Agreement and Test Duration of a Revised Modified Hughson–Westlake Down-Up Procedure for Pure-Tone Audiometry: A Method-Comparison Study
DOI:
https://doi.org/10.47895/Keywords:
Abstract
Background. The Modified Hughson–Westlake Down-Up Procedure (MHW) is the manual method for conducting pure-tone audiometry to determine auditory thresholds in adults. This method requires a repeat of the 10 dB descent in the second ascending run followed by two (2) successive 5 dB incremental ascending steps. It can be argued that this repeated step is unnecessary, since anecdotally and from the authors’ experience a 5 dB descent (instead of 10 dB) yields similar ATs while reducing test duration. A Revised MHW (Rev MHW) Procedure eliminates the repeat step by reducing the second descending step from 10 dB to 5 dB, with the aim of improving efficiency while maintaining comparable hearing-threshold measurements.
Objective. The study aimed to determine whether the Rev MHW produced hearing threshold measurements similar to those obtained in the MHW procedure. The secondary objective was to determine whether the Rev MHW reduced the total test duration.
Methods. This was a cross-sectional method-comparison study with a within-subject repeated-measures design. Thirty adults were recruited using convenience sampling from the community, and each participant underwent both testing procedures in randomized order. Inclusion criteria were adults aged 18–60 years with clear ear canals and intact tympanic membranes. Exclusion criteria included an active ear infection, ear malformations, and physical disability that may affect the participants’ ability to respond to sound. Bland-Altman analysis was used to determine the strength of agreement between MHW and the Rev MHW. A paired t-test was performed between the total test times of the two procedures to determine the mean difference and its statistical significance.
Results. Bland-Altman analysis demonstrated comparable threshold measurements between MHW and the Rev MHW. Across 600 paired hearing-threshold measure- ments, the mean difference (Rev MHW − MHW) was 0.55 dB, with 95% limits of agreement ranging from −11.65 to 12.75 dB, indicating minimal systematic bias between procedures. The Rev MHW significantly reduced test duration compared with MHW, with a mean reduction of 1.50 minutes (95% CI, 1.12–1.87 minutes; p <0.001), representing approximately a 22% decrease in administration time.
Conclusion. Results suggested that Rev MHW yields auditory thresholds comparable to those obtained using MHW. The minimal systematic bias observed between methods suggests that the revision did not meaningfully affect threshold estimation while providing a measurable reduction in administration time. Rev MHW may be a more efficient alternative for determining ATs in adults while maintaining comparable hearing-threshold measurements.
Author Biographies
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Maureen Joy M. Tanoy, RSLP, MClinAud, University of the Philippines Manila
Maureen Tanoy currently serves as a Clinical Audiologist at The Medical City Ortigas Ear Nose Throat - Head and Neck Institute and a Clinical Audiologist consultant for the Newborn Hearing Screening Reference Center. She is also a Senior Consultant Speech Language Pathologist at GOALS - BGC Therapy Center. She has been providing comprehensive and integrated care for hearing and communication disorders for more than a decade.
Maureen completed her undergraduate degree in BS Speech Pathology in 2008 at the University of the Philippines Manila where she also obtained her Master in Clinical Audiology degree. She holds various certificates and trainings in different therapy techniques and is currently training to be a Cochlear Implant Audiologist. -
Maria Rina T. Reyes-Quintos, MD, MClinAud, PhD, Philippine National Ear Institute, National Institutes of Health, University of the Philippines Manila, Department of Otolaryngology-Head and Neck Surgery, Philippine General Hospital, University of the Philippines Manila
Dr. Maria Rina T. Reyes – Quintos is a leading expert in pediatric otolaryngology and audiology. Currently, She is the Chair of the Department of Otorhinolaryngology – Head and Neck Surgery at the UP PGH, and a clinical professor at the UPM College of Medicine. She is also a research faculty at the UPM National Institutes of Health and the current section head of audiology, at The Medical City Ortigas ENT Head and Neck Institute. Dr. Maria Rina Reyes-Quintos is a stout advocate of pediatric early identification and intervention for Hearing Loss and her significant contribution to the field has led to policy making in the Philippines, specifically the enactment of RA9709 the Universal Newborn Hearing Screening.
Dr. Reyes-Quintos received her medical degree from the UP College of Medicine where she also completed her residency training in otolaryngology. She completed her fellowship training in pediatric otolaryngology in Montefiore Medical Center, Bronx, New York, USA. By 2003, she received a master’s degree of Clinical Audiology at the UPM – College of Allied Medical Professions, and finally in 2018 completed her PhD in Medical Sciences at the Radbaud University, Nijmegen, Netherlands.