A systematic review of mHealth-based paediatric hearing screening tools/devices.

Background: Despite the proven effectiveness of traditional screening devices for Early Hearing Detection and Intervention (EHDI) programs, the costs of these instruments are high to be implemented as a sustainable solution for low- and middle-income countries. Mobile Health (mHealth) hearing screeners are an alternative solution to support EHDI programs. Therefore, demand is increasing for accessible, affordable and scalable alternatives. Objective: This review reports on the validity, costs, status (commercially available/non-commercially available) of the mHealth screeners available globally for the paediatric population. Method: A systematic search of PubMed, Scopus and Google Scholar was conducted. Articles published from 2014 and study populations of 0-18 years were eligible. Thirty-eight studies met the inclusion criteria, and 27 mHealth screeners were identified in this review. Results: Three objective screeners were identified, OAEBuds, hearOAE and off-the-shelf OAE. Twenty-four subjective screeners were identified, mainly using pure-tone audiometry, game-based tests and speech-in-noise tests. Subjective screeners target children above 3 years of age. Sensitivity and specificity were comparable to those of traditional screeners, although the validation methodologies varied. Only one objective screener is commercially available. Few screeners are available free of cost and as open-source software. Compared to previous reviews on mHealth devices, this review captured objective hearing screeners. Conclusion: The review outlined the need for more mHealth-based screeners for lower age groups, particularly for infants and toddlers, as most of the identified screeners catered to an older population of more than three years of age.