Using web services to realize remote hearing assessment

Background. Internet-based tele-audiology is expected to relieve the dilemma between the lack of resources and high demand of audiological care services. This paper presents a web services based, distributed pure-tone hearing assessment system that improves accessibility of traditionally underserved groups to audiology care. Methods. The system employs browser-server network architecture to connect patients to audiology specialists through a web server where all application software is hosted. Software on the server is designed with a three-tier approach which makes the system scalable to include other audiological services. Hearing test data are stored in a standard database and can potentially be integrated into established electronic medical records. On the remote patient side, off-the-shelf audiometers are adopted. The Internet connection of these audiometers can be flexibly configured either with or without a computer. Two aspects of the system were tested: (1) the clinical effectiveness of the system: double-blinded experiments were conducted to assess hearing ability of 30 subjects and paired t-tests were utilized to compare assessment results from the remote approach and the conventional setup; and (2) to analyze the system bandwidth requirements, data traffic among the server, the audiometer, and the audiologist terminal was examined with a network monitoring software (wireshark). Results. Paired t-test results have demonstrated that the remote hearing assessment is equivalent in effectiveness to its conventional counterparts at all tested frequencies (P values are in the range of [0.12, 0.94]), and the bandwidth required by the system is less than 1 Mbps, falling within the capacity of average commercial Internet service subscription. Conclusions. The project developed a remote hearing assessment system based on services on a web server. The system minimizes hardware and software requirements on the audiologist’s computer and can be realized with regular Internet service subscription. Patient operations involved in hearing assessment are simple; making hearing test services more accessible to those otherwise may not be able to obtain the desired hearing care.

[1]  Gregg D Givens,et al.  Internet-based tele-audiometry system for the assessment of hearing: a pilot study. , 2003, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[2]  Nicolas D. Georganas,et al.  vCOM: Electronic commerce in a collaborative virtual world , 2002, Electron. Commer. Res. Appl..

[3]  John Greer Clark,et al.  Introduction to Audiology , 1975 .

[4]  Paul G. Shekelle,et al.  Screening and Management of Adult Hearing Loss in Primary Care , 2003 .

[5]  Frank Dignum,et al.  Information management at a bank using agents: Theory and practice , 2000, Appl. Artif. Intell..

[6]  J. Kronenfeld Changing conceptions of health and life course concepts , 2006, Health.

[7]  Nigel H. Lovell,et al.  A web-based approach for electrocardiogram monitoring in the home , 1999, Int. J. Medical Informatics.

[8]  D. S. Nikitov,et al.  Remote medical consultations over the Internet: An implementation based on web-service technologies , 2008 .

[9]  John Ribera,et al.  Providing basic hearing tests using remote computing technology , 2007, Journal of telemedicine and telecare.

[10]  Kwang Suk Park,et al.  PC-based tele-audiometry. , 2007, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[11]  Jack C Wei,et al.  A Web-based telemedicine system for diabetic retinopathy screening using digital fundus photography. , 2006, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[12]  Stephen J. H. Yang,et al.  Developing a Medical Image Content Repository for E-Learning , 2006, Journal of Digital Imaging.

[13]  Paul G Shekelle,et al.  Screening and management of adult hearing loss in primary care: scientific review. , 2003, JAMA.

[14]  Tetsuo Kinoshita,et al.  Design and Implementation of an Agent-Based Grocery Shopping System , 2000 .

[15]  Tatsuya Fujii,et al.  Design of medical teleconsultation support system using super-high-definition imaging system , 2002, Systems and Computers in Japan.

[16]  Gregg D Givens,et al.  Internet application to tele-audiology--"nothin' but net". , 2003, American journal of audiology.

[17]  Paul G Shekelle,et al.  Screening and management of adult hearing loss in primary care: clinical applications. , 2003, JAMA.

[18]  J. Ribera,et al.  Using a Telehealth Medium for Objective Hearing Testing: Implications for Supporting Rural Universal Newborn Hearing Screening Programs , 2005 .

[19]  David J Lee,et al.  Concurrent visual and hearing impairment and risk of mortality: the National Health Interview Survey. , 2004, Archives of ophthalmology.

[20]  M. Krumm Audiology telemedicine. , 2007, Journal of telemedicine and telecare.

[21]  N. Nakamura Development of “MobileAudiometer” for Screening using Mobile Phones , 2004, The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[22]  Alan D. Smith,et al.  Information exchanges associated with Internet travel marketplaces , 2004, Online Inf. Rev..

[23]  W. Levinson,et al.  Scientific Review and Clinical Applications , 2002 .