Primary Care: Whispered Voice Test For Screening For Hearing Impairment in Adults and Children: Systematic Review
Primary Care: Whispered Voice Test For Screening For Hearing Impairment in Adults and Children: Systematic Review
Primary Care: Whispered Voice Test For Screening For Hearing Impairment in Adults and Children: Systematic Review
Table 1 Methodological quality (*=“adequate” or better) of studies of whispered voice test according to five quality criteria
Studies of adults Studies of children
Swan and Dempster and Prescott et al19
Criterion Macphee et al17 Uhlmann et al14 Browning15 Eekhof et al16 Groen20 Mackenzie18 Study 1 Study 2
Consecutive or random *Yes *Yes *“All patients” *“All patients” Not stated Not stated Not stated Not stated
sampling
Independent assessment *Claimed *Claimed Not stated Not stated *Claimed and named Not stated No No
Blind assessment *Yes *Yes Not stated Not stated Not stated Not stated No No
Adequate test description *Good *Adequate *Good Poor *Adequate *Adequate *Adequate *Adequate
>80% verification with *100% *100% *100% *100% *100% *98% *94% *98%
audiometry
Table 2 Characteristics of participants, methods of testing and results of studies of use of whisper test in adults
Criterion Swan and Browning15 Macphee et al17 Eekhof et al16 Uhlmann et al14
Participants and setting
Number of participants (No of 101 (202) 62 (124) 62 (124) 31 (62) (non-demented group
ears) only)
Age (years) Mean 57, range 17-89 Mean 81, range 66-96 ≥55 Mean 76, SD 5.8
Setting Audiology Clinic Geriatric Assessment Unit ENT Outpatient Department Otolaryngology Clinic
Whispered voice technique
Audiometry cut-off for hearing 30 dB 30 dB 30 dB 40 dB
impairment
Distance 2 feet (arm’s length) 6 inches and 2 feet “Standard method”* Began at 6 inches and move
away at 6 inch increments
Masking Occlusion and rubbing of Occlusion and rubbing of “Standard method”* Pushing tragus over external
external auditory canal external auditory canal auditory canal
Letters/numbers/words Triplets of letters and 3 random numbers “Standard method”* Spondee words†
numbers, eg 5B6
Number of repeats 1 1 or 2 “Standard method”* At each distance until unable
to hear
Threshold for hearing <50% correct ≤50% correct ≥2 combinations incorrect <50% correct
impairment
Results of testing
Prevalence of hearing 43 61 59 26
impairment (%)
Sensitivity (%; 95% CI) 100 (96-100) 100 (95-100) 90 (82-95) 90‡
Specificity (%; 95% CI) 87 (80-92) 84 (71-92) 80 (68-89) 70‡
Likelihood ratios:
Positive 7.7 6.4 4.6 Not done (insufficient data)
Negative 0 0 0.12 Not done (insufficient data)
*“The whispered voice test was performed by a standard method (slightly modified)” –reference to Swan, 1985
†Spondee words are two syllable words with equal stress on both syllables, for example “baseball” or “hotdog.”
‡Specificities were given for two sensitivities (80% and 90%)—unable to calculate confidence interval or likelihood ratio.
broad variation between examiners’ outcomes to the dif- variations in the methodology of studies and the
ference in loudness of the whispering, a supposition that populations sampled, findings are relatively consistent.
was supported by patients who spontaneously com- One area of concern is the reproducibility of the
plained about the quiet whispering of several examiners. whispered voice test. The results of the studies that
measured reliability indicate that the test can be
reliable if a standard procedure is used. At the moment
Discussion there is considerable room for improvement in stand-
The whispered voice test is a simple and accurate test ardising the technique of conducting the test and in
for detecting hearing impairment and compares setting the threshold for hearing impairment by the
favourably with the portable audioscope. Despite some whispered voice test.
Table 3 Characteristics of participants, methods of testing, and results of studies of use of whisper voice test in children
Prescott et al19
Criterion Groen20 Dempster and Mackenzie18 Study 1 Study 2
Participants and setting
Number of participants 197 (394) 141 (282) 177 (354) 201 (402)
(No of ears)
Age in years Mean 5 Mean 7.2, range 5 to 12 Range 3-12 Range 3-7
Setting Audiology centre Otorhinolaryngology clinic Hospital School classroom
Whispered voice technique
Audiometry cut-off for hearing 25 dB 30 dB (also 20 dB and 25 dB) 20 dB 35 dB
impairment
Distance 3 m, 1 m, 0.3 m 6 inches, 2 feet 2 feet
Masking Finger occlusion of external Tragal rubbing Tragal pressure but only if hearing loss was asymmetrical
auditory canal
Letters, numbers, or words Spondee words (10) 3 numbers or 3 numbers and Spondee words
letters <6 yrs—point to picture
≥6 yrs—repeat word
Threshold for hearing <50% correct at 3 m <2/3 correct at 2 feet <50% correct
impairment
Results of testing
Prevalence (%) of hearing 14 13 31 9
impairment
Sensitivity (%; 95% CI) 96 (82-99) 90 (69-97) 80 (68-88) 83 (61-94)
Specificity (%; 95% CI) 92 (87-95) 90 (84-94) 96 (91-98) 98 (95-99)
Likelihood ratio:
Positive 11.6 9.1 19.5 38.1
Negative 0.04 0.12 0.21 0.17