Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

An off-the-shelf otoacoustic-emission probe for hearing screening via a smartphone

Abstract

Otoacoustic emissions (OAEs) provide information about the function of the outer hair cells of the cochlea. In high-income countries, infants undergo OAE tests as part of the screening protocols for hearing. However, the cost of the necessary equipment hinders early screening for hearing in low- and middle-income countries, which disproportionately bear the brunt of disabling hearing loss. Here we report the design and clinical testing of a low-cost probe for OAEs. The device, which has a material cost of approximately US$10, uses an off-the-shelf microphone and off-the-shelf earphones connected to a smartphone through a headphone jack. It sends two pure tones through each of the headphone’s earbuds and algorithmically detects the distortion-product OAEs generated by the cochlea and recorded via the microphone. In a clinical study involving 201 paediatric ears across three healthcare sites, the device detected hearing loss with 100% sensitivity and 88.9% specificity, comparable to the performance of a commercial device. Low-cost devices for OAE testing may aid the early detection of hearing loss in resource-constrained settings.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Overview of the earphone-based OAE probe system.
Fig. 2: Performance of the clinical study.
Fig. 3: Device performance in infant ears under 6 months of age.
Fig. 4: Audiograms of patient ears.
Fig. 5: Device performance in patient ears with SNHL.
Fig. 6: Benchmark testing across multiple smartphones.
Fig. 7: Benchmark testing of hardware distortion.

Data availability

All data supporting the findings from this study are available within the article and its Supplementary Information. The dataset used to generate the results for this study is available at https://github.com/uw-x/oae and https://zenodo.org/record/7032657 (ref. 48). Source data are provided with this paper.

Code availability

The custom code used in this study is available at https://github.com/uw-x/oae and https://zenodo.org/record/7032657 (ref. 48).

References

  1. Millions of People in the World Have Hearing Loss That Can Be Treated or Prevented (WHO, 2013); https://www.who.int/news/item/27-02-2013-millions-have-hearing-loss-that-can-be-improved-or-prevented

  2. Childhood Hearing Loss—Strategies for Prevention and Care (WHO, 2016); https://apps.who.int/iris/bitstream/handle/10665/204632/9789241510325_eng.pdf

  3. Patel, H. & Feldman, M. Universal newborn hearing screening. Paediatr. Child Health 16, 301–305 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. McPherson, B. Newborn hearing screening in developing countries: needs & new directions. Indian J. Med. Res. 135, 152 (2012).

    PubMed  PubMed Central  Google Scholar 

  5. Swanepoel, D. W. et al. Telehealth in audiology: the need and potential to reach underserved communities. Int. J. Audiol. 49, 195–202 (2010).

    Article  Google Scholar 

  6. Chan, J. & Gollakota, S. Inner-ear cochlea testing with earphones. In Proc. 20th Annual International Conference on Mobile Systems, Applications and Services 609–610 (ACM, 2022).

  7. Abdala, C. & Visser-Dumont, L. Distortion product otoacoustic emissions: a tool for hearing assessment and scientific study. Volta. Rev. 103, 281 (2001).

    PubMed  PubMed Central  Google Scholar 

  8. Walker, J. J., Cleveland, L. M., Davis, J. L. & Seales, J. S. Audiometry screening and interpretation. Am. Fam. Physician 87, 41–47 (2013).

    PubMed  Google Scholar 

  9. Mimi Hearing Test (Mimi Hearing Technologies GmbH, 2022); https://apps.apple.com/us/app/mimi-hearing-test/id932496645

  10. Hearing Test—Audiometry, Tone (IT4YOU Corp., 2022); https://apps.apple.com/us/app/hearing-test-audiometry-tone/id1368396053

  11. Hearing Test & Ear Age Test (PortTownSoft, 2022); https://apps.apple.com/us/app/hearing-test-ear-age-test/id1067630100

  12. Thompson, D. C. et al. Universal newborn hearing screening: summary of evidence. JAMA 286, 2000–2010 (2001).

    Article  CAS  PubMed  Google Scholar 

  13. Torre, P. III, Cruickshanks, K. J., Nondahl, D. M. & Wiley, T. L. Distortion product otoacoustic emission response characteristics in older adults. Ear Hear. 24, 20–29 (2003).

    Article  PubMed  Google Scholar 

  14. Heitmann, N., Rosner, T. & Chakraborty, S. Designing a single speaker-based ultra low-cost otoacoustic emission hearing screening probe. In 2020 IEEE Global Humanitarian Technology Conference (GHTC) 1–8 (IEEE, 2020).

  15. Campbell, L. J. & Slater, K. D. Personalization of auditory stimulus. US patent 10154333B2 (2018).

  16. Heitmann, N., Rosner, T. & Chakraborty, S. Mass-deployable smartphone-based objective hearing screening with otoacoustic emissions. In Proc. 2021 International Conference on Multimodal Interaction 653–661 (ACM, 2021).

  17. Heitmann, N. et al. Sound4all: towards affordable large-scale hearing screening. In 2017 12th International Conference on Design & Technology of Integrated Systems in Nanoscale Era (DTIS) 1–6 (IEEE, 2017).

  18. Novel pediatric hearing screening device. Johns Hopkins Technological Ventures http://jhu.technologypublisher.com/technology/40355 (2018).

  19. Generic eartips from Grason Associates fitment guide eartips. Electro-Medical Instruments https://www.emi-canada.com/new-page-5 (2021).

  20. Newborn hearing screening protocol. Iowa Department of Public Health https://idph.iowa.gov/Portals/1/userfiles/77/Newborn%20Hearing%20Screening%20Protocol-11-08.pdf (2008).

  21. Parthasarathy, T. K. & Klostermann, B. Similarities and differences in distortion-product otoacoustic emissions among four FDA-approved devices. J. Am. Acad. Audiol. 12, 397–405 (2001).

    Article  CAS  PubMed  Google Scholar 

  22. Frequently asked questions: EroScan OAE Test System. Maico https://www.schoolhealth.com/media/pdf/51075_FAQ%20EroScan.pdf (2022).

  23. Chan, J., Michaelsen, K., Estergreen, J. K., Sabath, D. E. & Gollakota, S. Micro-mechanical blood clot testing using smartphones. Nat. Commun. 13, 1–12 (2022).

    Article  CAS  Google Scholar 

  24. Funk, J. Technology change, economic feasibility, and creative destruction: the case of new electronic products and services. Ind. Corp. Change 27, 65–82 (2018).

    Article  Google Scholar 

  25. Device compatibility overview. Android Developers https://developer.android.com/guide/practices/compatibility (2022).

  26. For iPhone headphone adapter 3.5 mm jack aux cord dongle audio cable connector US. eBay https://www.ebay.com/itm/313802818623 (2022).

  27. Device software functions including mobile medical applications. US FDA https://www.fda.gov/medical-devices/digital-health-center-excellence/device-software-functions-including-mobile-medical-applications (2019).

  28. Policy for device software functions and mobile medical applications. US FDA https://www.fda.gov/regulatory-information/search-fda-guidance-documents/policy-device-software-functions-and-mobile-medical-applications (2019).

  29. Software as a medical device (SaMD). US FDA https://www.fda.gov/medical-devices/digital-health-center-excellence/software-medical-device-samd (2018).

  30. Software as a Medical Device: Possible Framework for Risk Categorization and Corresponding Considerations (2014); http://www.imdrf.org/docs/imdrf/final/technical/imdrf-tech-140918-samd-framework-risk-categorization-141013.pdf

  31. What are examples of software as a medical device? US FDA https://www.fda.gov/medical-devices/software-medical-device-samd/what-are-examples-software-medical-device (2017).

  32. Examples of premarket submissions that include MMAs cleared or approved by the FDA. US FDA https://www.fda.gov/medical-devices/device-software-functions-including-mobile-medical-applications/examples-premarket-submissions-include-mmas-cleared-or-approved-fda (2019).

  33. Chan, J., Raju, S., Nandakumar, R., Bly, R. & Gollakota, S. Detecting middle ear fluid using smartphones. Sci. Transl. Med. 11, eaav1102 (2019).

    Article  PubMed  Google Scholar 

  34. Chan, J. et al. Performing tympanometry using smartphones. Commun. Med. 2, 57 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Siegel, J. & Hirohata, E. Sound calibration and distortion product otoacoustic emissions at high frequencies. Hear. Res. 80, 146–152 (1994).

    Article  CAS  PubMed  Google Scholar 

  36. Siegel, J. Ear-canal standing waves and high-frequency sound calibration using otoacoustic emission probes. J. Acoust. Soc. Am. 95, 2589–2597 (1994).

    Article  Google Scholar 

  37. Charaziak, K. K. & Shera, C. A. Compensating for ear-canal acoustics when measuring otoacoustic emissions. J. Acoust. Soc. Am. 141, 515–531 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Maico Diagnostics. School Nurses Guide to Otoacoustic Emissions (OAEs) (2009); https://www.schoolhealth.com/media/pdf/School%20Nurse%20Guide%20to%20OAEs_web%202016.pdf

  39. Hall, J. W. III The Important Role of Otoacoustic Emissions (OAEs) in Preschool Hearing Screening (2018); https://www.audiologyonline.com/articles/important-role-otoacoustic-emissions-oaes-22091

  40. Technical specifications—Lyra. Interacoustics https://www.interacoustics.com/download/lyra/3111-datasheet-for-lyra (2019).

  41. OtoRead™ – instructions for use. Interacoustics https://www.interacoustics.com/download/otoread/manuals-otoread/1236-instructions-for-use-otoread (2021).

  42. Welch Allyn® OAE hearing screener—directions for use. Welch Allyn https://www.henryschein.com/assets/Medical/80022349LITPDF.pdf (2019).

  43. r140 Portable OAE hearing screener. Resonance http://www.resonance-audiology.com/wp-content/uploads/2018/05/R14O-TECNICAL-SPECIFICATION.pdf (2018).

  44. AVLinearPCMBitDepthKey. Apple Developer Documentation https://developer.apple.com/documentation/avfaudio/avlinearpcmbitdepthkey (2022).

  45. USB Digital Audio. Android Open Source Project https://source.android.com/devices/audio/usb (2022).

  46. Reavis, K. M. et al. Distortion-product otoacoustic emission test performance for ototoxicity monitoring. Ear Hear. 32, 61 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Goodman, S. S., Fitzpatrick, D. F., Ellison, J. C., Jesteadt, W. & Keefe, D. H. High-frequency click-evoked otoacoustic emissions and behavioral thresholds in humans. J. Acoust. Soc. Am. 125, 1014–1032 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Chan, J. et al. A low-cost smartphone-based otoacoustic emission device for hearing loss. Zenodo https://doi.org/10.5281/zenodo.7032657 (2022).

Download references

Acknowledgements

We thank our participants and their families at Seattle Children’s Hospital. We thank K. Sie, D. Horn and H. Ou at the Seattle Children’s Hospital and Research Institute for permitting us to recruit patients from their clinics. We thank S. Norton for her critical and important feedback on the manuscript and methods. N.A. discloses support for the research described in this study from the National Institute on Deafness and Other Communication Disorders award T32DC000018. R.B. and S.G. disclose support for the research described in this study from the Washington Research Foundation, Seattle Children’s Research Institute, Research Integration Hub. S.G. discloses support for the research described in this study from the Moore Inventor Fellow award #10617.

Author information

Authors and Affiliations

Authors

Contributions

All authors designed the experiments and interpreted the results. J.C. and S.G. wrote the manuscript, and N.A., A.M., L.R.M., E.G. and R.B. edited the manuscript. J.C., N.A. and A.M. conducted the experiments and performed the analysis, under technical supervision by S.G. and J.C.; A.N. and S.G. designed the algorithms. J.C. and S.G. conceptualized the study.

Corresponding authors

Correspondence to Justin Chan, Randall Bly or Shyamnath Gollakota.

Ethics declarations

Competing interests

S.G., J.C. and R.B. are co-founders of Wavely Diagnostics, Inc. S.G. is a co-founder of Jeeva Wireless, Inc. and Sound Life Sciences. R.B. is a co-founder of EigenHealth, Inc. R.B. is a consultant and stockholder of Spiway, LLC. The other authors declare no competing interests.

Peer review

Peer review information

Nature Biomedical Engineering thanks the anonymous reviewer(s) for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary Information

Supplementary note, figures and tables.

Reporting Summary

Supplementary data

Source data for Supplementary Figs. 2, 3 and 8.

Source data

Source data for Figs. 2–7.

Source data for all main figures.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chan, J., Ali, N., Najafi, A. et al. An off-the-shelf otoacoustic-emission probe for hearing screening via a smartphone. Nat. Biomed. Eng 6, 1203–1213 (2022). https://doi.org/10.1038/s41551-022-00947-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41551-022-00947-6

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing