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Title: Whispered Voice Test Accurately Detects Hearing Impairment in Adults and Children

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BMJ 2003;327:967.
10/28/2003 12:17:00 PM
By Joene Hendry

The whispered voice test, which is simple to administer, can accurately detect hearing impairment in adults and children, according to the findings from a systematic review of studies analysing the accuracy of the test. The whispered voice test requires the examiner to stand an arms length behind the patient while whispering a combination of letters and numbers for the patient to then repeat. The examiner tests each ear separately with different letter/number combinations. The test is comparable to the portable audioscope in sensitivity and specificity which may make it a particularly useful tool in developing countries with limited access to standard audiometric facilities. Sandi Pirozzo, senior lecturer in epidemiology at the School of Population Health, University of Queensland, Australia, and colleagues reviewed data from 8 studies using cross-sectional designs to test the efficacy of the whispered voice test in adults and children. In the 4 studies of adults, the prevalence of hearing impairment ranged from 26% to 61% in a population that was mostly aged 55 years or older. In the 3 studies that used similar techniques, the sensitivity of the whispered voice test was either 90% or 100% while the specificity ranged from 80% to 87%. In the 4 studies that examined the accuracy of the whispered voice test in children, the prevalence of hearing impairment ranged from 9% to 31%. The children ranged in age from 3 to 12 years. The investigators report that the test was less sensitive but more specific in children than in adults (sensitivity 80% to 96%, specificity 90% to 98%). However, all of the studies in children used slightly different techniques. Despite some variations in the methodology of studies and the populations sampled, the investigators indicate that the findings are relatively consistent. However, "there is considerable room for improvement in standardising the technique of conducting the test," the authors report, noting "the greatest difficulty in standardising the test is the loudness of the whisper." They also note concern regarding the lower sensitivity of the test in children. "Further studies are needed that compare the diagnostic accuracy of the whispered voice test when different methods are used in younger and older children," the authors conclude, adding that further studies are also needed "to promote standardisation of the testing procedure."

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