Real-world performance of a Japanese browser-based hearing test: large-scale online usage data and concordance with clinical speech audiometry

Abstract

Browser-based hearing tests offer a scalable alternative to clinic-based assessment, but most validated tools have been developed in English-speaking populations. The authors conducted a retrospective observational analysis of real-world use of a Japanese browser-based hearing test platform (April 2023–March 2026), complemented by a prospective multicentre paired sub-study against conventional clinical speech audiometry. The retrospective analysis included 8,022 unique users and 86,959 test executions across four modules: music perception (Montreal Battery of Evaluation of Musical Abilities); speech perception in quiet; speech in noise at +10, +5, and 0 dB signal-to-noise ratios (SNRs); and consonant identification. Completion rates of the full-length modules ranged from 43.7% to 85.8%. Speech perception in quiet showed pronounced upper-end clustering (41.0% of completed attempts and 57.9% of users scored ≥90%), whereas music perception was more broadly distributed (20.8% and 21.2%, ≥90%), and speech-in-noise accuracy fell progressively from a mean of 72.0% at +10 dB to 57.0% at 0 dB SNR, where no attempt reached 90%. These patterns persisted when the analysis was restricted to one attempt per user. Music perception correlated only modestly with all speech-related outcomes (Spearman ρ = 0.31–0.39). Repeat administration by the same user yielded intraclass correlation coefficients of 0.58–0.85 and a smallest detectable change of 17.6–35.8 percentage points. In the sub-study, 41 participants (25 unaided, 16 aided) completed the conventional 20-item 67-S word recognition test in a calibrated booth and, within days to weeks, the 20-item online check unsupervised on their own device. Agreement was moderate (Pearson r = 0.65, 95% CI [0.43, 0.80]; ICC(2,1) = 0.62, 95% CI [0.37, 0.78]), with a small negative bias (−6.2 percentage points, 95% CI [−10.8, −1.6]) and wide limits of agreement (−34.7 to +22.2). These data characterize the concordance of a non-English digital hearing assessment platform with clinical speech audiometry and provide the first estimates of its measurement error. They do not establish screening accuracy: no pure-tone reference, referral threshold, sensitivity, or specificity was evaluated, and the limits of agreement are too wide for individual-level clinical interpretation.