Publications

The evaluation of the KUDUwave™ against standards and regulations revealed that the KUDUwave™ complies with all required standards as an audiometer used for hearing conservation purposes as guided by the SANS 10083:2012. The KUDUwave™ (and its insert earphones) specifications adhere to SANS 8253-1:2011.

This report further specifies that the end-user using the KUDUwave™ for hearing conservation purposes as per the SANS 10083:2012 must comply with the minimum of three-monthly calibration and the keeping of adequate records of daily and weekly biological checks as per the SANS 10154:2012. Furthermore, as much as the KUDUwave™ is able to highly attenuate ambient noise, the user must ensure that the environment where testing down to 0 dBHL is conducted complies with maximum permissible ambient noise levels as per the SANS 10182:2006.  

This report concludes that the KUDUwave™ complies for use in hearing conservation and therefore in medical surveillance since the above-mentioned standards are requirements for SANS 10083:2012, the standard which specifies how the medical surveillance is conducted. The KUDUwave™ has an advantage for quality control of the test validity and reliability, which is often a concern in occupational and industrial settings.

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This study aimed to investigate the validity of the use of the KUDUwave™ for diagnostic pure-tone audiometry in a natural environment. The KUDUwave used in this study uses the combination of insert earphones covered by circumaural headphones to attenuate ambient noise during audiometric testing. The device also incorporates real-time monitoring of environmental noise in order to notify the clinician if the ambient noise is masking the tone presented. The clinician in the study waited for the ambient noise to subside before continuing with the test.  .

The sample for this study consisted of 147 elderly people with an average age of 75.8 years (Range = 65-94). The subjects in the study were included as they had visibly intact tympanic membranes through a otoscope and a normal Type A tympanogram.

Audiometric testing (air and bone conduction) was conducted using the KUDUwave in both a natural environment  (a quiet furnished room) and in a sound-treated booth in a audiology clinic separately.

The results of the study shows that both air and bone conduction thresholds corresponded within 0 to 5 dB between the two test environments. comparisons. The average threshold differences and standard deviations were within typical test-retest reliability limits. Thresholds recorded showed no statistically significant differences.This concludes and confirms that the KUDUwave can be used for valid diagnostic pure-tone audiometry in a natural environment without a sound-treated booth.

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Air- and bone conduction thresholds obtained with the KUDUwave™ were compared with those obtained by the industry standard audiometer. Both these audiometers obtained thresholds inside a soundbooth.

Results from this study indicate that air conduction thresholds recorded with the KUDUwave™ audiometer corresponded within 5 dB or less of thresholds obtained with the industry standard audiometer in 90% of all instances. Bone conduction thresholds obtained with the KUDUwave™ corresponded within 5 – 10 dB with the  industry standard audiometer.

This validates and concludes that the KUDUwave™ can yield accurate and reliable air- and bone conduction thresholds.

The study demonstrates the validity of using synchronous telemedicine for conducting hearing assessments with the KUDUwave™ in a remote rural agricultural community without a sound booth. The KUDUwave™ uses insert earphones covered by circumaural ear cups (Ambidome) to attenuate noise. The Ambidome provides noise attenuation similar to a single-walled sound booth.  Telemedicine offers unique opportunities for providing access to hearing healthcare services to underserved populations worldwide. However, it is important to validate the potential benefit that the KUDUwave™ could have to increase access. This study investigated the reliability and accuracy of synchronous KUDUwave™ audiometry in a rural agricultural community where there is limited access to audiological services.

Three test environments were used the validate the KUDUwave™ synchronous telemedicine use in a natural environment (Without booth).

1. Booth environment: Test was conducted in a single-walled booth with the clinician and participant/s face-to-face in a hospital.
2. KUDUwave™ without a soundbooth: This test was conducted with the clinician and participant/s face-to-face in the participants office on the farm.
3. Tele-audiology configuration using the KUDUwave™: The test was conducted in the second environment (KUDUwave™ use in participants office on the farm) while the clinician or tester was in a remote location 1.2 KMs away from the patient. A teleaudiology facilitator from the local community and with no formal audiology training or tertiary education facilitated the participants during the test, while an audiologist (clinician) conducted the air conduction hearing assessment through videoconferencing (Skype™)  and the wireless 3G Internet connection.

Test–retest threshold correspondence in the booth and natural environments (KUDUwave™) was within – 5 dB in 96.7% and 97.5% of comparisons. Threshold correspondence between the KUDUwave™ telemedicine compared with booth and natural environments were within – 5 dB in 82% and 85% of comparisons.

Results demonstrate KUDUwave™ telemedicine hearing assessments to be comparable to the current ‘‘gold standard.’’ These technologies make it possible for diagnostic hearing assessments to be included as part of a remote telemedicine kit and can give new opportunities in telemedicine support.

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This study investigated the accuracy of pure-tone air conduction thresholds obtained by the KUDUwave™ in automated mode of testing, with a controlled level of background noise (40 dBA), at a level that would typically be present in a closed non-sound treated room.

Air conduction thresholds from individuals with normal hearing and those with a hearing loss were collected and compared. These thresholds were obtained in three test conditions. (1) GSI-61 clinical audiometer in a double-walled sound-booth, (2) KUDUwave™ in a quiet environment (sound-treated booth), and (3) KUDUwave™ in a noisy (40 dBA) environment.

Findings from this study revealed that the KUDUwave™ testing in automatic mode can accurately obtain pure-tone air conduction thresholds in a quiet sound booth as compared to thresholds obtained with a typical clinical audiometer in a sound booth. Furthermore, this study indicates that the KUDUwave™ produced accurate thresholds in the presence of background noise (40 dBA). Ambient noise used in this study is similar to typical ambient noise found in a closed room without a sound booth. This study shows that the KUDUwave™ can be used outside of a sound booth.

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Diagnostic Pure-Tone Audiometry in Schools: Mobile Testing without a Sound-Treated Environment. (Publication)

The purpose of this study was to validate diagnostic pure-tone audiometry in school without a sound-treated booth using the KUDUwave™. The KUDUwave™ incorporates insert earphones covered by circumaural ear-cups and real-time environmental noise monitoring.

Air and bone conduction thresholds were obtained using the KUDUwave™ in natural school environments. The thresholds obtained with the KUDUwave™ were compared to thresholds obtained in a single-walled sound-treated booth with the KUDUwave™. The subjects in this study were school children with an average age of 6.9 years (Range = 5-8).

Results from the study showed no statistically significant differences between thresholds recorded in natural school environments and sound-treated booth environments for air and bone-conduction thresholds.

Diagnostic air and bone conduction audiometry in schools, without a sound-treated room, with the KUDUwave™ is possible. This is as a result of sufficient ambient noise attenuation and real-time monitoring of environmental noise provided by the KUDUwave™.

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This study investigated the accuracy, reliability and time-efficiency of automated pure-tone audiometry (air and bone conduction testing) using the KUDUwave™. This was done by comparing thresholds obtained through automated air and bone conduction audiometry using the KUDUwave™ with manually obtained air and bone conduction thresholds. Both manual and automated testing and threshold collection was done with the use of a KUDUwave™.

The KUDUwave™  automated audiometry test showed similar test-retest reliability to that of the KUDUwave™ manual audiometry across the frequency spectrum for air and bone conduction audiometry. Test-retest correspondence for both automated and manual air conduction audiometry fell within 5 dB.  Additionally, the test-retest correspondence for manual and automated bone conduction audiometry fell within a 0 to 10 dB range.

No significant difference was noted between thresholds obtained with the KUDUwave™ automated air and bone conduction audiometry when compared to the KUDUwave™ manual air and bone conduction audiometry. Automated audiometry demonstrated similar time-efficiency to manual audiometry procedures. The accuracy and reliability of the KUDUwave™ automated audiometry thus allows audiologists to confidenty use automated audiometry in their clinical test battery.

This research aimed to investigate the validity of the use of the KUDUwave™ for testing hearing threshold levels and monitoring the Percentage Loss of Hearing (PLH) in the occupational health setting for the purpose of medical surveillance of hearing without a sound booth. This study was conducted to answer the question: ‘’How do Kuduwave results compare with industry standard air conduction pure-tone audiometry?’’

Participants hearing thresholds levels were obtained with the use of a conventional audiometer inside a sound booth. The same participants were then further tested to obtain their threshold levels using the KUDUwave™ in a room without a sound booth to validate the results. The Percentage Loss of Hearing (PLH) of each participant was recorded with both the the KUDUwave and the conventional audiometer and the results compared.

The results from this study conclude and confirm that the KUDUwave is suitable for medical surveillance audiometry without the use of a sound-treated booth. Additionally, the study also confirms the clinical validity of the KUDUwave audiometer for calculating the Percentage Loss of Hearing accurately without a sound-treated booth.

Validity of Diagnostic Pure Tone Audiometry Using A Portable Computerised Audiometer Without a Sound-treated Environment. (Thesis)

Historically diagnostic air and bone conduction audiometry has been conducted in conventional annually certified audiometric test booths that allow for testing of hearing thresholds down to 0 dB. Advances in technology with double transducer attenuation incorporating insert earphones with circumaural earcups and real-time on-screen monitoring of noise provide both passive control and active quantification of transient extraneous interference for testing outside of a booth.

This study presents evidence that valid diagnostic air and bone conduction pure tone hearing thresholds can be recorded using a mobile computerised audiometer without an audiometric booth or sound-treated environment. The potential to take diagnostic audiometry beyond the regular clinical establishment may extend hearing healthcare services to patients unable to attend clinics for any number of reasons. The possibility of coupling the extension of diagnostic hearing tests outside of a sound booth with tele-audiology applications may empower hearing healthcare professionals to reach remote communities in low and middle income countries where audiometric booths and human resources are a scarce luxury and diagnostic evaluations improbable as a result. It is a global concern that communities everywhere have access to hearing healthcare services and for this cause the continued advances in technology need to be garnered and developed for the benefit of all people.

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This dissertation combines the 2 previous large studies and provides additional qualitative proof that the KUDUwave™ audiometer tests air and bone conduction with masking accurately outside a sound booth in uncertified ambient noise environments

In this study, the air and bone conduction threshold results obtained with the GSI-61 audiometer were compared with thresholds obtained with the KUDUwave™ PC based audiometer. The test-retest reliability was also assessed and compared. This was done in order to validate the KUDUwave’s air conduction and forehead bone conduction audiometry tests results. All tests were conducted in a sound-treated booth.

Air conduction thresholds for the two audiometers corresponded within 5 dB or less. Whilst bone conduction thresholds corresponded with 10 dB or less. Occlusion effect may have influenced BC thresholds in this study. The researcher minimized the occlusion effect by deeply inserting the earphones down to the bony areas during BC testing. However, the insertion may not have been deep enough.

The average absolute test-retest threshold difference for bone conduction on the industry standard audiometer was 5.1 dB (5.3 SD) and for the computer-based audiometer 7.1 dB (6.4 SD). Computer-based audiometry provided air and bone conduction thresholds within the test-retest reliability limits of industry standard audiometry.

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