Automated pure tone audiometry (PTA) in the assessment of hearing loss in pediatric populations: A systematic review and meta-analysis of diagnostic test accuracy studies.
Abstract
Background
Childhood hearing loss severely delays the normal development of children. While traditional pure-tone audiometry (PTA) is the gold standard, it faces logistical barriers, specialist shortages, and high costs. Automated, smartphone-based testing addresses these gaps by enabling remote, task-shifted screening by non-specialists. This meta-analysis evaluates the diagnostic accuracy of automated PTA specifically within pediatric populations.
Methods
We searched for relevant articles up to March 2026 from PubMed, Scopus, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, type of device used for testing, and diagnostic accuracy metrics. All data analyses were performed using R version 4.4.1.
Results
After removal of 1186 duplicates, 2703 records were screened and 12 studies were included. In the bivariate model, automated PTA demonstrated a pooled sensitivity of 0.745 (95% CI, 0.620-0.840), specificity of 0.882 (95% CI, 0.785-0.939), diagnostic odds ratio of 24.667, and area under the curve of 0.878. In the univariate analyses, pooled sensitivity and specificity were 0.78 and 0.91, respectively. Across individual studies, sensitivity ranged from 0.28 to 1.00 and specificity ranged from 0.58 to 1.00.
Conclusion
Automated PTA showed high specificity but moderate sensitivity in pediatric populations. It may be useful as an initial hearing-screening or triage tool, particularly in cooperative school-aged children and resource-limited settings, but it should not replace comprehensive diagnostic audiometry. Performance was less consistent in children younger than 7 years and varied with ambient noise, hardware, calibration, and testing protocol.