G. J. (2019). Portable audiometric screening platforms used in low-resource settings: a review. The Journal of Laryngology & Otology, 133(2), 74-79.
|
KUDUwave |
AMTAS |
SHOEBOX |
HearX |
|
|
Initial purchase price (basic) |
~$4000 |
~$4000 |
~$4000 |
~$860-1400 |
|
Subscription? |
No |
No |
Shifts to subscription model |
Yes - costs depends on assessment volumes |
|
Hardware used for attenuation of Ambient noise |
Ambi-dome (Insert and circumaural earphones together) |
RadioEar DD450 |
RadioEar DD450 E-A-RTONE 3A Inserts Sennheiser HDA280 |
Sennheiser HD280/ HDA 300/ HD 280 Pro |
|
Additional hardware required |
PC |
Tablet Or GSI audiometer for the Pro version |
Tablet |
Headsets and cell phones supplied |
|
Air- and Bone conduction |
Yes |
Yes |
Yes |
No |
|
Speech audiometry |
Yes SRT/WR Speech-In-Noise CAPD |
SRT/WR |
SRT/WR |
Speech-In-Noise |
|
Masking |
Yes |
Yes |
Yes |
Yes |
|
Extended-High Frequency |
Yes |
Yes |
Yes |
Yes |
|
Upgradable to additional audiological test battery? |
Tympanometry Acoustic reflex |
N/A |
N/A |
Video otoscopy |
*The financial values shown in the table are expressed in US dollars. This article was written in 2020 and financial values may have fluctuated since.
As shown in the table above, the initial prices of the Kuduwave, AMTAS, and SHOEBOX are roughly similar. Some audiometers have a subscription model that applies after purchases of the audiometer/ headsets. This needs to be taken into account.
Perhaps one of the biggest differences between the four audiometers tabled above is the different levels of ambient noise attenuation capabilities. Information pertaining to the attenuation of these audiometers has been extracted from multiple sources and plotted on the graph below. The higher the ambient noise a transducer or hardware can attenuate, the higher the noise can be during audiometry testing. In essence, some transducers will be able to handle the noise in school settings during school-based hearing screenings while some won’t. As noted from the graph below, the KUDUwave far exceeds the attenuation levels of various boothless transducers/audiometers in the market. This affords the KUDUwave to be used in much louder environments and to test lower intensities than most transducers (i.e. -10 dB HL).
The use of audiometric transducers with lower attenuation capabilities in noisy environments can lead to elevated and inaccurate thresholds. This may result in misdiagnosis and management of the patient. From a clinical standpoint, the use of such transducers might affect the services that you can provide. For example, if a transducer has lower attenuation capabilities, then you might be forced to only evaluate patients in a booth setting. Or in relatively quiet environments. As a result you may not be able to provide school, community, and occupational-based hearing healthcare services.
Attenuation values for earphones/ headphones used in boothless audiometry.
*Swanepoel et al. (2015) | ‘RadioEar DD450 spec sheet | ^Madsen and Margolis (2014)
AUDIOMETRIC CLINICAL CAPABILITIES
As shown in the pricing and features comparison table, not all boothless audiometers are the same nor can they be used to provide the same services. As noted above, some audiometers only allow the clinician to conduct air conduction testing. It is a known fact that bone conduction testing is crucial for diagnosis purposes and to identify the site of lesion. Pure tone air conduction alone may not always be sufficient to make an accurate and valid diagnosis.
In addition, certain populations may require objective assessments such as immittance audiometry in order to come to a final diagnosis.
It is important to note the initial, interim, and final cost of the audiometer you purchase. Either the cost is to you or your practice. Certain considerations are paramount when making these choices.
Finally it is important to understand that not all booth-less audiometers are equal. Not in their ability to perform diagnostic tests, nor in their ability to attenuate ambient sound. Even the long term costs of these audiometers differ from each other.
Don’t let the true cost of booth-less audiometry have a negative impact on your patients.