Original Paper

Audiology
Audiol Neurotol 2013;18:201207 Received: September 27, 2012
Neurotology Accepted after revision: February 11, 2013
DOI: 10.1159/000349913
Published online: May 14, 2013

Smartphone-Based Hearing Test as an

Aid in the Initial Evaluation of Unilateral
Sudden Sensorineural Hearing Loss
Ophir Handzel a, c, d Oded Ben-Ari c Doris Damian f Maayan M. Priel b
Jacob Cohen bd Mordechai Himmelfarb b, d, e
a
The Cochlear Implant Program and b Institute of Audiology, Speech and Swallowing, Department of
Otolaryngology/Head, Neck and Maxillofacial Surgery, and c Department of Otolaryngology/Head,
Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, and d Sackler School of Medicine,
Tel-Aviv University, Tel-Aviv, and e Department of Communication Disorders, Ariel University, Ariel, Israel;
f
Vertex Pharmaceuticals Incorporated, Cambridge, Mass., USA

Key Words rion of a loss of 2 hearing grades over at least 2 frequencies

Sudden hearing loss diagnosis Smartphone and tablet
application Hearing test
Abstract
Sudden sensorineural hearing loss (SSNHL) can cause signif-
icant morbidity. Treatment with steroids can improve out-
come. Delay in initiation of treatment reduces the chance to
regain hearing. For this reason SSNHL is considered an emer-
gency. Diagnosis is based on history, physical examination
and a standard audiogram, the latter requiring specialized
equipment and personnel. Standard audiogram may not be
available at the time and place of patient presentation. A
smartphone or tablet computer-based hearing test may aid
in the decision to prescribe steroids in this setting. In this
study the uHearTM hearing test application was utilized. The
output of this ear-level air conduction hearing test is report-
ed in hearing grades for 6 frequencies ranging from 250 to
6000 Hz. A total of 32 patients with unilateral SSNHL proven
by a standard audiogram were tested. The results of stan-
dard and iPod hearing tests were compared. Based on the
accepted criterion of SSNHL (at least 30 dB loss or 2 hearing
grades in 3 consecutive frequencies) the test had a sensitiv-
ity of 0.76 and specificity of 0.91. Using a less stringent crite-
the sensitivity was 0.96 and specificity 0.86. The correlation
coefficient for the comparison of the average hearing grade
across the 6 measured frequencies of the study and standard
audiogram was 0.83. uHear more accurately reflected hear-
ing thresholds at mid and high tones. Similarly to previously
published data, low frequency thresholds could be artificial-
ly elevated. In conclusion, uHear can be useful in the initial
evaluation of patients with single-sided SSNHL by providing
important information guiding the decision to initiate treat-
ment before a standard audiogram is available.
Copyright 2013 S. Karger AG, Basel
Introduction
Sudden sensorineural hearing loss (SSNHL) is consid-
ered an otological emergency. The mainstay of treatment
are steroids [Wilson et al., 1980; Chen et al., 2003], giv-
en systemically or locally by intratympanic injections.
Chances of regaining hearing in response to treatment
are inversely related to the time elapsed from hearing loss
to initiation of treatment [Rauch, 2008]. SSNHL is sus-
pected based on medical history and physical examina-
tion. The diagnosis is verified by an audiogram obtained

2013 S. Karger AG, Basel Ophir Handzel, MD

14203030/13/01840201$38.00/0 The Cochlear Implant Program
Department of Otolaryngology/Head, Neck and Maxillofacial Surgery
E-Mail karger@karger.com
Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv 64239 (Israel)
www.karger.com/aud
E-Mail ophir.handzel@yahoo.com

in a soundproof booth by a qualified audiologist, which
is considered the gold standard for diagnosis. Audiolo-
gists capable of performing this test and a suitable facil-
ity are rarely available 24 h a day, 7 days a week. This may
leave the clinician facing a patient with suspected SSNHL
with the dilemma of treating the patient based solely on
medical history and physical examination, or withhold-
ing treatment until a standard audiogram is obtained.
The sensation of a sudden drop in hearing can be a symp-
tom of etiologies other than SSNHL such as inadequate
pressure in the middle ear. On the other hand, SSNHL
can manifest itself in a variety of symptoms such as aural
pressure or distortion of sounds. Since steroids have po-
tential significant side effects, it is best to limit treatment
to patients with high probability of suffering from
SSNHL.
Smartphone and tablet computer-based hearing tests
were developed mostly as screening tools to identify pa-
tients with hearing loss. uHearTM is a hearing test applica-
tion developed by Unitron. It is an ear-level pure-tone
hearing test designed to measure air conduction thresh-
olds in each ear independently. This application has been
previously evaluated [Himmelfarb et al., 2012; Szudek et
al., 2012]. Smartphone and tablet computer-based hear-
ing tests may improve the accuracy of history and physi-
cal examination in the initial screening of patients being
evaluated for unilateral SSNHL and indicate initiation of
treatment in the absence of an audiogram. In this study
the accuracy of the application-based hearing test in the
evaluation of SSNHL was estimated and compared to the
standard audiogram.
Materials and Methods
An ethics committee approval was obtained for the study
(0483-11-TLV). An iPod touch (Apple Inc., Cupertino, Calif.,
USA) was used in this study to avoid any possible effects of mobile
phone capabilities. Wi-Fi connectivity was turned off. The uHear
application (Unitron, Victoria, B.C., Canada) was downloaded to
the iPod from the iTunes store [uHear, 2011]. It is available free of
charge. This application has three modules for testing hearing. The
study utilized one of the modules designed to test hearing sensitiv-
ity or pure-tone thresholds. The software uses the bracketing tech-
nique (testing for sounds louder and softer than thresholds) to
determine thresholds at 6 separate frequencies ranging from 250
to 6000 Hz. Of note is the lack of testing for 8000 Hz. Creative EP
630 (Creative, Singapore) earbud speakers with replaceable rubber
covers were used for all subjects. One of three available sizes was
chosen by the examiner based on his best judgment and comfort-
able fit was verified by the test subject. The study hearing test can
be completed in an average of 6 min. Completing the test required
no learning curve.
202 Audiol Neurotol 2013;18:201207
DOI: 10.1159/000349913
Color version available online
Fig. 1. Screenshot depicting the results of the uHear hearing test.
Each ear is presented separately. The columns represent the tested
frequencies: 250, 500, 1000, 2000, 4000 and 6000 Hz. The rows are
grades of hearing loss: normal 025 dB, mild 2640 dB, moderate
4155 dB, moderately severe 5670 dB, severe 7190 dB and pro-
found >90 dB. The name of the subject tested was masked.
The results of the uHear hearing test are depicted on a screen
divided by frequencies and severity of hearing loss (fig. 1). The
hearing thresholds are grouped into 6 grades from normal hearing
to profound hearing loss. Standard audiograms were similarly
grouped following the American Speech-Language-Hearing As-
sociation (ASHA) categorization [ASHA, 2012], with the excep-
tion of uniting the normal and slight hearing loss into the same
grade of hearing (in decibel hearing level): normal = 025 dB,
mild = 2640 dB, moderate = 4155 dB, moderately severe = 5670
dB, severe = 7190 dB and profound >90 dB. Together these com-
prise 6 grades of hearing sensitivity. The term hearing grade will
be used throughout this paper.
A total of 32 consecutive adult patients presenting to the
emergency ward with unilateral SSNHL as reflected by a standard
audiogram were included in the study. For all patients, the inter-
aural difference in hearing thresholds was used as the base for
computing the degree of hearing loss. For each frequency the dif-
ference in the thresholds between the diseased and nondiseased
ears was used as a basis for decision making. Patients were in-
cluded in the study if hearing loss based on the standard audio-
gram was deemed sufficient to warrant treatment. Of the 32 pa-
tients, 20 had hearing loss of at least 30 dB in 3 consecutive fre-
quencies. The remaining had either a loss across 3 frequencies
not amounting to 30 dB and/or a loss in less than 3 consecutive
frequencies that was still interpreted as significant. Subjects were
admitted and treated with systemic oral steroids in accordance
with our institutes protocol. All participating patients signed a
written informed consent form to participate in the study. Stan-
dard and study (application-based) hearing tests were separated
by no more than 12 h. Standard audiograms were obtained at our
medical center. Study hearing tests were supervised by either the
first or the second author.
Handzel /Ben-Ari /Damian /Priel /Cohen /
Himmelfarb

Difference audiogram
Fig. 2. Difference in grades of hearing levels
of the diseased minus the nondiseased ear
(y-axis) for each frequency (x-axis) for sub-
ject 12. This difference is the basis for clin-
ical decision making. Subject 12 represents
a typical result as uHear measured the
hearing loss accurately at mid and high
tones but underestimated the hearing loss
in low tones. This deviation was the result
of increased thresholds at low frequency
for the nondiseased ear and the reduced in-
teraural difference.
Patients with a conductive component to the hearing loss based
on standard audiogram were excluded as it would have made in-
terpretation of an air conduction-based hearing test impossible.
Other exclusion criteria were hearing loss evolving in more than 3
days and patients presenting more than 2 weeks after the initial loss
of hearing. Patients treated with intratympanic injections were
also excluded from the study.
All study audiograms were performed in the same room. This
is a relatively quiet office space in a hospital that is not sound-
proofed. The level of noise present in the room was measured at 3
different times of the day and night using a sound level meter,
model TES-1350A (TES Electrical Electronic Corp., Taipei, Tai-
wan). Ambient noise varied between 41 and 42 dBA measured at
7 a.m., 3 p.m. and 1 a.m.
The commonly accepted definition of SSNHL is an increase of
hearing thresholds of at least 30 dB in 3 consecutive frequencies
[National Institute of Deafness and Communication Disorders,
2000] compared to a prior audiogram or the contralateral ear.
However, patients with lesser degrees of hearing loss are often con-
sidered candidates for steroid treatment since their hearing loss
can cause significant morbidity even when the above-mentioned
criteria are not met. Hence, the study population included patients
with hearing loss of less than 30 dB and/or less than 3 consecutive
frequencies. Accordingly the data were analyzed using 3 separate
hearing loss definitions: (1) loss of 2 or more hearing grades of the
uHear hearing test in 3 consecutive frequencies, compatible with
the commonly accepted definition of SSNHL, (2) loss of 2 hearing
grades over 2 consecutive frequencies and (3) loss of 1 hearing
grade over 2 consecutive frequencies.
The hearing grades as obtained through the audiogram were
considered the truth relative to the particular definition of hear-
ing loss. Namely, a subject diagnosed with hearing loss based on
the audiogram was considered as indeed suffering from hearing
loss (diseased). Similarly, a subject not diagnosed with hearing
loss based on the audiogram was considered as normal. The sen-
sitivity and specificity of the uHear test were estimated as the pro-
portion of diseased diagnosed with hearing loss and the propor-
tion of normal found normal by the test, respectively.
Smartphone-Based Hearing Test in
Unilateral SSNHL
6 6
4 4
Difference uHear
2 2
0 0
2 2
250 500 1000 2000 4000 6000 250 500 1000 2000 4000 6000
Frequency (Hz) Frequency (Hz)
Results
The age of the 32 patients (24 male and 8 female)
included in this study ranged from 20 to 82 years (aver-
age 51.4 years); 14 subjects had hearing loss in the right
ear and 18 in the left; 18 subjects had normal hearing on
the contralateral ear as measured by a standard audio-
gram.
In order to compare the results of the study and stan-
dard hearing tests for the complete cohort the averages of
the differences between the nondiseased and diseased
ears at the 6 tested frequencies were used. First, for each
subject two graphs depicting the difference in hearing
grades between the diseased (higher score) and nondis-
eased ear were plotted for the standard and study audio-
grams (fig.2). For each frequency the hearing grade of the
nondiseased ear was subtracted from the grade of the dis-
eased ear. The average differences were then calculated.
In subject 12 the average was 1.83 for the standard audio-
gram and 1.33 for the study test (fig.2). Lastly, a graph of
this relationship for the complete cohort was plotted,
with the average of the standard audiogram on the x-axis
and the average of the study hearing test on the y-axis
(fig. 3). Spearmans correlation coefficient was used to
compare the averages for the standard versus the study
hearing test and was found to be 0.83.
The accuracy of the study hearing test in the evaluation
of SSNHL was measured compared to standard audio-
gram. Sensitivity and specificity were calculated using 3
different definitions of hearing loss (table 1). The most
stringent criterion that was used reflects the most accept-
ed definition of SSNHL and was defined as a loss of at least
2 hearing grades across 3 or more consecutive frequencies
Audiol Neurotol 2013;18:201207 203
DOI: 10.1159/000349913
 5 1
4 2
3
uHear
2
1
0
0 1 2 3 4 5
Audiogram
Fig. 3. Relationship between the standard and study hearing tests
for the cohort. For each subject a graph depicting the difference
between the hearing grades of the nondiseased and diseased ear at
each frequency was plotted (as seen in fig.2). The average differ-
ence was calculated for each test separately. This average repre-
sents the result of the hearing test. The correlation between the
average of the standard vs. study audiogram was 0.83 (Spearmans
correlation coefficient).
(table1a). Sensitivity was estimated to be 0.76 and speci-
ficity 0.91. The second criterion was loss of at least 2 hear-
ing grades across 2 or more consecutive frequencies (ta-
ble1b). Sensitivity was estimated to be 0.96 and specific-
ity 0.86. The least stringent criterion used was defined as
a loss of at least 1 hearing grade across 2 or more consecu-
tive frequencies (table 1c). Sensitivity was 0.94, but not
enough normals were found through the audiogram to
calculate specificity. For all 3 definitions, the point esti-
mates of sensitivity and (when estimable) specificity were
reasonably high. However, the sample size of 32 was too
small to provide tight confidence intervals.
uHear reflected hearing thresholds more accurately in
mid and high tones compared to low tones (fig.4). Low-
tone inaccuracy is more prominent in the nondiseased
ear.
Discussion
SSNHL was first recognized in the medical literature
in 1944 [De Kleyn, 1944]. Although almost 70 years have
elapsed since this publication, the etiology remains un-
known in most cases [Chau et al., 2010]. SSNHL can be
associated with significant morbidity as a result of hear-
ing loss, tinnitus and dizziness. Spontaneous recovery of
204 Audiol Neurotol 2013;18:201207
DOI: 10.1159/000349913
Hearing grade
3
4
5
6
250 500 1000 2000 4000 6000
Frequency (Hz)
Fig. 4. Average hearing thresholds (in hearing grades) at each fre-
quency for the study and standard audiogram and for the diseased
and nondiseased ears. uHear measured inaccurately elevated
thresholds at low frequencies. The deviation is more pronounced
for the nondiseased ear. The solid line depicts the standard audio-
gram and the dashed line depicts the uHear results. For each of
them the bottom line is the diseased ear and the top the nondis-
eased ear.
hearing happens in 32% [Wilson, 1980] to 64% [Mattox
and Simmons, 1977] of patients. Treatment with steroids
can improve a patients chance of regaining hearing [Wil-
son et al., 1980; Chen et al., 2003]. There is an inverse cor-
relation between the chance to respond to steroid treat-
ment and the time elapsed until its initiation [Rauch,
2008]. Hence, SSNHL is thought of as an emergency.
The gold standard for the diagnosis of SSNHL is a stan-
dard audiogram performed in a soundproof booth by a
qualified audiologist. Unfortunately, this test may not be
available 24 h a day, 7 days a week. In addition, some
populations such as military personnel or those in small-
er or remote communities may not have this service read-
ily available. Since steroids have potential significant side
effects, treatment is best reserved to patients with a high
probability of suffering from SSNHL. Medical history and
physical examination are often insufficient to reliably in-
dicate the need for treatment. For example, commonly
available tuning forks are 512 and 1024 Hz, leaving a wide
spectrum of hearing frequencies untested during physical
examination. If a standard audiogram cannot be obtained
at initial presentation of a patient complaining of a sud-
den drop in hearing, the clinician faces a decision to start
treatment based on history and physical examination or
to delay treatment until an audiogram is made available.
This dilemma was the motivation for the current study.
Handzel /Ben-Ari /Damian /Priel /Cohen /
Himmelfarb
Table 1. Estimated sensitivity and specificity of the study hearing ify that the medical history validates the single-sidedness
test using 3 criteria for hearing loss of the complaint and the sensation of symmetric hearing
a Hearing loss is defined as 2 or more hearing grades in 3 or prior to the sudden hearing loss. For all subjects in the
more consecutive frequencies reported cohort these conditions have been met and the
uHear contralateral ear is used as a baseline for comparison.
As detailed in Materials and Methods the hearing
normal hearing loss
thresholds of the uHear hearing test are reported as hear-
Audiogram normal 10 1 ing grade per frequency rather than in sound intensity.
hearing loss 5 16 The software does not assign a numerical decibel thresh-
Sensitivity = 0.76 (0.53, 0.92); specificity = 0.91 (0.59, 0.99). old for the results. For this reason we have used hearing
grades rather than thresholds in decibels in this study.
b Hearing loss is defined as 2 or more hearing grades in 2 or Applying a decibel value to the results of the uHear hear-
more consecutive frequencies ing test would have added unnecessary inaccuracy to the
uHear results. In these circumstances it is better to grade the
hearing loss of the standard audiogram and perform a
normal hearing loss
comparison of hearing grades between the test and stan-
Audiogram normal 6 1 dard audiogram.
hearing loss 1 24 A commonly used definition for SSNHL is a sensori-
Sensitivity = 0.96 (0.82, 0.99); specificity = 0.86 (0.42, 0.99). neural hearing loss appearing within 3 days and encom-
passing at least a 30-dB loss at 3 or more consecutive hear-
c Hearing loss is defined as 1 or more hearing grades in 2 or ing frequencies [National Institute of Deafness and Com-
more consecutive frequencies munication Disorders, 2000]. This definition is a widely
uHear acceptable one but does not represent a distinct patho-
normal hearing loss
logical, etiological or therapeutical entity from lesser de-
grees of hearing loss. The NIDCD definitions equivalent
Audiogram normal 1 0 as reflected in the uHear output is a loss of at least 2 hear-
hearing loss 2 29 ing grades over 3 or more consecutive frequencies. For
Sensitivity = 0.94 (0.81, 0.99); specificity = sample size too small this definition the sensitivity of the study hearing test
to calculate. compared to standard audiogram was found to be 0.76
Values in parentheses are 90% confidence intervals. and specificity was 0.91. For a patient meeting this uHear
hearing test criterion the diagnosis of SSNHL can be
made with good certainty. However, if the loss does not
fulfill this criterion an audiogram should be obtained be-
fore the need for treatment is dismissed.
Internet-based hearing sensitivity screening has been Often, patients suffering from hearing loss not
previously studied [Bexelius et al., 2008]. Smartphone amounting to the 3 days/3 frequencies/30-dB rule will
and tablet computer-based applications may be a useful still be candidates for treatment with steroids as reflected
tool for this purpose, utilizing widely available hardware, by the recent guidelines from the American Academy of
being cheap and not necessitating specialty training to Otolaryngology Head and Neck Surgery [Stachler et al.,
perform. The present study used uHear (Unitron) which 2012]. Milder forms of hearing loss can result in a sig-
has been previously evaluated [Himmelfarb et al., 2012; nificant handicap and as a consequence are included in
Szudek et al., 2012]. The application is available for free. the current study, e.g. 1 of our subjects had hearing loss
Evaluating a sudden loss of hearing requires a baseline of 60 dB or more in 4000 and 6000 Hz. Such a patient may
for comparison. In the great majority of cases a recent benefit from treatment with steroids although his condi-
audiogram preceding the hearing loss is not available. In tion does not fit the commonly accepted definition for
the most common situation, the patients report symmet- SSNHL. For patients with a loss of at least 2 grades of
ric hearing prior to the sudden decrease in hearing in one hearing in 2 or more consecutive frequencies the sensi-
ear. In these circumstances the contralateral ear can be tivity of uHear is very good at 0.96, although the specific-
used as a base of comparison [Stachler et al., 2012]. In or- ity of 0.86 had a very wide confidence interval. This sub-
der for this comparison to be valid the clinician must ver- group of patients should be candidates for treatment be-

Smartphone-Based Hearing Test in Audiol Neurotol 2013;18:201207 205

Unilateral SSNHL DOI: 10.1159/000349913

Difference audiogram
Fig. 5. Subject 6 had severe hearing loss at
6000 and 8000 Hz as reflected in a standard
audiogram. In the study test 8000 Hz is not
measured, resulting in measurement of
hearing loss limited to 6000 Hz. A loss lim-
ited to 1 frequency could be considered in-
sufficient for treatment with steroids. The
y-axis represents the difference in grades of
hearing levels of the diseased minus the
nondiseased ear; the x-axis represents the
frequencies tested.
fore a standard audiogram is available. For the most
relaxed criterion of hearing loss studied, i.e. loss of at
least 1 grade of hearing over 2 or more frequencies, the
sensitivity was high (0.94) as expected but the cohort was
too small to calculate specificity. As a result, it is impos-
sible to draw a conclusion regarding treatment for this
group based on the studys data. Milder forms of SSNHL
have a better chance for spontaneous recovery [Rauch,
2008] and may not warrant treatment even when proven
by a standard audiogram.
The comparison of the average differences between
hearing in the diseased and nondiseased ears for the study
versus standard hearing test resulted in a high correlation
coefficient of 0.83 (fig.3). The average difference can be
used as a single factor representing the overall output of
the hearing tests. The good correlation between the aver-
ages of the study and standard audiogram is another
method to validate its use for the evaluation of single-
sided SSNHL.
uHear reflected hearing thresholds more accurately in
mid and high tones compared to low tones (fig.4). These
findings corroborate those of Szudek et al. [2012] and
Himmelfarb et al. [2012]. This can result in wrongly ex-
cluding eligible patients from treatment. The clinical im-
plication can be seen in the results of the testing of subject
12 (fig.2). uHear accurately measured hearing thresholds
at mid and high frequencies; however, due to elevated
thresholds at low frequencies in the nondiseased ear the
interaural difference is reduced, masking some of the
hearing loss. In addition, since low-tone sensitivity is
moderate, prognostication based on the type of the au-
diogram [Kuhn et al., 2011] will have limited accuracy.
206 Audiol Neurotol 2013;18:201207
DOI: 10.1159/000349913
6 6
4 4
Difference uHear
2 2
0 0
2 2
250 500 1000 2000 4000 6000 250 500 1000 2000 4000 6000
Frequency (Hz) Frequency (Hz)
This inaccuracy probably results from the acoustic
characteristics of the particular earbuds used in the study
and from the presence of ambient noise in the test envi-
ronment. Imperfect fitting of earbuds, especially if creat-
ing a vent effect, can cause this phenomenon as well.
Szudek et al. [2012] found that testing in a soundproof
room did not eliminate this low-tone deviation.
The regulatory and legal status of smartphone and tab-
let computer-based applications for clinical use has not
been established [Sherwin-Smith and Pritchard-Jones,
2012]. An application aiding clinical decision making
may be viewed as a medical device. Such applications are
currently exempt from the usual approval procedures for
medical devices. Ideally, applications used for clinical de-
cision making and treatment will be prevalidated inde-
pendently for a particular indication such as the one pre-
sented in this paper.
A few additional limitations of this study are worth
mentioning. Accuracy of the iPod-based hearing test is
sensitive to variables such as the quality and characteris-
tics of the software application and earbuds and ambient
noise during testing. These variables may restrict some
aspects of generalization of the data and analysis present-
ed in this paper to other applications, earbuds and envi-
ronments. However, most of these limitations can be
overcome by evaluating the smartphone-based hearing
testing of normal hearing ears prior to evaluating dis-
eased ears. As hearing at 8000 Hz is not tested, accuracy
of the study test is reduced for patients suffering from
high tone loss, for example subject 6 (fig.5), who experi-
enced hearing loss in excess of 60 dB at 6000 and 8000 Hz.
Based on these findings he was treated (successfully) with
systemic steroids. However, based on the study test he
Handzel /Ben-Ari /Damian /Priel /Cohen /
Himmelfarb
would probably not be eligible for treatment since hear- Conclusion
ing loss was limited to a single frequency. Hearing tests
performed solely with the popular ear-level hearing buds uHear, a smartphone and tablet computer-based ear-
cannot differentiate conductive from sensorineural hear- level air conduction hearing test, has a role in the initial
ing loss, resulting in potential over- or underestimation evaluation of single-sided SSNHL. The test can help the
of SSNHL. This could be partially addressed by careful clinician decide whether treatment with steroids is indi-
otoscopy and testing hearing with tuning forks of a num- cated until a standard audiogram is available. Accuracy of
ber of frequencies. Bone-level hearing buds are commer- the hearing test is best at mid and high tones tested.
cially available (i.e. for swimmers) and may provide ad-
ditional data, but they have not been validated for these
medical diagnostic purposes. Due to its limitation, uHear
hearing test is not designed to and cannot replace a stan-
dard audiogram.

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Unilateral SSNHL DOI: 10.1159/000349913
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