What does it mean to say the KUDUwave is the “gold standard”?

the gold standard

noun [ S ]

the situation in which a currency’s value is based on the price of gold

something that is very good and is used for measuring how good other similar things are

On a regular basis, you will hear KUDuwave users and academics say that the KUDUwave is the golden standard for boothless audiology. Allow me to explain why this is happening.

The KUDUwave was launched more than 10 years ago at the ENT and Audiology Conference, Durban, South Africa on the 4th of November 2009. The KUDUwave was the first-ever commercial audiometer that could conduct pure-tone (air- and bone conduction), and speech audiometry tests reliably and accurately outside of a sound-booth in an uncertified noise environment. After 2 weeks of extensive testing by Intertek, a British product testing and certification company, in the United Kingdom, the KUDUwave received the European CE mark on the 16th of August 2010 from Lloyd’s Register Quality Assurance Ltd (LRQA) also based in the United Kingdom. Currently, the CE mark sits with British Standards Institution (Bsi UK).

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More than 10 years ago the KUDUwave introduced a few claims unheard off in the past:

  • Booth-less diagnostic audiometry
  • Tele-audiology audiometry
  • Automated diagnostic audiometry
  • Single eartip for standard and extended high frequencies

Recently, the KUDUwave introduced two more upgrade modules with claims that have never been heard off:

  • Bilateral simultaneous impedance audiometry
  • Contra-lateral acoustic reflexes without swapping probe eartips

All these claims were validated and published in peer-review international journals:

  1. Ramatsoma, H., & Koekemoer, D. (2020). Validation of a Bilateral Simultaneous Computer-Based Tympanometer. American Journal of Audiology, 1-13.
  2. Swanepoel, D. W., & Biagio, L. (2011). Validity of diagnostic computer-based air and forehead bone conduction audiometry. Journal of Occupational and Environmental Hygiene, 8(4), 210-214.
  3. Swanepoel, D. W., Matthysen, C., Eikelboom, R. H., Clark, J. L., & Hall III, J. W. (2015). Pure-tone audiometry outside a sound booth using earphone attenuation, integrated noise monitoring, and automation. International Journal of Audiology, 54(11), 777-785.
  4. Maclennan-Smith, F., Swanepoel, D. W., & Hall III, J. W. (2013). Validity of diagnostic pure-tone audiometry without a sound-treated environment in older adults. International journal of audiology, 52(2), 66-73.
  5. Swanepoel, D. W., Maclennan-Smith, F., & Hall, J. W. (2013). Diagnostic pure-tone audiometry in schools: mobile testing without a sound-treated environment. Journal of the American Academy of Audiology, 24(10), 992-1000.
  6. Visagie, A., Swanepoel, D. W., & Eikelboom, R. H. (2015). Accuracy of remote hearing assessment in a rural community. Telemedicine and e-Health, 21(11), 930-937.
  7. Swanepoel, D. W., Mngemane, S., Molemong, S., Mkwanazi, H., & Tutshini, S. (2010). Hearing assessment—reliability, accuracy, and efficiency of automated audiometry. Telemedicine and e-Health, 16(5), 557-563.
  8. Brennan-Jones, C. G., Eikelboom, R. H., & Swanepoel, D. W. (2017). Diagnosis of hearing loss using automated audiometry in an asynchronous telehealth model: a pilot accuracy study. Journal of telemedicine and telecare, 23(2), 256-262.
  9. Swanepoel, D. W., Koekemoer, D., & Clark, J. (2010). Intercontinental hearing assessment–a study in tele-audiology. Journal of telemedicine and telecare, 16(5), 248-252.
  10. Storey, K. K., Muñoz, K., Nelson, L., Larsen, J., & White, K. (2014). Ambient noise impact on accuracy of automated hearing assessment. International journal of audiology, 53(10), 730-736.
  11. Edwards, A. L. Validity of the use of the Kuduwave 5000 audiometer for medical surveillance audiometry without a sound-treated environment.
  12. Brennan-Jones, C. G., Eikelboom, R. H., Swanepoel, D. W., Friedland, P. L., & Atlas, M. D. (2016). Clinical validation of automated audiometry with continuous noise-monitoring in a clinically heterogeneous population outside a sound-treated environment. International journal of audiology, 55(9), 507-513.
  13. Govender, S. M., & Mars, M. (2018). Validity of automated threshold audiometry in school aged children. International journal of pediatric otorhinolaryngology, 105, 97-102.

These articles set the stage for other audiometers to follow in our footsteps. Much effort went into disrupting the default mindsets of audiology for the sake of improving the lives of audiologists and occupational health practitioners to reach more patients and employees, respectively, and to take audiology services to the masses – hospitals, schools, industrial sites, clinics and higher institutions. 

Listed below are multiple publications and articles where the KUDUwave was selected as the gold standard for comparison

Diagnostic Hearing Assessment in Schools: Validity and Time Efficiency of Automated Audiometry

Mahomed-Asmail, F., Swanepoel, D. W., & Eikelboom, R. H. (2016). Diagnostic hearing assessment in schools: validity and time efficiency of automated audiometry. Journal of the American Academy of Audiology, 27(1), 42-48.

The KUDUwave was used as the reference gold standard in this publication: 

“Conventional manual pure-tone audiometry as the gold standard (Burns and Hinchcliffe, 1957; Mahomed et al, 2013). Results of the current study confirmed equivalent hearing thresholds for children tested with automated pure-tone audiometry compared to manual testing.”

Little-used medical technology could help thousands see, hear and feel better

Bateman, C. (2015). Little-used medical technology could help thousands see, hear and feel better. SAMJ: South African Medical Journal, 105(5), 334-336.

The KUDUwave as “new innovation” sets the stage to be the future reference device for the new claims introduced to the audiology fraternity.

“A dramatic diagnostic innovation is a device called the KUDUwave 5000 Portable Diagnostic Audiometer”

Clinical validity of hearScreen™ smartphone hearing screening for school children

Mahomed-Asmail, F., Swanepoel, D. W., Eikelboom, R. H., Myburgh, H. C., & Hall, J. (2016). Clinical validity of hearScreen™ smartphone hearing screening for school children. Ear and hearing, 37(1), e11-e17.

The KUDUwave was used as reference audiometer (conventional) to validate the accuracy of this cell phone hearing screening applications:

“Each child was screened twice by the same tester, once with a conventional screening audiometer and once with the smartphone hearing screening device on the same day in the same room.’’

Passive Noise Reduction Improvement by Modifying the Standard Audiology TDH-49 Headphone

Shalool, A., Zainal, N., Gan, K. B., Umat, C., & Mukari, S. Z. M. S. (2017). Passive noise reduction improvement by modifying the standard audiology TDH-49 headphone. Advanced Science Letters, 23(2), 1320-1324.

The KUDUwave is referenced as the passive noise attenuation comparison headset.

Sound attenuation and permissible noise levels for hearTest™ occupational health audiometry

Swanepoel, D. (2020). Sound attenuation and permissible noise levels for hearTest occupational health audiometry. HearX Group. White Paper 07/19

The KUDUwave is used as a reference to validate the noise attenuation of the cell phone app screener.

“The average MPANLs of the hearTest transducer setup compared to ISO/SANS 8253-1 and Kuduwave transducer setup is provided”

Monitoring Hearing in an Infectious Disease Clinic with mHealth Technologies

Brittz, M., Heinze, B., Mahomed-Asmail, F., Swanepoel, D. W., & Stoltz, A. (2019). Monitoring hearing in an infectious disease clinic with mHealth technologies. Journal of the American Academy of Audiology, 30(6), 482-492.

Again the KUDUwave was used as the reference audiometer test.

“In this case, a clinical audiometer (KUDUwave) was used as the reference test because it has been validated for use in controlled environments outside a sound booth (Maclennan-Smith et al, 2013).”

Smartphone threshold audiometry in underserved primary health-care contexts

Sandström, J., Swanepoel, D. W., Carel Myburgh, H., & Laurent, C. (2016). Smartphone threshold audiometry in underserved primary health-care contexts. International Journal of Audiology, 55(4), 232-238.

Smartphone thresholds obtained in primary health-care clinics outside a sound booth were validated by comparing the thresholds to those obtained with the KUDUwave as a reference gold-standard audiometer.